We recently had the chance to sit down with Dr. Gordon K. Lee, MD, an Associate Professor of Surgery (Plastic and Reconstructive Surgery), Residency Program Director, and Director of Microsurgery at the Stanford University Medical Center. Dr. Gordon Lee has authored two virtual surgical simulations on Touch Surgery, a Carpal Tunnel Surgery (which was also featured as our TS3D simulation) and a Breast Tissue Expander procedure.
Touch Surgery: Can you tell us a bit about what sparked your interest in medicine in general and specifically surgery?
Dr. Gordon K. Lee, MD: So basically what is my life story in a nutshell? Well, I’m originally from Southern California, Santa Monica specifically, in Los Angeles. I was always really interested in science and went on to graduate from UCLA. I did a lot of biology and basic science research. A lot of my research was focused on cancer genes. Who didn’t want to find a cure for cancer at that time? Little did I know, it was a lot more complicated than that. But after I finished there, I came to Stanford for medical school to continue researching cancer genes, specifically skin cancer. I was working in a laboratory and I certainly enjoyed it, but I wasn’t sure if I necessarily wanted to be a dermatologist, so I spent some time in the clinics with the dermatologists. They were taking out skin cancers around the face and procedures of that sort, and I thought that was really cool – cutting the skin.
It reminds me a little bit of Touch Surgery, in how you see all the incisions of the skin and you making them – it reminds me of what my memories are of being medical student looking at that on a patient, cutting little skin cancers off the face. And so I was exposed to surgery that way, and when it came to dermatology it wasn’t quite as interesting to me. It was predominantly topical creams and lotions, which are certainly quite useful and important for patients, but it’s not as interactive with your hands as surgery.
But there was a plastic surgeon who would come down to the dermatology clinic that would help out with some of the bigger skin cancers. I never thought in a million years that I would ever become a plastic surgeon – I thought that surgeons had pretty poor lifestyles. That’s what most people see – always on call, middle of the night, blood everywhere. Not to mention in the media, surgeons are generally portrayed as being mean people, or at least not very… nice. And so it didn’t seem really very appealing. But Dr. William Lineweaver, the plastic surgeon I mentioned, who is now the Editor-in-Chief of the Annals of Plastic Surgery, would come down and he was a really nice person, a really jolly guy. Jolly is the word I would use – he was always happy and always engaging. And he would always say, ‘if you ever want to come by, please let me know. Come to the OR, come spend time with me.’ And the other stereotype about plastic surgery is obviously cosmetic surgery – while cosmetic surgery is important, I knew I wanted to take care of patients who had deformities due to trauma or cancer. Suffice to say, I finished my time in dermatology research and said sure, I’m interested in exploring all kinds of avenues. I was in my second year of medical school, so I wasn’t yet doing the clinical work. I was just doing pre-clinical, mainly book-based work, and then I was spending time in physicians’ clinics. And so I decided to go spend some time with the plastic surgeons.
I remember going to the operating room, and that was really a very eye-opening experience. When you’re in dermatology, you’re taking out these little skin cancers on the face, and that was so cool – I really liked doing that. Sometimes they let me take out stitches – it was great. Going to the operating room was orders of magnitude bigger – it was like dermatology on steroids. I was able to scrub in and assist in surgery. There were these big wounds on the abdomen and various other places and that really increased my interest in surgery. It was so much more involved. From that, I became involved in some research with Dr. Lineweaver, and did some projects on flaps and blood flow and using MRI to measure blood flow. Then I started my clinical rotations and I was interested in surgery, something operative, but I wasn’t sure what specifically. I went through my general surgery and various other rotations, but suffice to say plastic surgery always kind of stuck with me me – mostly from the reconstructive side. I feel very fortunate because at every step I liked what I was doing more and more.
Residency is very hard, and was more exhausting back then than it is now because we didn’t have the duty hour restrictions. 95 hours to 120 hours per week in the hospital, on call every other night, working 40 hours straight? All of that was normal. And I guess to me, there was always something to be sought after in that – if you could do it, you were tough. And you weren’t in it alone – you were doing this with your co-resident, so there was a sense of being in the trenches together. I really enjoyed that, and taking care of patients. It was always exciting to be at the point of care.
Touch Surgery: Do you have any memorable cases that inspired you in some way or that have always stuck with you?
