The ability to use my hands gift as part of my job, as a surgeon, and to bring a technicality in caring for people. The ability to act directly on the patient's body to heal it. I am a fan of superheroes, I was immersed in the culture of DC Comics and Marvel, and to become a surgeon is the only profession which allows me to identify myself to these superheroes.
All the population of the central region, from all generations, from adolescent to elderly, regardless of social or professional background. My activity is more oriented towards the pathologies of the spine (70% of my activity), and I do for the rest general orthopedics (feet, hips, knees).
A relationship of trust and empathy.
My team is made up of 3 secretaries, and one assistant nurse. Everything is based on a relationship of trust, and harmony in teamwork. Together we are in a process of listening and constant improvement in working conditions.
I was chief of clinic during 4 years at CHU of Montpellier, and then I decided to have my independent activity at Clinique of Archette at Olivet (Central region), first under-medicalised region of France. I am the only orthopaedic surgeon in the Central Region to practice spine surgery. I go to congresses, seminaries and practical exchanges with colleagues in France and in Vietnam. Indeed, I take part in an association of help for medical development in Vietnam, and I go there every 2 years to operate and train some surgeons.
Satisfaction of patients.
I could say the most notable surgery which was a success: it was the removal of a bullet located at 1mm of the spinal cord in a pregnant woman, attacked by a psychopath.
By proposing ideas to improve techniques with ancillaries and implants to treat pathologies. By allowing the evaluation of our practices by studies. By sending us in trainings. And by allowing us to meet colleagues to exchange our experiences and our practices.
At my first case, in the first year of internal surgery, where I had to operate a single patient successfully, I had to use an anatomy book. I have acquired many experiences and I can do now without the famous book.
The surgical robot in urological surgery.
Find a technique accessible to all surgeons, minimally invasive, and effective for the patient. My analysis of the available products is always positioned in relation to these 3 criteria, and some techniques of non-fusion meet it perfectly.
Yes, I prefer, where possible, textile to metal. The textile is not visible on post-op X-Ray, and it reassures some patients that they can be treated without having metal in their back.
I am a real family surgeon, after 30 years of practice (and 20 000 surgeries) in the same hospital. I have often operated the grandmother, uncle, neighbour... of my patient and that is why "they trust me with their lives". And in recent years, some patients came from far away after surfing on the internet.
For unknown reasons, since I was a boy I wanted to be a neurosurgeon, so after finishing Medical School, I trained in Neurosurgery in Madrid. By that time my main interest was brain and spinal cord surgery. In those times, thirty some years ago, spine surgery, at least in my environment, was quite “non important” and not very appealing.
With time, spinal surgery has evolved to a highly technical and specialized surgical activity that has nothing to envy brain surgery and has thus become very appealing activity. This is how others and I have embraced spinal surgery although not abandoning brain surgery.
This is not difficult to answer.
Success starts at the very moment the patient enters our office. This is when we have to get a global idea of his problem and needs. That is followed by a correct diagnosis with acquisition of adequate images leading us to a correct indication and planning of the proper surgical procedure. Finally there is the execution of this procedure that needs both personal surgical skills and technical and material support, helping us to achieve the proposed goal. Years ago, success was dependent mostly on the surgeon personal skills. This is not so anymore and I would say that, for the procedures that we undertake today, at least 50% of success rests upon adequate technical support: intraoperative imaging, navigation, new materials and devices. But we must not ever forget the utmost importance of sound clinical decisions.
My very first case was drainage of a chronic subdural hematoma, but regarding spinal surgery my first case was, of course, a lumbar disc herniation surgery. As I recall, it was 1977, there were very good instruments, but poor technology. We had an EMI CT scan in our hospital but we did not have an image intensifier in the O.R. Location of the proper level of surgery was usually performed in the Radiology Department marking the skin under fluoroscopy, or identifying the first “non-mobile” spinous process corresponding to S1 during surgery, this required an incision that sometimes was unduly long. In spite of this, operating a wrong level was not uncommon.
