Vestnik Kavkaza visited the Honored Doctor of the Russian Federation, winner of numerous awards, who contributed to the development of world medicine in the field of endoscopy, Sabir Gabibov. This year, the Doctor of Medicine, professor, a full member of the Russian Academy of Medical and Technical Sciences and the All-Russian Society of Endoscopic Surgeons temporarily left the Department of Reconstructive Plastics and Endoscopic Surgery of the City Clinical Hospital No. 79 of the Moscow Health Department headed by him and moved to Baku.
- How did you become a surgeon?
- I was born in the Kelbajar region of Azerbaijan and as a schoolboy, I already knew that I would become a surgeon. My countryman, Dr. Sariev, was an example for me. He was an assistant professor at the Azerbaijan Medical Institute, performed surgeries, saved lives, and people from our district went to Baku to him. Parents often talked about him, and he became a symbol of surgery for me. Every year, Dr. Sariev came on vacation to Kelbajar, and my father introduced him to me.
In 1967 I entered the Azerbaijan Medical Institute. There, my friend and I made a vow that later we would study in Moscow and become good surgeons. After graduation, he moved to Moscow and worked at the Vishnevsky Institute. And after an assignment in 1973, I first worked at the Research Institute, now it is called the Center of Surgery of Azerbaijan, and then I entered the post-graduate school at the All-Union Cancer Research Center of the USSR Academy of Medical Sciences in Moscow. (Today, this is the N. N. Blokhin Russian Cancer Research Center.) There I upheld a thesis, and since I really wanted to perform surgeries, I settled in the 79th city hospital, which is not far from the cancer center, where I worked for 34 years.
In 1987, I found out that the French surgeon Philippe Mure began to perform laparoscopic surgery. After the first surgery to have the gallbladder removed, which lasted 7 hours, he promised himself never to do this again - as this operation was too exhausting. However, the very next day patient thanked him for his work. Only then did Mure understand the importance of such operations, which were called the “second French Revolution” in surgery. In 1988, Americans began to perform these surgeries. In 1990, I was able to see such an operation, and I decided that I would perform them. In Russia, the first laparoscopic surgery to have the gallbladder removed was performed in 1991, and I, working in an ordinary clinical hospital, began performing such operations since 1993.
In 1997, for the first time in Moscow, we opened a specialized department of endoscopic surgery for 25 beds at the 79th hospital. Nothing like this ever happened before in the Moscow healthcare structure. I gave all my strength to the further study of this technique, traveled to European countries to watch operations on the stomach, on the intestines, and returning to Moscow, I introduced these innovations here. Therefore, it turned out that our range of these operations was even wider — on the stomach, on the large and small intestine.
Working in this field, I received the Moscow Government Award, the Chizhevsky Gold Medal - the highest award mark of the Academy of Medical and Technical Sciences; I got into the Swiss edition of the reference book Who is Who, Moscow Most Famous People in 2007. In 2016, I received an honorary diploma from the President of the Republic of Azerbaijan, Ilham Aliyev. For me, this was the main of all awards.
-Were you the first doctor in Russia to implement the technique of endoscopic vein surgery?
- I studied the technique of vein removal for lower limb varicose veins from my colleagues in America. I specifically met with its creator, learned how to do it and implemented it in Russia. I also introduced an Italian method of removing perianal fistula in Russia. Just a few months ago, I arrived in Azerbaijan, and have already implemented this technique here.
- There is an opinion that varicose veins are the cost of humanity for bipedal locomotion. How far has medicine gone in its treatment?
- Very far. The most modern technique is a treatment of vascular diseases of the lower extremities with ultrasound. Today there are many methods, minimally invasive, cosmetic, but the most radical is the surgical method. At the same time, it is the most traumatic. However, minimally invasive methods of surgical removal of varicose veins are being developed. One of them is miniflebectomy when we remove all convoluted vein conglomerates through small incisions with a special apparatus.
- What is the probability of the disease’s relapse when using this method?
- It exists because it is a chronic disease. In this case, you should try to follow the basic principles of the method of varicose vein removal. If all of them are observed and technically the operation is performed at the proper level, then the results are good.
