Cureus interviews Garnette Sutherland, M.D.

Cureus interviews Garnette Sutherland, M.D.
Garnette Sutherland M.D.

Garnette Sutherland, MD recently published a paper on Cureus.com entitled: Surgeon at a Workstation: Information Age Surgery. I had the chance to talk to Dr. Sutherland about his work and robotics in particular.

Q. How many papers have you published?

A. About 180 peer-reviewed papers, 25-30 book chapters and 10-20 patents.

Q. When did you know you wanted to be a physician?

A. As an undergrad in chemistry and physical chemistry I enjoyed investigating molecular structure and during this time I decided to apply to medical school. Professors suggested I could always come back to chemistry if the doctor thing didn’t work out. During my summer breaks I returned to the lab for work.

I was particularly influenced to become a neurosurgeon by eminent figures such as Dwight Parkinson, MD, Theodore Rasmussan, MD and Bill Feindel, MD. I was drawn to Ontario by Charles Drake, MD – one of the grandmasters of neurosurgery. He performed thousands of challenging cases but he always took great care examining x-rays when things didn’t go well…not just when procedures were a success. When I began my practice, I continued his tradition. This inspired me to bring imaging into the operating room.

Q. Your paper describing the potential and current usage of robots in surgery and involving brain tumors in particular is fascinating. Give us a little background as to how project neuroArm came about.

A. While having intraoperative images obtained during surgery is wonderful, the process of acquiring the images disrupts surgical rhythm. So I thought it would be great to have a machine that could acquire images during surgery without such a disruption. Essentially, I wanted a machine that could operate within the image as it is acquired. NeuroArm is a step towards this goal.

Q. You mention the system has been used on over 30 cases to date. What have been the primary learnings from these instances?

A. One of the early requirements was to create a workstation that recreates the sight, sound and touch of surgery. The learning curve of using such technology is relatively steep, taking 20 cases to become confident using the unfamiliar tools of the workstation. It became clear that the workstation would be an ideal platform to bring the various technologies of the operating room to a single console.

However, the workstation is not yet perfect. While technology is quickly advancing, it cannot yet perfectly replicate complex human senses like touch. There is still some ways to go in order to understand and replicate touch. As this technology improves, so will the workstation’s ability to transmit the sensations of surgery back to the surgeon.

Garnette Sutherland, M.D. operating NeuroArm

Q. If you were telling a patient why a robotic procedure is optimal for their particular circumstance, what would be the typical drivers for that recommendation? How should a patient weigh their decision?

A. We had to go through normal ethics and regulatory approval processes which includes informed patient consent. The primary indicators for the use of the robot were brain tumor, cavernous angioma, and infection. Patients with these conditions were approached about robotic surgery. Patients were informed that the robot would be integrated in a safe and graded manner. If the situation would not be ideal for robot use, we would revert to conventional procedure. Effective treatment always takes precedence over the experimental use of the robot.

Q. What are some of the bigger challenges associated with getting published?

A. Getting a paper into the review process is not simple. Each journal has different style and formatting requirements, and look for different content. Top journals have a rapid initial review which will determine if the paper is appropriate for their publication. My major critique is that once you submit for peer review and it goes through the process of revisions and resubmissions and so forth it is not uncommon to take a year. This can result in publications that are not timely, and do not accurately reflect current advances.

As a case in point, I have a paper in the queue based on the first 35 robot cases, and by the time it’s published, we will have likely performed 80 robot surgeries. The paper may be out of date before it’s even published. Unfortunately, in the academic world there is a lot of emphasis on publication volume, which might interfere with the research process. This creates a conflict between the length of time it takes for publication and the required output of a career academic.

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Writing a Cureus-ly Good Paper

Writing a Cureus-ly Good Paper

Writing a scientific paper is hard work and takes considerable time. We at Cureus are here to make your publication process as quick and painless as possible. After publication your contribution will be rated by the community (SIQ). You should keep in mind these important steps when you prepare your manuscript.