Today the picture is totally different, we have intraoperative imaging – 3-D C-arms, CT scanners and even magnetic resonance –; we can navigate with pinpoint exactitude; we also have power tools that were unavailable when I started; we have new devices and implants that outperform anything we used before and so on. Without speaking of the diagnostic tools that allows us to see the pathology as never before, making possible to design the best approach virtually to any problem.
There have been many innovations as I already pointed out. In any case if I had to mention one, I would say that the most important innovation in the last years has been the introduction into the O.R. of highly sophisticated imaging equipment, including navigation, that show us the anatomy and what we are doing in real time. The result of this is more accuracy and LESS complications leading to BETTER results. But not all innovations have been on the material side. Our understanding of spinal pathology and thus our way of thinking about it has also changed in the last years. I want to mention here the concept of motion preservation in spinal surgery that has arise to live together with fusion as one of the most important innovations.
The future is difficult to predict. Fifty years ago everyone thought that the future was going to be one of domestic airplanes for everyone, self-driving cars, holographic TV´s in every house, commercial planes at 10 or 20 times the speed of sound etc.… Nobody thought of internet! Predicting the future in spine surgery is difficult, but I guess that in a near future we will have better diagnostic tools and more efficient surgical tools in our O.R´s. I think that the biggest improvement in the future will be the introduction of ROBOTICS to perform the operations or at least the most critical steps with unparalleled safety and exactitude. But this will be the privilege of those that will replace us.
Now a retired urologist, I followed my whole hospital-university course in Lyon. After spending 18 months in the context of co-operation in Afghanistan, at the Hospital Ali Abad de Kabul (1969-1970), I became head of department at the Saint-Luc Hospital in Lyon and then worked in the private sector at the Private Hospital Jean Mermoz.
I was attracted by the manual and efficient nature of the surgery which actions are guided by knowledge and controlled by reflection. And also by the craftsmanship of the profession which allows a continuous improvement of the quality of action, linked to the repetitive but never identical nature of the work. Finally, I was attracted by the permanent contribution of technical developments and technological innovations.
By accident, throughout my internships with a master with communicative rigour and enthusiasm.
Also maybe unconsciously because of the family history of prostate cancer!
Certainly by the multiple facets of that specialty that concerns children (congenital malformations), women (pelvic disorders, incontinence) and adults of both sexes (cancerology, lithiasis,...).
Varied and complementary surgery, either for exeresis, reconstructive or functional, open or endoscopic, applying various technological methods (ultrasound, laser, cryotherapy...) and implants (artificial sphincter, penile prosthesis, strips...).
Finally, it is an autonomous and completely responsible speciality: the urologist recruits patients directly, gives indications, carries out interventions and ensures the follow-up of the patients.
You would need a complete book to describe all the different varieties of urinary incontinence in women, primitive or recurring, isolated or intrinsic, linked or not to static pelvic disorders that lead to codified surgical indications with multiple high or low techniques, open or laparoscopic surgery.
Overall, in women: sub-urethral strips (TVT, TOT, mini invasive) associated or not to coelioscopic sacrocolpopexy.
In men, faced with the frequency of prostatic cancers, I started a technique of retrograde extra-peritoneal laparoscopic prostatectomy (RELP) in 1999.
I also dealt with the possible iatrogenous after effects of that surgery: erectile dysfunction and urinary incontinence. For the latter, outside the artificial urinary sphincter which is the gold standard, not a single one of the currently available devices is satisfactory. That is the subject of our research in co-operation with Cousin Biotech.
Flexible, strong, well tolerated and adjustable.
Personally, regularly and also distanced from the action to objectively appreciate the reality and durability of the results.
It is a company at a human scale, with a family spirit that combines the enthusiasm of the teams, rigour and effectiveness.