It is believed that those people who are always on their feet - surgeons, salespeople, hairdressers - are subjects of varicose veins in lower legs. They need to wear compression stockings for the prevention of the disease.
- Should the surgeon have a specialization, engage only in one direction, improving his skills, or should be able to perform a surgery in any area?
- There were great surgeons who worked in Azerbaijan: surgeon, academician of the National Academy of Sciences of Azerbaijan Mustafa Agabek oglu Topchibashev, his son Ibrahim Topchibashev, my teachers, professor Mirsalimov, professor Gurbanaliyev. We learned from them, often performed surgeries. Many different patients were admitted to the general surgery department because in the Soviet Union there were practically no specialized institutions.
Today there is an idea to divide the centers of surgery of the stomach, liver, biliary tract by creating narrow specializations. I think that with the development of technology this will be done, but today the surgeon must have comprehensive skills so that patients do not remain without help. To get to a specialized center you need to wait. For example, to get to the All-Russian Cancer Center people are waiting for 6-7 months.
I consider myself a happy person because I met great specialists with whom I studied. In the 1990s, the field of low-impact laparoscopy was new for us, but conferences, congresses, and master classes were held in Europe. This was necessary because traditional surgeries are very traumatic. After abdominal surgery, rehabilitation is long, and after laparoscopy, the patient is checked out the next day. It is cost-effective.
Now, these methods are still being improved, surgeons are trying to reduce the number of punctures so that patients can recover even faster. Painkillers are not applied, antibiotics are not used. The patient feels well after the operation, rapid rehabilitation takes place, and patients return to their former physical condition. Quality of life is completely different. With the traditional operation, after the removal of an organ, we had to sew up, stop the bleeding, and now we have all those new devices - just one tool, for instance, highlights, mobilizes an organ, cuts, sews, and stitches. All this is done inside the abdominal cavity mechanically by using special equipment.
Sometimes even punctures can be avoided. In the anterior abdominal wall, there is a natural opening - the navel. To remove the gallbladder, we first made four, then three, two, and now we don’t do punctures at all. We inject a special trocar through the navel, the port, and through it remove the gallbladder. On the anterior abdominal wall, a scar does not remain. This is a low-impact, low-painful and cosmetically effective operation. Here, different areas of physics, biology, chemistry are integrated.
I am very pleased that such operations are being done in Azerbaijan: someone has learned to do a removal of the gallbladder, someone - of hernia of the anterior abdominal wall, someone has performed surgery on the intestine.
- You were working in a Moscow hospital for 34 years, and now you have returned to Azerbaijan. Why?
- Through the Heydar Aliyev Foundation. Here, a respected Mr. President controls medicine. Today, there are a lot of modern clinics in Azerbaijan, diagnostic centers that are provided at the most modern level, but all patients come to Baku for treatment. The idea is that we want to open a center for the study of minimally invasive surgery, where operations and master classes for surgeons will be conducted. We can invite foreign teachers from whom I studied to hold international conferences. But the most important thing is that we and our teams can travel to the regions, involving them in the process of studying the methods of this operation. Work is underway.
- Are there any special features of the development of surgery in Russia and Azerbaijan or is it still a common Soviet school of surgery?
- I have been working in Azerbaijan for only a few months, but I already see how hard they work here. When I first arrived, I was shown several clinics. I chose the Central Customs Hospital - an excellent organization of work, operational support. In Baku, there are many private clinics, I honestly admit, I didn’t have much contact with them, I know that one or two have the operating rooms, but there the provision is not at the same level as in those medical centers controlled by the state.
- What is the most difficult part in your work?
- The most difficult part is to treat patients so that they quickly recover and return to a productive life.
- What advice can you give to future surgeons?
- The modern surgery is very difficult. You need to love it fanatically, set yourself a task at the stage of specialization. We had one professor who said: "I would be happy to hear that some surgeon celebrated his 100th anniversary." This does not happen. Surgeons do not live long, because their work is very hard. Before becoming a surgeon, you need to think about it well.
