"Distrust of Russian doctors is absolutely unfounded"
Medical tourism to, for example, Germany or Italy is common among Russians, although there are enough professionals in the country, Semyon Melchenko, a neurosurgeon at the Federal Brain and Neurotechnology Center of the Russian Federal Medical and Biological Agency, is convinced. He assured that communication channels for consultations are maintained between Russian and foreign surgeons, but such a system is well established within the country. About the availability of medical equipment and training of surgeons - in an interview with Izvestia for the Surgeon's Day in Russia, which is celebrated on November 25.
"We perform these operations of much higher quality than in other countries"
- How has the number of surgical interventions changed in recent years?
- At the Federal Brain and Neurotechnology Center of FMBA of Russia, the number of surgeries is gradually increasing every year. In my opinion, this is not due to the fact that the need for surgeries has increased, but because more patients come to us.
- Does the country have enough equipment for surgical interventions?
- In my opinion, we have everything we need. And in our center, if there is a need for additional equipment, it appears quickly enough. Good analogs are produced in Russia. In particular, there are Russian navigation systems that make it clear where the doctor is in the cranial cavity when operating on tumors, or aneurysms, or other complex pathology. In the past, such systems were mostly purchased abroad, but now they are being manufactured in our country.
- Are all the approaches to surgery that are used in the West now available in our country?
- In my opinion, even more approaches are available in Russia than in most countries where people go to receive medical care. I have spoken to my colleagues on the sidelines about this more than once. I am surprised at how developed medical tourism is in our country: people go to Germany, South Korea, Italy, Israel to perform surgeries, even though there is no need to do so. After all, there are federal centers in Russia where all these operations are performed, and on a flow basis and sometimes of much higher quality than in other countries. For example, this is the situation in Moscow, St. Petersburg, Tyumen, Novosibirsk, and Vladivostok.
- What do you attribute the popularity of medical tourism to foreign countries?
- It seems to me that there is a certain amount of distrust of Russian doctors, particularly neurosurgeons, in our country. But it is absolutely unfounded. We communicate with our foreign colleagues and see their reports: they present cases that are rare for them as something unique, although for us it is routine.
- After the beginning of the SWO, has communication with Western colleagues been preserved?
- We are invited, and we invite colleagues from different countries to conferences and forums. In our specialty, there are definitely no problems with communication with foreign colleagues. And if we in Russia are faced with complex cases, which not many doctors in the world specialize in, we consult with foreign colleagues, and they do not refuse us. Although there are also many such specialists in Russia, you can always turn to them and they will give advice. All communication channels are well established.
- What areas of surgery are the most popular among students?
- Probably those that are on the rumor mill, those are more popular. For example, cardiac surgery or neurosurgery. Although other surgical specialties are also quite interesting. Each of them can be practiced all your life and develop in it. A lifetime is not enough to learn surgical specialties.
- How is the process of training for a surgeon organized?
- We have young doctors who have been with us since the second or third year. They mainly observe the operation, but sometimes they help. For example, if the administration of the clinic gives permission for the student to participate in the operation, the student has provided a medical book and the surgeon believes that he is able to help him, the student is taken as an assistant. For example, the student may be entrusted to hold a retractor hook or an aspirator.
But there are also those who get into the operating rooms only in the fourth or fifth year. A lot depends on the student's initiative.
In addition, most medical schools have surgical circles in various specialties. At them, students not only read books, but also improve their skills. For example, in some circles they have the opportunity to operate on animals.
- And how do surgeons assess what kind of manipulations can be entrusted to a student in the operating room?
- This question is more relevant to residents. They have, first, a diary of necessary skills, which they must acquire during training. Each of them is assigned a supervisor, who not only works with the resident in maintaining medical records, but also sometimes asks him questions, recommends reading this or that material, and first controls the performance of elementary manipulations.
In the first year, residents are usually entrusted with simple things. In the second year, depending on their skills and knowledge, they begin to be entrusted with something serious. For example, in neurosurgery - skull trepanation.
"Malignant tumors should strive to remove completely, as far as possible"
- One of your areas of expertise is neuro-oncology. How does the number of patients with brain tumors change?
- On average, about 40 thousand people fall ill with central nervous system tumors in our country per year. Now in Russia about 350 thousand people have a brain tumor. I do not have exact statistics on mortality, but I know that in America on average 15 thousand people with this diagnosis die per year. At the same time, the US has about twice as many inhabitants as Russia. Therefore, I think that about 7,000 such patients die in our country per year.
It is wrong to estimate whether there are more or fewer patients with this diagnosis from year to year. The figure will be relative. The fact is that this year they will conditionally become more, because 30 years ago more people were born. And 10 years from now there will be fewer because the birth rate was lower.
- How does the tactics of patient management differ depending on the nature of the tumor?
- The main goal in treating patients with tumors of any nature is not only to remove them, but also to preserve the functional status of the patient. In other words, our goal is: what kind of person came to us, let him leave at least the same way. And ideally, if some function is disturbed due to the tumor, there will be a tendency to restore it.
Malignant tumors should strive to remove completely, as far as possible, so as not to disable the patient. As a rule, a complex therapy is now prescribed. For example, in addition to removing the tumor, radiation chemotherapy is carried out. Photodynamic therapy may also be performed after surgery. Immunotherapy and viral therapy are also prescribed.
Depending on the type and nature of the tumor, the approach to therapy can vary greatly. For example, there is a benign and hormonally inactive tumor, it is observed. If it begins to compress the optic nerves, it is tried to remove without incisions, for example, through the nose. But if the benign tumor is hormonally active and, for example, it produces prolactin, it is enough to prescribe a certain drug to the patient. He drinks it, and the tumor goes away.
- Your other area of expertise is spinal surgery. What spinal diseases do patients come to you with?
- If we are talking about spinal diseases, which are characterized by a process of gradual destruction and wear and tear of its structures, as a rule, patients with spinal canal stenosis come to us. In this case, the spinal cord or spinal nerves are compressed. Most patients complain of pain syndrome. The goal is to remove the pressing spinal roots.
We use various endoscopic surgeries or microsurgical surgeries. They are chosen depending on the type of pathology.
- What is the average age of patients with spinal diseases? Are these diseases getting younger?
- The average age is still 55 years and more. And these diseases progress with age. But young people, I think, have actually started to have these problems a little bit more often. I think this is due to the fact that many people nowadays do not pay proper attention to gymnastics and physical training.
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