Juillet - Août 2015
It was my first chief, because in the year 1978, he started to think that each component of his staff must be a complete neurosurgeon, but he must have a special field « of super-specialisation » and he pushed me to the spine.
I started to be in the staff in Florence from 1977, and in the year 1980, I spent 6 months in Germany in the very famous neuro-surgical department of the Saarland University. I was very lucky to work with Dr Caspar who in this time developed many new instruments for the spine surgery.
From many years, I receive patients coming from whole the country. I said many times that the patients arrive to me from “radio-patient” (diffusion of the information from patient to patient).
I like each time to spend time during my consultation with my patients to understand which type of person is in front of me. Everybody, when arrive in my consultation room, put immediately all the investigations on the table and immediately, I say to the patient: “be quiet, please, before we must know one to each other”. I think in my mind that a doctor can not look the image, but should look the person. And only after, connect the problem of the patient with the images.
When I was young surgeon, I had a training, not only in Germany, but also in other countries. I learned for first that a good surgeon is of course a surgeon who knows his work, but who also don't keep his knowledge only for himself, in contrary, a good surgeon is a surgeon who is ready to share his knowledge with others. I learned from many other surgeons, and, I am very happy if somebody can learn from me, and after spread this out to others. For this reason, my relations with my co-workers are very nice, and spontaneous.
My spirit is to be very curious. For this reason, I don’t say never no immediately to the new ideas. So, also now, many years have passed since 1987, I still go around the world and exchange my ideas and working philosophy with all the surgeons that I meet and each time, I can learn some to bring with me, and to share with my team.
It’s the rule of 7 R : right indication, right diagnosis, right patients, right surgical technique, right post OP treatment, right surgeon, and finally right luck.
My biggest success was a young patient (22 years old) for whom I performed a surgery 15 years ago with a « sarcoma » on the vertebral body T8 & T9. I remember that she was very pretty, and we followed the protocol to treat this very terrible type of tumour, and for that, the patient had for first chemotherapy. When she came back in my department for the surgery, she was completely transformed, and I nearly didn’t recognize her. We did a surgery of 13 houres, with dubbel spodilectomy in block, and after recovery in intensive care, she came again in my department.
The patient was after transferred to the oncologic department, where they did the radiotherapy. I follow this patient very strictly for 3 years, and at this point, she didn’t show any recurrencies of the tumour. Now, after 15 years, she is free of pathology, she is happy married, she had two sons, and she sent me one message two time each year for Christmas and Easter. But was is particular, now she is again very nice and pretty woman, and also her husband send me one message for each year.
I think that the industry can help the surgeon by warranting the quality of the products that they deliver and taking in consideration all the suggestions that each surgeon can give. And also, it’s mandatory that they assure that the material necessary for the surgeon is always available at the hospital.
I remember that my first case was chronic subdural hematoma (Brain surgery) and from this time, I don’t change nothing about my surgical technique. What has only changed is the instrumentation. In 1977, we use hand drill and monopolar forceps, now we use high speed drill, bi-polar forceps and we have CT-Scan and MRI image, and not more angiography.
I think that the best innovation of the last then years is the minimal invasive surgery and devices which enable us to preserve the motion in the lumbar DDD treatment.
We must increase the possibility to do the surgical procedure with the minimal possible cost, not only for the patients, but also for the national health. I think that when we are able to have some “instrumentation” to save the patients from 20 or 30 screws in their back, we will achieve this goal.
Yes, Yes and again Yes…. For more then 15 years!!
I don’t think I made a conscious decision in that way. I was trained as a general physician with an interest in cardiology. I then moved into epidemiology and for a number of years was Director of the UK Women’s Heart Study at Imperial College School of Medicine. Data from this study confirmed the importance of obesity and metabolic syndrome in the aetiology of cardiovascular disease, so I guess it was a natural progression for me to move into the treatment of obese patients.
No, as I said above, my interest has really been in cardiovascular disease and epidemiology. However, I also have a strong background in exercise medicine and spent the early part of my career at the Human Performance Laboratory in Manchester where I worked with many world-class and Olympic athletes.
