Editorial 2006

Spring 2006 saw us in Berlin, visited for the fourth time but the first since the unification of Germany. The autumn visit to Ashford, Middlesex, was the first to that hospital, uniquely close to Heathrow Airport, and our programme capitalized on this. But first to the capital of Germany where the destruction in 1991 of the Wall – that physical symbol of the Iron Curtain generated by the communists to prevent their peoples leaching West – has allowed East Berlin to develop. Many of the buildings we saw and visited (including the ornate Regent Hotel where our TSS dinner was held on our last night) had been built recently, often on wasteland. Now Berlin can again hold its head high as a world city, its streets broad and straight with matchless buildings: big, well-proportioned and either ancient and elegant or modern and stylistic.

This proved a historic visit, for we saw places crucial to the reconfiguration of the post-war world: Potsdam, where the Big Three convened to decide how Europe should be sliced up; Berlin itself – many buildings still battle-scarred – rebuilt by some of the world’s most famous architects; the Reichstag surmounted by Norman Foster’s great glass dome symbolising the people’s dominance over the Bundestag , the summer palace of Frederick the Great at Sanssouci (symbol of Prussia’s heyday following the military successes of his father, Frederick the Soldier King); a river cruise along the Spree seeing the modern homes, embassies, businesses and palaces built (or rebuilt) since the war. By contrast, those few who travelled via Berlin’s third airport (Schonefeld, some twenty miles southeast of Berlin) in the former GDR (a distinction still subtly drawn by West Germans) saw dilapidated buildings and untended grassland suggesting a lack of money or the will to match the burgeoning west, whilst ubiquitous graffiti conveyed a sense of frustration in a deprived, demoralised community despite modern cars and houses.

The visits to the three Charité hospitals were well worthwhile, and reached a climactic day at the cancer Klinikum Buch where we were treated to unrivalled hospitality, papers and a look at what technology might offer in the future in the way of touch screens, three dimensional peroperative imaging, virtual reality simulation, laser usage, telecommunications, telemedicine and nano-technology – amongst much else! Berlin’s four Charité hospitals form the largest university hospital complex in Europe, and the three we visited each offered us something special and different. The Charité Virchow was named after Berlin’s most famous surgeon, whose name is also remembered in the Langenbeck-Virchow Haus (owned jointly by the German Surgical Society and the Berlin Medical Society) which we visited informally on our final day: it once housed the GDR Parliament. At the hospital we saw elegant operations (particularly liver resection) and a well-reasoned aggressive approach to cholangio-carcinoma, sleeve resection of the portal vein offering the promise of longer survival. At the Benjamin Franklin Hospital Professor Buch gave us a morning and afternoon meeting either side of a tour of the theatres, ITU and research facilities. In the latter there was good work on intestinal absorption, of sodium particularly, and the investigation of tight-junctions between cells. Liver resection was aided by the CUSA , infra-red coagulation and in some cases radio-frequency ablation, which was also the subject of research. Five papers were contributed to the Berlin meeting by our own members, namely our President Geoffrey Glazer, our Secretary Bill Thomas, President-elect David Ralphs, civilian surgeon Stephen Chadwick and military surgeon Simon Mellor: a good mix, reflecting our Society’s roots, officers and contributions to clinical care, surgical progress, teaching and evaluation. This is the last spring meeting under the present President and Secretary, and what kudos and organisation have Geoffrey and Bill brought over these few years. The groundwork in organising each visit beggars belief (e-mails everywhere, and not a little rescheduling), and we have much to be grateful for, including the cheerful support of their wives Sandra and Grace respectively. Thank you all.

The future direction of the TSS was discussed at the AGM in the light of a changing surgical world. No longer is the operating theatre solely the preserve of the surgeon: the interventional radiologist – as we saw at Charité Campus Benjamin Franklin – is often found there, as are cardiologists (and indeed occasional mathematicians, biologists and pure scientists, as at our last rendezvous). Medication has almost eliminated gastro-duodenal surgery and many junior surgeons have not seen a gastrectomy, let alone done one. The breast surgeon will not want to deal with trauma or abdominal emergencies, the cancer surgeon is becoming a race apart, and the gastro-intestinal surgeon may be the emergency surgeon of the future, with trauma dealt with by specialist units. Progress in imaging and nanotechnology will change the training and skills required of the surgical technician, as has already happened with minimally invasive endoscopic techniques. Certainly visits like this one to Berlin can help illuminate the future, and we may need to formulate our membership accordingly.

The visit to Berlin was a very happy one save in two respects. We learnt of the sudden death of David Pratt, former Leeds surgeon and a conscientious attender of TSS meetings with his wife Libby. Their presence, gentle humour and common sense always brought a smile and he will be much missed; his contribution to the TSS is acknowledged in his obituary. Our thoughts also turned to three former Presidents who had been unwell recently: Ivan Johnston, Alan Green and Robert Shields. All were sent postcards.

Our home visit in September was the first to Ashford, Middlesex, where Joe Horner and Brian Ellis assembled a busy programme, starting at Brooklands, ending at Wisley, and stimulating us between times with thoughts on our PSA and cholesterol. The professional programme began with a welcome by the Chief Executive, Glenn Douglas, in what has become a sign of the times – the involvement of managerial staff, both as a courtesy and in the hope of involving clinicians in major managerial decisions. The eclectic programme covered topics of universal interest (thoracic endoscopic sympathectomy, sclerotherapy of veins, procto-colectomy, breast reconstruction, thyroid and bariatric surgery, aortic and urinary stenting) then others on aviation medicine, reflecting the proximity of Heathrow Airport. The topics (drug smuggling, Terminal Five, air accidents) held the audience spell-bound, if a little nervous of future air travel. The Friday dinner at Great Fosters – at which the guest speaker was Norman Willis (the former General Secretary of the Transport and General Workers Union) – rounded off an exceptional day, which concluded with the transfer of the Presidency to David Ralphs from Geoffrey Glazer, who has given so much to the TSS in so many roles that he has come to embody much of what it stands for: vision, friendship and even international standing. At the Business Meeting the next morning Dimitri Hadjiminas was welcomed as a new TSS member.

Following the Ashford meeting, co-host Brian Ellis created the well-catalogued TSS photographic archive at his separate web-address, for viewing by the TSS membership. Truly have we entered the digital age, into which he and our new Secretary (and our on-going web-master) Terry Irwin are carrying us forward apace. Indeed, the initial TSS website (www.travsurgsoc.com) has since been upgraded to www.travellingsurgeon.org, to which interest in the former is now automatically directed.

Tim Williams