Dr. Gordon Lee: Well I remember I had a really impactful experience as a medical student, right here at this hospital. We were rounding in the morning and one of the patients had a tracheostomy. We went and changed out the tube, and after we left the room he started coughing and gagging and then he coded – went into cardiac arrest. I remember we were all together as a team and the residents were initiating CPR and bagging the patient and giving drugs. The Chief Resident obviously recognized my interest surgery and he told me, ‘Okay, I want you to do the chest compressions.’ So he had the other senior resident stop and had me, a medical student, come in and do it to get me involved and not just stand in the back of the room. So I did it and I remember standing there over this patient doing chest compressions, looking down at his face. We did everything we could to save his life, but he had a terminal illness and he was very debilitated and elderly. They had put the gels on his chest because they were shocking him between the chest compressions. I even remember how the gel felt – it was cold, and it was slippery. And unfortunately, despite our best efforts, he expired… after about an hour of trying.. I was so exhausted from doing all of the chest compressions. And then we left and went to the next patient. We had more patients to take care of. But it was an awe inspiring experience. I was just grateful to have been there to have tried to save his life. And that experience repeated itself several times over the course of my training and practice – a lot of patients live, and a few patients die. Some unfortunately you can’t save if the accident or cancer is bad enough.
Touch Surgery: You’re also the Chair of Microsurgery at Stanford. Where did your interest in using technology in the operating room stem from?
Dr. Gordon Lee: Well I think it’s all about looking at what people spend their time doing, and nowadays, everyone is using their smartphones. They’re texting, facebooking, instagramming, checking lab results on a blood test, doing Touch Surgery. And everywhere and constantly- on CalTrain, on the subway, at the airport…
Touch Surgery: Walking down the street…
Dr. Gordon Lee: Which is dangerous! And in their cars! But literally all the time, this is what they’re doing. So while I’ve been here at Stanford in plastic surgery, I’ve been thinking a lot about what people are doing and spending their time on. We’ve been looking for how we can incorporate more digital platforms for education. First, we started just with a very simple website. There’s a major problem with learning microsurgery. Yes, there are books, and there are some DVDs you can get, but particularly for microsurgery, there’s not a great way to learn. Personally, I learned from watching this set of 4 VHS tapes made by Robert Acland in the 70’s or early 80’s, and to a large degree if you talk to trainees now, a lot of them learn from these exact same tapes. And the guy talks so slowly, and gives all sorts of advice in terms of no weight lifting and no drinking and no caffeine and even no sex before a surgery. Which now, they really just say “don’t break your routines.” In short, the tapes are incredibly outdated, so we created the website and are continuing to do work integrating digital technology into our training programs.
Touch Surgery: What do you see on the horizon in terms of changes in surgery that are facilitated by technology coming in the next 5 to 10 years?
Dr. Gordon Lee: I think they’ll really be around patient safety, and so simulation will be extremely important – tools like Touch Surgery, especially because you can have it anywhere on your phone, are really fantastic. Before a surgeon goes in the operating room, they should have completed 100 hours in simulation, maybe half the time in a simulation center and half the time on Touch Surgery. There needs to be some way to measure competency before a surgeon walks into the OR. Now they have surgical simulation centers, although most of them are built around laparoscopy because general surgery is moving towards minimally invasive procedures. It would be ideal to expand these simulation centers to cover more open and non-laparoscopic surgeries, especially because these simulators aren’t really that applicable to procedures in plastic and reconstructive surgery.
Touch Surgery: What initially got you interested in working with Touch Surgery?
Dr. Gordon Lee: Touch Surgery is really great way for people to be introduced to surgery. I can sit on a chalkboard and reiterate the steps of a procedure before we go to the OR, but better than that, I can tell someone to download Touch Surgery, download a procedural simulation and review it. I can then check that on the dashboard and see if they did or didn’t do it. Then when we’re in the OR and I ask, “what’s the next step”. If they’re fumbling and they didn’t complete the module, I’ll say well maybe you should have done that. Then they’ll be a bit embarrassed and put on the spot, but they’ll probably go back and do it. I would expect that the next time we’re in the OR, their competency would likely increase, particularly in terms of the steps of the procedure.
Touch Surgery is a great, great tool for the training surgeons who come on board, and even for more experienced surgeons to test themselves and review. It brings you back to some really fundamental principles and can help refine your technique and knowledge. Touch Surgery is a really great resource to have, and it should be a part of every residency program, and downloaded by every trainee. I mean seriously, why would you not? It’s free.