I am not a surgeon, but 10-years ago I founded a company called Healthier Weight which offers the entire spectrum of interventions for chronic obesity. This includes a specialist range of food products and dietary treatments all the way through to surgery. Surgical options include gastric banding, sleeve gastrectomy, gastric bypass and duodenal switch. I have also developed our own range of vitamin and mineral supplements, specifically for bariatric patients. We are currently following around 3000 band patients.
My relationship is empathetic but not sympathetic. The aim is for patient to lose weight and in order to do so they need to make a number of important commitments in terms of their eating behaviours, physical activity patterns and self-monitoring. If they fail to do this they will not be successful with the gastric band – or any other procedure. I think it’s possible (and necessary) to be quite tough with patients on occasions. But all my experience tells me that patients are happy with this so long as they know that it is in their best interests and you are concerned for them. As a colleague once said: “They want to know you care, before they care what you know”.
Careful patient assessment, an experienced surgeon followed by close monitoring and follow-up. This is true for all patients, but especially for those with gastric bands.
It’s absolutely essential that patients are followed carefully. This is obviously true for those with gastric bands, but is equally true for those with sleeve gastrectomy or gastric bypass where nutritional deficiencies can so easily supervene if one is not diligent. I do not think there is any role for psychologists in the post-operative phase and there is no need whatever for specialist dietetic input in most cases. Nutritional guidance for bariatric patients is actually quite simply and it does not help to over-complicate things.
If a patient is obese and has genuinely tried a variety of non-surgical interventions without success, then they are a potential surgical candidate. Of course there are specific exclusion criteria, but beyond that we will consider most obese individuals. A couple of points about our practice are important.
Firstly the body mass index (BMI) cut-point for surgery in our practice is 30kg/m2. This is somewhat lower than in some practices, but there are reasons for this. The fact is that BMI is an extremely poor predictor of risk, and discriminates on the basis of age, ethnicity and physical fitness. Everyone in the field knows this, but guidelines are still being published which use BMI as the criteria for surgical eligibility. Remember that the BMI was devised by a Belgian social statistician in the middle of the 19th century – and we are still using it today!
With help in attending conferences, providing regular updates, answering technical questions and giving training support to new surgeons.
In the next few years, we will see two main strands of development. First, more effective endoscopic interventions for obesity as the various technical hurdles are overcome. Secondly, I think we will see the development of a variety of drugs which will be enormously helpful as adjuvant therapy after bariatric surgery.
Since I was young, I decided to become a doctor and it is at the Timone’s medicine faculty in Marseille, that my vocation was born.
I continued my studies at the Pitié Salpêtrière Hospital in Paris as Clinical Chief. Then, over the course of my practice, I specialized in spine medicine. I am now self-employed at the Argonay Clinic, since 2010, where I practice exclusively spine surgery.
During many years, my practice was quite polymorphic because I worked as much on brain tumours as on cervical and lumbar herniated discs. My life choices progressively oriented me towards spine surgery. Today I sub-specialized in this field which is, I think, in constant progress, for both techniques and indications. This is a challenging surgery because of the goal of releasing patients from pain: it is called a functional surgey, and not a vital one. It makes this surgery extremely challenging and so, requires expertise and resources.
In my opinion, the ideal implant is the one which is useful and helps patients. Every patient does not require an implant! But it is sometimes a tool that the surgeon can use to facilitate the surgery and improve the patient’s care. Every implant needs studies proving its security and efficiency before its promotion. Unfortunately, I feel that the marketing has a too big influence on the practitioner. We have to be reasonable. extremely challenging and so, requires expertise and resources.
I know the Cousin Biotech company and I’ve got the opportunity to visit the manufacturing plant. This is a real chance for us being able to identify every step of the manufacturing process, rigor and know-how: it a peace of mind to know that, when I implant a device in a patient’s body. The other particularity of the company is its low profile. They do not constantly send advertisements and organize marketing visits.