Do you have something worth publishing? If so, here are the main criteria to consider:

  • Significance: Why was this work done? Did you solve an important problem of current interest or is it an obscure or obsolete problem?
  • Originality/Novelty: Is your approach novel or is it tried-and-true? Did you need to develop new tools, either analytical or physical?
  • Completeness: Have you tested a wide range of scenarios, or is this just a simple proof-of-concept?
  • Correct: Is your solution technically sound or are there errors?

It is important to consider your audience. It should be written to an audience that knows generally about your field but does know what you have done. In addition, before you begin your process you should research and read similar scientific papers that have been written in the format you plan to use.

Write clear and concise content

The main assumptions and results should be explained clearly. If there are multiple assumptions, present them together. Do not bury them in long paragraphs.

Define every symbol when it is first introduced. Otherwise, your peer reviewers will be frustrated. That can negatively affect your SIQ score. Clearly state the contributions of the paper in the concluding remarks.

Focus on the Material and Methods section first

When writing a report, it is often a good idea to begin by writing the Materials and Methods section. This section is usually straightforward. Writing it first helps to establish the proper thought process and understanding of the work. This will allow the rest of the report to flow more smoothly.

Next, it is generally recommended to write the Results section, followed by the Discussion, and finally the Introduction. Although this recommendation may seem illogical at first, many have found this approach to be very effective.

Limit your references

An inexperienced writer rarely resists the temptation to cite all papers that have been written on the subject. This may be appropriate for a doctoral dissertation, but not for a journal paper. An ideal number of references is a dozen. A practical upper limit is twenty.

Design your tables and figures clearly and intuitively

A (good) figure is worth a thousand words. Do not use too many curves, lines, or labels. Ten years after publication, readers may not remember equations or derivations, or anything else about a paper. But they may remember a figure.

As a general rule, a paper should not contain more than two figures – rarely more than three. Too many figures suggest that the paper represents a low-tech research effort. Tables and figures should be put into a contextual framework in the corresponding text. They should typically summarize results, not present large amounts of raw data. When possible, the results should provide some way of evaluating the reproducibility or statistical significance of any numbers presented.

Following these tips will make your paper highly valuable and guarantee high SIQ scores. This ensures wide distribution of your work and will serve in  adding significant value to your professional reputation.

Why We Founded Cureus

Why We Founded Cureus

The world of medical journals is broken. After 25 years of active engagement in academic medicine, I have come to this inescapable conclusion. This dysfunction is manifest in the fact that over 85% of peer reviewed journals including the most prestigious journals, remain locked up behind pay walls — inaccessible to a majority of physicians and nearly all patients. As both an author and reviewer I have learned firsthand how political and slow the existing method for scholarly review and publication can be. Interesting but controversial research papers can take years to get published.

The glacial pace, with which many medical journals publish important research, contrasts with new physics journals like ArXiv which enable instantaneous publication of cutting edge research and lively post publication scientific discourse. Although the protectors of the status quo argue that this inefficiency is necessary to ensure quality, ever more frequent scientific misconduct is being reported in even the so-called “best medical journals”. In an otherwise rapidly accelerating world of communication that is enabled by the internet, standard peer review processes have become an antiquated practice largely sustained by centuries of tradition.

John R Adler M.D.

What perpetuates the status quo? Money, and even more money. Modern peer reviewed journals exist to maximize revenue for sponsoring medical societies and the international corporate publishing conglomerate.

Medical journals are a primary source of revenue for nearly all medical societies. The largest publisher of all, Reed Elsevier, routinely reports annual profits in excess of a billion dollars. The scientific journal industry has become rich off the backs of societal funding of medical research AND the hundreds of thousands of “volunteered” hours that are contributed annually by physician authors and reviewers. Arrogant self-serving medical publishing complex, is willfully neglecting their societal duty to efficiently disseminate scientific truths.

Frustrated and thoroughly unimpressed with the existing world of medical publishing we are challenging a 200 year old system with the launch of Cureus.com. And not a moment too soon.

Our story is a little like David vs. Goliath. Having offices in Silicon Valley we are constantly reminded of the power of technology, and the advantages of being small and agile. That agility coupled with precise aim gives us an edge over the giant(s).

Maybe it is time you too joined the revolution in peer-reviewed medicine. Register with Cureus.com today.