SEARCH
Log In
Santiago Horgan, MD, is an internationally recognized expert in minimally invasive and robotic surgery. We recently had the opportunity to speak with Dr. Horgan from his office in the Center for the Future of Surgery at UC San Diego School of Medicine about the bariatric surgical advancements he has witnessed and in multiple cases, pioneered. He also shared his thoughts (and some great golf analogies) on developing and leveraging the digital surgery ecosystem to advance surgical learning and reduce variability in care.
WHERE DO YOU FIND YOUR INSPIRATION TO CONTINUALLY BE PUSHING THE SURGICAL ADVANCEMENT ENVELOPE?
I was exposed to new technologies in 1995 when I did a fellowship in Seattle. I perform a lot of esophageal and bariatric surgeries and I have a passion for new technologies. I’ve been involved with and exposed to robots from “time zero.” I was one of the first in the world to use a robot and that was 21 years ago. We were inventing all new operations. We were using the robot for surgery where the robot was never used before and looking at the outcomes to understand if patients benefited from it or not. This was critically important for us. Many operations we continued doing, and many new techniques we adopted. That was a challenging time. Now we teach people what to do and we can give them tips and feedback.
I’ve been lucky to be in universities where I can be exposed to the latest technologies. That inner energy drives me to continue evolving my career into new areas.
WHAT ARE SOME OF THE MORE RECENT HIGHLIGHTS/ACCOMPLISHMENTS COMING OUT OF THE CENTER FOR THE FUTURE OF SURGERY (CFS) AT UC SAN DIEGO SCHOOL OF MEDICINE?
Our Center for the Future of Surgery is one of the largest in the world. We just celebrated our 10-year anniversary. We’ve trained over 40,000 staff and physicians at CFS. That in and of itself is a good outcome. Last year, we opened CFS 2.0, that includes a state-of-the-art operating room for endovascular surgery, cardiac endovascular surgery and endovascular neurosurgery as well as state-of-the-art microsurgery suite with 16 microscopic stations.
The Center has evolved. We are helping industry to develop new technologies and teach with new technologies. It’s a true teaching facility. I’m very proud of what we have achieved in this period of time. It’s just incredible.
WHAT DO YOU FIND MOST REWARDING IN TRAINING AND MENTORING FELLOWS AS WELL AS ESTABLISHED SURGEONS THROUGHOUT THE COUNTRY ON MINIMALLY INVASIVE SURGICAL TECHNIQUES?
I love to teach. The way I see teaching is that when I operate on a patient, I impact one patient at a time. Let’s say I perform 400 surgeries a year. I impact 400 patients. When we teach physicians, residents and fellows, we impact many more. I see the next generation of my career focusing on understanding how we elevate the standard of care and how we improve surgeons’ skills. That’s where I get really empowered by trying to take this to the next level and impact more lives.
When we train the surgeons, I believe the patients are going to get a better outcome, without question. That’s what really drives me. First you have a brand-new fellow and then they graduate. After a year or two, you can see what they are now, how they operate, how they are leaders. We make leaders. It’s very good for your heart. It’s something I really enjoy. I would not change it for anything.
WHAT DO YOU FIND TO BE THE MOST VALUABLE ASPECT(S) OF THE C-SATS PLATFORM?
I like the C-SATS platform because, really, it’s easy. I remember uploading videos and you had to record the video, take them home, send them somewhere, etc. It was a nightmare. Now, it’s seamless. The fact that you have access as a practicing physician, as a trainee, as a new physician, to be able to upload your video easily into the cloud and have a mentor taking a look and giving you honest and candid feedback. I think it’s very important.
I like that drive to relearn every day. A nice thing with C-SATS, it’s a platform that is allowing surgeons to have a coach in the back, that is a friend coach, not a mean coach. Because when I talk to them and I say, “Hey, it’s in your best interest. I don’t get anything more than making you better.” That’s why I enjoy the platform so much.
WHAT DO YOU FIND TO BE THE MOST VALUABLE ASPECT(S) OF BEING A C-SATS EXPERT REVIEWER?
I think that being an expert reviewer at C-SATS allows you to impact more lives, allows you to really spread your knowledge and not keep it for yourself for when you die. That’s something that really bothers me. I say, how can I share more of what I know with other people and other surgeons? Yes, I can impact so many at UCSD, but through C-SATS, we are giving access to many surgeons in the world to touch the leaders and have the leaders coaching them. I think that that is unique.
I am a single digit handicap golfer. I'm a 5.2 golfer. I’ve played golf all my life. Still today, I take lessons. Every two or three weeks, I go and I take lessons. How can I improve? People say, "Well, you are 56, you’ve got a five handicap. Why do you want to get better?" Because I want to get better. I try to get better every day.
In surgery, we need that desire. We need that coach, that hopefully with time, you create a relationship with that coach, and then that coach is going to give you better and better feedback. We didn’t have that. The only way to have that was to go to meetings or travel for four days somewhere to a coach. This you can do from home in your environment, operating with your scrub nurses, with your team, with your assistants, comfortable and doing the operation you do every day and getting coached by the outside. I think that that’s incredibly valuable.
WHAT IS ONE PIECE OF ADVICE YOU WOULD GIVE TO SURGEONS TO MAXIMIZE THE VALUE THEY CAN GET FROM THE C-SATS PLATFORM?
Don’t feel that C-SATS is here to criticize. C-SATS is here to coach. It is your personal private coach. Like the one that you have when you golf or when you go to a gym, you always want to have a coach. Well, this is your surgical coach. They’re going to tell you, “Hey, in this area, there are things you can do better.” There’s nothing wrong with that.
It’s even more important because I usually say that we surgeons go to play our best tournament in the operating room on Tuesday, but we didn’t practice at the driving range on the weekend. When you play golf, you practice before. Many times with C-SATS, they’re reassuring you, telling you, “Hey, what you’re doing is great. Don’t change anything.” I think that’s very valuable. It’s not only about telling you this is what you’re doing wrong but, “Hey, am I doing this well?” “Yeah, you’re doing that well. Don’t change it. It’s fantastic.” I think that’s very important.
ANYTHING ELSE YOU'D LIKE TO ADD?
It’s always good to go and relearn. I’m lucky that I get to travel around the world a lot, so I get to see other surgeons operating when I give lectures and I always learn something. There’s always something I’m bringing back to my career, to my practice.
I think that we need to be more open-minded as surgeons and be willing to say, “I need a coach. I’m going to learn.” Look at your outcomes. Are your outcomes where they should be and are you happy, or is your operation is taking four hours when it should take one? Because that’s something that C-SATS gives you, right? They give you feedback based on data. That’s passive and then it becomes active. You can compare initially without any feedback and see where you are and then go from there. Don't be scared. Feel it as something that’s going to make you a better surgeon.