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of water and putting in a small handful of salt, so you could get approximately 0.9% saline, and then inject it underneath the scalp. Although you would think that you were being a bloody idiot injecting a nonsterile solution under the scalp like that, these dehydrated kids, nearly dead, would wake up, get up and go. We were literally saving babies and young children's lives from dehydration by the simplest, yet efficient, treatment imaginable. So, I learned an awful lot from that, but you know, that's how you learn things. Incidentally, I did also quite a lot of reconstruction. After a while, we got some good medical equipment and that was sheer coincidence too. The Shah of Iran, who was still alive at that time, was coming over to visit the Sultan of Oman. So, all of a sudden, we had a hospital built for us in six weeks, 24 hours a day, seven days a week. During the day and night, a hospital was built. As you can see again, chance plays a part in how things happen and how things develop. So, instead of working outdoors and in tents, suddenly we had a hospital, which meant that we could have all sorts of different equipment. I used to do quite a lot of surgery for obvious reasons. I was the only one there. I learned how to deal, for example, with mitral stenosis, in a country where scarlet fever was common in children. Developing mitral stenosis in teenage years and then dying as a result of it used to be quite common. I learned from another one of these very old books, that if you want to treat a patient who has got mitral stenosis, you make an incision in the auricle, you stick your right index finger in and then with the patient lying on their left-hand side you turn around 90° to the left and face the patient's head. As you do that, your finger rotates and it drops into the mitral valve. Then, the instructions from the book just say: “push”! When I did general surgery during my training, I used to do literally everything. I learned enough of abdominal surgery and the like and I was able to adapt what I
read in this 1929 book according to circumstances. There is also my own experience of history unfolding. Sometimes these things are very helpful. I remember an occasion only about ten years ago when I saw a patient with ghastly ureteric strictures due to Crohn's disease. The ureters had been more or less completely destroyed on each side. Because of Crohn's disease, they couldn't do an ileal conduit or ileal ureter for the patient so, I said: " Well, why don't you use a stomach flap?". I was talking to my colleagues who were abdominal-intestinal surgeons. They said: "A stomach flap? What's that?". I said: " You know, like doing a partial gastrectomy". I suddenly realized, of course, that I had been doing this procedure at a time in my career when there was no medical treatment for gastric and duodenal ulcers. Nowadays, you just give them all Omeprazole or something like that and you never do vagotomies, pyloroplasties, and partial gastrectomies. But I used to do two every week when I was a trainee, having done a total of 90 or so of these procedures in two years of training. All of a sudden, using that same operation that I hadn't done for 40 years. I found that it was a useful technique to take care of a modern problem. Having the ability to adapt to the experience of previous different types of surgery was very useful. I've never done anything with a nephroscope or anything like that, but 20 years or so ago we used to treat people with huge staghorn calculi by mobilizing the kidney and then splitting it open on the outside margin along the so-called avascular line, so that you could go down into the calyces, you could take the stone out from the outside and then sew up the parenchyma. Now, if somebody asked you to do that today, you would think he was mad, wouldn't you? But this was how we used to deal with big staghorn calculi in the 1970s and 1980s.
T.S.: What is the role of minimally-invasive surgery (laparoscopy and robotics) in your area of specialization? Could you please describe to us your feelings when laparoscopy and robotics started trending in Urology?
Prof. Anthony Mundy: I think you have to remember these are just surgical instruments. A robot is a surgical instrument, just like a cystoscope. You can always improve on these surgical instruments. I have given you an example already. I used to get really fed-up doing bladder cancer follow-up lists in theatre, on a Wednesday afternoon, because the bulb kept falling off
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