"Rossiyskaya Gazeta" - Dmitriy Dzukaev: Exclusive surgery must become the standard of treatment
Dmitry Nikolaevich, why do you strongly object when I talk about your unique surgeries?
Dmitriy Dzukaev: I'll tell you why. Exclusive surgery must become the standard of treatment. Because each patient is unique, and his/her treatment requires a unique approach.
- Does it contradict with so popular now treatment protocols?
Dmitriy Dzukaev: No at all. Protocols are created either for very smart or for conservative people. A smart person can use a protocol in a way to better help the patient. Protocols itself cannot solve a problem because each case is unique. Medicine is mostly art and requires a creative approach. Especially when we are talking about the spine. Creative people are always able to change the protocol to get the best outcome. But for mediocrity following protocol is of paramount importance: with this blind adherence, one can minimize his mistakes.
- Have you never had errors? And what about the opinion that each surgeon has a skeleton in a closet?
Dmitriy Dzukaev: Unsuccessful treatment results can be caused by an error or by complex nature of the disease. When it is simply impossible to change something and achieve the desired outcome. But the surgeon should be able to minimize any error, and preferably to zero. How? The surgeon should learn a lot. Learn for the whole life.
- Do you always learn? Don't you mind that your students will be able to do some operations that you taught them, better than you?
Dmitriy Dzukaev: I don't like to say that I have students. But if my young colleagues say they are my students, I am pleased. Glad to see how colleagues use my surgical approaches. This motivates me to self-improvement.
- Usually, after such publications, our readers approach us and ask how to get to this particular specialist. Possibly it will be the same after this publication.
Dmitriy Dzukaev: Our Centre is famous for the fact that we have a strong team of highly trained professionals. So we will be happy to help.
- What spinal pathologies do you treat? And how do you treat them? And what about rehabilitation?
Dmitriy Dzukaev: The main specialization of our Center - degenerative diseases of the spine. People call them a spinal hernia. We treat patients of a different age - from very young to the elderly patients. Every patient needs individual treatment tactics, not only because of age but also considering individual condition. For example, one we must immediately put on the operating table. Another requires long preparation for surgery. The other requires no surgery at all.
- Is it possible to cure the pain of a hernia without an operation?
Dmitriy Dzukaev: The main thing is to make the right decision: when surgery is required, and when a patient doesn't need it. Age is not a determining factor. A recent example. We were approached by a patient aged 85 years. Pain chained him to a wheelchair. But he has been very active all his life and never wanted to accept his disability. We decided on the operation after some time. Weighed all the pros and cons. The patient could get surgery abroad. However, he realized that surgical strategy proposed by our Centre is optimal.
When operating patients in age, we take into account the risk from concomitant diseases. Primarily cardiovascular diseases. That is why so important is the coordinated work of all professionals - anesthesiologists, emergency physicians, cardiologists, endocrinologists. It is very important that our Center is based on multidisciplinary hospital, very well equipped. In particular, in we have the state-of-art robotic system. And it means that the results of any laboratory tests are ready as soon as possible. And this is extremely important, especially during surgery. That patient, which I told you about, after we removed several herniae, he no longer sits in the wheelchair - he works and travels. And this is not the only example.
- Any difficult cases? When a patient is discharged from the hospital, and no one looks after him/her. Who will deal with his/her rehabilitation? This is considered a responsibility of the patient and his/her relatives. And positive results after surgery often are lost.
Dmitriy Dzukaev: This is a standard approach to treatment. We are lucky with the Manager, Chief physician of the hospital Andrey Sergeevich Skoda. He became our advocate: we can keep patients after the procedure in our center couple extra weeks for rehabilitation, that is very beneficial for the patient. And only after the rehabilitation we discharge patient - now he is healthy and ready for the new life. We call this treatment 'all inclusive.'
- According to you, no problems with spinal problems? Sorry for the tautology.
Dmitriy Dzukaev: There is a problem. The lack of correct information. Many people believe that if diagnosed with herniated disc, the operation will not help. And this conviction stems from the view of many, including doctors.
- A familiar picture: queue to the neurologist's office with many patients suffering from back pain, and some of those tried to get rid of them through surgery, but for some reason without any success. And those people set an example for patients who must decide for themselves whether to take the risk and get the surgery. The saddest of all, that the doctor supports: play it safe. Although apparently, it has to do with something else...
Dmitriy Dzukaev: Totally agree with you - the number of unsatisfactory results is very high. Such operations must be carried out in specialized centers, where everything is dedicated to helping patients with spinal pathology.
- And what are requirements for such clinics?
Dmitriy Dzukaev: First and foremost, well-trained team of professionals. The innovative high-tech equipment, modern methods of rehabilitation. Operating room in our Center by a combination of technologies, including robotic system, perhaps is the best in the world.
- Are you bragging now?
Dmitriy Dzukaev: Stating a fact.
- And that is why at the last international exhibition of medical technology in Dusseldorf Moscow City Hospital No. 67 had a personal stand, and you made a presentation on ideal operating for spine surgery. And then your hospital hosted the chief physicians of Dusseldorf hospitals. Not afraid of losing your unique status? Maybe it could be replicated?
Dmitriy Dzukaev: As soon as the uniqueness is duplicated, it becomes a standard. And we intend to go further while maintaining our uniqueness.
- Why of all medical specialties you have chosen spinal surgery?
Dmitriy Dzukaev: Spine is the supporting structure of the whole organism. Everything is held on it. And this structure is flexible, mobile. And we should operate it in the light of these characteristics, not forgetting that inside the spine runs the spinal cord and nerve roots. When we do spinal surgery, we are engaged in reconstructive orthopedics, delicate microsurgery of nerve structures.
-And it's so interesting that you can devote your life to it?
Dmitriy Dzukaev: It is a complicated surgery. It's hard work. But it brings tremendous positive emotions.
- So you like to operate?
Dmitriy Dzukaev: Not at all! I don't like the process of operation. But I love the result.
Dmitri Dzukaev graduated from the North Ossetian Medical Institute in 1979. Since 1982 he has been working in Moscow City Hospital No 67.
Head of the Spinal Centre for degenerative diseases of the spine and acute trauma. Married. He has two sons.
"Rossiyskaya Gazeta" Federal Issue No. 6659 (88)