Surgeon of the world. It is a definition with which Diego González Rivas (A Coruña, 1974) feels comfortable. Since he developed the uniportal VATS technique in 2010 to operate through a single 3 cm incision, especially in lung cancer surgeries, he has not stopped traveling the globe. He performs nearly a thousand of these minimally invasive interventions a year and has operated in 133 countries, a record for any specialty. This interview was conducted at the Bellvitge hospital during a break from a master class he gave to Catalan and Madrid doctors.
Do you feel obsessed with work?
I have a lot of passion for what I do, for my profession, for everything we have achieved. It's like something that hooks you and hooks you and you can't stop. My life is completely dedicated to this.
He could have limited himself to applying his technique in Galicia but he chose to expand it throughout the world.
I was always in favor of sharing knowledge and not keeping it to myself, creating a school so that other people can learn the technique and improve the quality of life of patients. Developing something and keeping it is a very classic, very traditional concept of surgery. There were surgeons who did something very well and they didn't like to teach their tricks. Very prestigious surgeons at one point did not let people see a certain maneuver because they wanted to be exclusive. This concept has changed with technology, with social networks, people share more than before. What you are doing here now could be seen in the Philippines or Peru at the same time. Not before. There is a lot of value in sharing because then this technique becomes universal and you help many more people. My life has been dedicated for 13 years to traveling and teaching and operating around the world but I enjoy it.
When it started, the entire chest was opened; in 2007, making three incisions was a revolution. Where is the limit?
The evolution has been to go from open surgeries and large incisions, which are still being done in many parts of the world and there is still an indication in some very specific cases – less than 2% or 1% in our experience – to minimal invasion. . Opening a chest and separating the ribs is tremendously painful. We went from three to two and then we saw that a single incision was possible. We also had to adapt specific material. In recent years, with the arrival of robotic surgery, which gives precision and clearer vision, it was seen that it was possible to adapt robotics also to the single incision and give all the benefits of minimal aggression. The only and minimal incision is the final evolution.
How is the development of the Chinese robot going?
China now has the Shurui, the most advanced robot, with nitinol technology [a new metallic material that stands out for not losing its shape]. It has much greater emulation in the arms. We are collaborating with them to get the product to Europe. It is already being used there in clinical studies to begin to gather evidence, especially in urology, and it is being improved because it is a new technology that will arrive soon. There are other companies that are launching uniportal robots and each one has its advantages and disadvantages. I think China is leading the way in this type of technology.
Does this technological luxury increase differences in the world?
Robotics is an expensive technology and is not accessible to all countries or all hospitals. But now many robots are going to come out, there is going to be more competition and costs are going to go down because there will be more companies and more models available of all types. This will make robotics almost standardized in the future. At the moment, developing countries still do not even have video surgery.
You will have encountered extraordinary cases.
I have seen many surreal cases, like that of a girl who had swallowed a key and had had the key in her lung for two years. I was in the Congo operating, we were on TV, the girl saw it at her house and came with her mother the next day. She couldn't breathe. We operate on it and remove it. In Tanzania, a girl had a rib piercing her lung for ten years. She had been attacked when she was little, she didn't say anything, we don't really know why, and she was suffering with that broken rib, with pneumonia, she was bleeding from the mouth... We removed it with the uniportal VATS technique. In fact there is a documentary about this mission on my YouTube channel. We did it with my foundation.
Is your pioneering mobile unit project advancing?
We are building a mobile unit to go to Africa. It is unique. There are mobile units but for minor surgery, for war surgery, ophthalmology, ENT things... but not to do minimally invasive surgery, which is the great deficiency that exists in Africa. They have no resources. When I go to operate in Africa, and I have already done it in 30 countries, the problem we have is that the towers are very old, there are no cameras, it looks terrible, a nut is missing and we cannot connect the electricity or the power goes out. In the middle of the operation... everything has happened to us. To solve this, we have designed a mobile unit, we are building it and I think we will have it in February 2024. It will be a truck that, like a hospital, will have an operating room, an ICU, a resuscitation room and an operating room equipped with everything the technology, not robotics but with 4K high definition cameras, all the instruments. We will move from one place to another, we will take the patients from the hospital to the mobile unit, we will operate on them in ideal conditions, that is, with our anesthetist, with our nursing, with all the technology of a first world hospital, and then we will return them to the hospital. We will take the first steps in Ghana and then in Benin.
How many operations do you perform per year?
Between 900 and 1,000. In Shanghai he ran the world's largest minimally invasive surgery training program at Shanghai Pulmonary Hospital. He spends about six months a year there. In China I operate between 5 and 6 lung cancers a day, including Saturdays and Sundays. I come and go, because I operate in Spain every month for one weekend, in Madrid and sometimes in A Coruña, and the rest of the time I spend traveling around countries in the hospitals where I work. There are many patients. I like it, it makes me gain much more experience and enjoy it.
Do you feel like a surgeon of the world?
Yes, because I don't have a fixed place. I work in eleven countries on a regular basis, where I go from time to time to perform surgeries: Kuwait, Germany in various hospitals, Portugal, Spain, India, China, Bosnia... In each country I have a team, I go to the most complex cases but the team is still there, operating and with the patients.
