L. Michael Brunt, MD, president of the Society of American Gastrointestinal and Endoscopic Surgeons, is chief of the section of minimally invasive surgery in the department of surgery at Washington University School of Medicine in St. Louis.

Conversation With
L. Michael Brunt, MD
The Future of Surgery Is Less Invasive

What's the future of
minimally invasive surgery?
We still haven't moved the needle far enough in terms of patients being offered minimally invasive approaches for a variety of conditions. Not every patient is a candidate for a laparoscopic procedure, but we know that the rate of lap colon resection is not at the level that it could be.

What innovations
are you excited about?
Enhanced imaging makes everything we do easier and safer. One of the biggest areas of future development will involve doing more therapeutic procedures with an endoscope. And more procedures will be done through natural orifices.

As techniques evolve, there has to be a focus on patient safety. Technology is great, but it has to be safe.
Absolutely. It has to be safe for patients, but it also has to be cost effective. We can no longer add the cost of new procedures unless we're also adding value to patient outcomes, to faster returns to activity, work and productivity.

What accomplishments are you proudest of during your tenure as SAGES president?
Patient safety is one of the themes of my presidential year. Last summer we rolled out the Fundamental Use of Surgical Energy (FUSE) program (tinyurl.com/l7dhx2q), which is a free web-based didactic educational program available to any surgeon or health provider. It addresses a huge gap in surgical education aimed at reducing injuries related to the use of surgical energy devices. It's a huge initiative that's garnering a large amount of attention and interest worldwide.

Is enough being done to enhance lap surgery safety?
This is something I'm really passionate about. Even though it's been a quarter-century since lap cholecystectomy began the minimally invasive era, we're still seeing issues with bile duct injuries.

How big is the problem?
The incidence has not gone down — approximately 3,000 injuries occur each year. At my direction, SAGES initiated a 6-step safe cholecystectomy program (tinyurl.com/kghfvzy) to better educate surgeons about strategies for reducing biliary injuries and other complications from cholecystectomy, which at approximately 750,000 surgeries each year, is the most common procedure done by general surgeons.

So teaching is a passion of yours?
SAGES is an education society. We're forming a task force to address the topic of robotic surgery. We need to provide some balance on the issue and help surgeons understand where the robot adds value and where it doesn't.

What common challenges do surgeons face today?
We work in such an incredibly tight regulatory environment. Payors are driving what can and can't be done in the OR. It's a barrier to getting paid for some of the new technologies that we want to make more available to patients. I think there are increasing external and regulatory pressures that aren't necessarily integral to how surgeons practice, yet are a blanket requirement for all physicians without any real adjustment for the unique aspects of a surgical practice versus a medical practice.

What do you still love about operating?
You lose yourself because you're so concentrated and focused on what you're doing. Time flies and you really get into the flow of the task at hand. Patients come in with problems that adversely impact their quality of life in dramatic ways and we get them back to normal life routines quickly. It's still incredibly satisfying to do that.

What music must be on in the OR when you operate?
I'm a classic rock guy. I listen to music from the 60s, 70s and 80s. I'll try some of the new stuff now and then, but I like the Eagles, Beatles, Springsteen — they're all terrific. Music isn't a distraction. It really helps the surgical team relax. I'd much rather have music playing than listen to people chit-chatting during procedures.

This year's SAGES conference is in Nashville.
We're going. What's a must-see in the city?
If you're going to do one thing SAGES-related, check out the main event Friday night. We've rented out the entire Wild Horse Saloon. There'll be great live music and the SAGES sing-off, which is always a popular conclusion to the evening. For me, it will be all SAGES, all the time.

We believe you, but you have to say that.
(Laughs) There's also the Country Music Hall of Fame. Checking out all the live music venues on Broadway is a great way to spend an evening. And off the beaten path, Franklin Battlefield is a little south of the city, and Andrew Jackson's home is not far from the Opryland Hotel.

— Daniel Cook