I am a Visceral, Digestive, General and Endocrinal surgeon.
I was born in Gand, in Belgium and I went to primary and secondary school in that city before studying medicine in Namur and Brussels and obtaining my physician’s degree in 1987. Finally, I passed my assistant surgeon degree in Namur, Geneva and Brussels. I have been a surgeon at the Centre Hospitalier Régional de Namur now for 21 years.
Why surgery? While taking an interest in the medicine studies of my older sister who was to become an anaesthetist I asked myself « And why not me? ». She helped me discover the hospital and surgical environment. I was attracted by the highly technological environment of the operating theatres and that concentrated element of innovation inherent to surgery.
In the large majority of cases, I am a "plugger" for treatment of inguinal hernias while saving a place for laparoscopy in certain indications of bilateral hernias.
The « Plug » technique consists of a double reinforcement of the inguinal floor through open surgery : a « plug » is directly introduced in the hernial orifice, and then a second reinforcement, this time anterior, is placed on the fascia transversalis. This mini-invasive approach is standardised for that pathology. The advantages are numerous: treatment under local anaesthesia perfectly adapted to out-patient surgery and with few contra-indications. In addition to post-surgery comfort and the low level of recurrence associated to that technique, reduced hospitalisation costs represent an advantage for our care system.
It is a simple, fast and efficient technique. Personally, I use a partially absorbable prosthesis that I secure with surgical glue. I have to this day not experienced a recurrence and my patients are satisfied with their hernia treatment, in particular in terms of post-surgery comfort.
First of all, the product must have demonstrated its clinical efficiency. I also think it is important to know the manufacturing origin of the implant. I am reassured when it is made in Europe as I know that it meets strict marketing authorisation standards. To me it is important to know the company that manufactures the product.
Finally, the ideal implant is a product with the goal of improving the quality of life of my patients. Its design must be based on the objective of reducing pain and discomfort.
In the immediate post surgery period, I am very strict with my patients about the fact that they must not carry heavy loads. Physical workers are off work for 1 month; for office workers 10 days are enough. The objective is to reduce any early post-surgery recurrence.
I see them all at 10 or 15 days after surgery and at 2 months. These two follow-up visits are important. I carry out a simple clinical auscultation and I check the feeling of discomfort and pain in particular.
When I think of the Cousin company, three more or less linked images come to mind.
The first is that it is a European company, I think it is important to privilege European Union industry. That is economic solidarity but also a guarantee of quality.
The second image corresponds with the notion of “high technology”. Products combining state-of-the-art technology and quality.
The last one is “proximity”, both geographical – as Wervicq-Sud is near to Namur – and at service level, thanks to the strong partnership with the local representative, i.e. your distributor. It is efficient, high quality work by three players at the service of the patient.
François Tortel : Our vocation is to conceive, manufacture and commercialise innovative implantable medical devices of very high quality.
François Hénin : We are based on technical know-how on flexible and textile materials. That know-how is the heritage of a long history and we make it develop continuously, in particular through our R&D teams who represent 10% of our manpower.
François Tortel : We try to do what others don't. That creative, edgy, smart side is our strength. The history of the Cousin group is based on that idea.
François Hénin : the company culture, its organisation enable us to welcome and listen to the ideas of market players, health professionals or industrialists. We co-operate with them, in co-concept policies, and thus create ideas and new products through our technical know-how.
François Hénin : Innovation is our identity. Both in R&D and in white room, our teams consist of curious, creative men and women, who can imagine sensible solutions and concretely implement those solutions. All the above of course with the greatest rigour and conscience.
François Tortel : Yes And when we innovate it always is with the greatest concern for quality. We work for the patient and must be attentive to the quality of our products at all times. It is a matter of integrity, an ethical and human rule. These qualities are at the core of the Cousin Biotech culture.