The journey of becoming a surgeon

Mario Bozhilov
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What it is like to become a surgeon through the words and thoughts of a resident: from watching a monitor in a darkened room to practicing with a simulator at home.

It all started while I was a medical student. Every day I volunteered at one of the big hospitals in my city. Every single surgeon starts with watching the work process.

It was the same with me. And that’s how I got into the operating room where laparoscopic surgery was performed. As you know, surgeons perform the entire procedure via observation through the camera. But I remember the only thing I saw at that time was a monitor in a darkened room. I understood almost nothing. It was difficult to navigate and I hardly distinguished the individual anatomical structures I could see. From that moment on, my interest in minimally invasive surgery increased with each subsequent surgery. I was impressed with the opportunities offered by this type of surgery. Everything was so elegant and it was done through very subtle movements. It took me a few months to get into the work process. Then I had the opportunity to take part in some surgeries.

Minimally invasive surgery, along with robotic surgery, is starting to increasingly displace conventional surgery. Laparoscopic surgery differs from open approach surgery at several fundamental levels. Mainly, these are two-dimensional view,, lack of tactile feedback and depth perception, fulcrum effect (laparoscopic instruments are limited in their motion by the fixation enforced by the abdominal wall trocars) and different ergonomics for the surgeon. These differences combined with basic anatomy are the main theoretical knowledge young surgeons should start with.

Watching an experienced surgeon perform a laparoscopy looks much easier than it is.. A unique set of skills needs to be acquired to be a good surgical assistant in operations. After acquiring basic theoretical knowledge, my mentor sent me to try out the training simulators at this hospital. All the others have been practicing there. My first impression was that it was like a computer game. Oh, I love computer games.

After a few visits to the training room, I began to consider the possibility of having such a simulator at home.

It is a very good long-term investment because you can train on it indefinitely. You can use it with your morning coffee or after a hard day at work. This could distinguish you from your other colleagues and give you more opportunities in the future, I thought. I took it as the kind of a game to play in my spare time. These were the reasons why I got my trainer.

In the beginning, I started with beginner tasks, in which you move different objects between your laparoscopic instruments and execute simple movements. Then I began to do more advanced tasks in which I performed complex movements, transferring objects through small obstacles.

This included cutting with scissors different objects that you can draw on a white sheet.

The ‘final monster’ was suturing. I decided to record videos of every single exercise and keep track of time. That’s how I monitored my progress. I took the whole workout as a fun game in which I tried to enhance my technique and improve my time with every subsequent exercise. – Yes, I’m a competitive person – Thus, the time spent in training was not annoying and I had a lot of fun. Through these various tasks, all the basic movements needed for a novice assistant in the operation can be trained.

The journey of becoming a surgeon is difficult. The most important quality we need to apply every day is patience. One of my mentors has said that the learning process goes through 3 steps – watching, doing paperwork and finally practicing. Through surgical simulators, it is now possible to train outside the hospital. They provide a secure method for training without the danger that comes with operations on real patients. They are highly engaging and immersive to the point that physicians forget they are in a simulation.

A day without learning and practicing is a wasted day!

Mario Bozhilov

Mario Bozhilov

First Obstetrics and Gynecology Hospital "Saint Sofia" View all Posts

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