'Doctors should be creative, too'

Noh Sung-hoon / Korea Times photo by Shim Hyun-chul

By Jung Min-ho, Kim Eil-chul

Creativity is not the first quality that comes to mind when one thinks of a doctor. However, for doctors to stay true to the ideals of medicine, they need to be more creative, according to Noh Sung-hoon, director of Yonsei Cancer Center.

"If the purpose of medicine is to save and improve lives, doctors should not limit themselves to textbook knowledge," the 61-year-old said.

"Young, passionate and creative doctors have brought many new ideas to hospitals. And their ideas propelled Korea to become one of the world's best medical service powerhouses."

Noh is among the nation's most reputable and prolific surgeons in the field of gastric cancer. Since 1983, he has performed operations on more than 9,500 patients.

As a young doctor, Noh never relied on textbook methods and always tried to come up with better ways to improve the health of his patients, he said.

"One of my biggest interests was how to reduce the duration of surgical procedures," he said. "It is a critical factor in the patient's health and recovery, because the longer a procedure takes, the greater the possibility of postoperative complications."

Noh Sung-hoon performs gastric cancer surgery. He is one of Korea's most reputable and prolific surgeons. / Courtesy of Yonsei Cancer Center

Surgery typically involves the manual cutting and stitching of tissue, which requires sophisticated techniques and therefore time. Noh pondered on how to do the work faster without increasing the risks on the patient's health."

"Then one day, an idea came to me, ‘What if I use electrocautery to make incisions?'"

In the 1980s, the medical device, which cuts and seals tissues and blood vessels with a direct electrical current, was used in a limited number of fields such as neurosurgery. For other operations, doctors used scalpels and scissors to make cuts to the body.

"I started using the device in 1990, and it has worked well. Yet other doctors advised me not to use it. They said it could be dangerous," Noh said. "But I have proved that their fears were unfounded."

The method, which freed his hands from scalpels, scissors and sutures, halved the duration of his gastric cancer operations to about two hours.

"For patients, lesser blood loss means fewer chances of receiving blood transfusion, which carries risks such as infection," he said. "Shorter operation time means fewer anesthetic drugs and faster recovery for them. In fact, their hospitalization period on average was reduced to one week from two to three weeks."

In 1995, Noh presented the idea of scalpel-free surgery through videos at the Korean Surgical Society's conference. The response was very positive. Many encouraged him to share it with doctors in other countries as well, so the following year, Noh brought the videos to an international conference in Athens.

"After my presentation, some world-famous experts in gastric cancer treatment came to me and said they were shocked by my discovery," he said. "The presentation was a big success."

Since then, many hospitals and cancer centers from around the world, including Shizuoka Cancer Center in Japan, have adopted this surgical method.

And today, about 100 doctors from other countries, including Japan, China, India and the United States, come to Yonsei Cancer Center every year to learn his surgical know-how.

"Creativity is the key to generating groundbreaking development," Noh said. "We need more of it in the medical field."

Empathy fuels creativity

What has kept Noh creative as a surgeon is his empathy for his patients.

"The patients are my biggest motivation to improve as a doctor," he said. "I always ask my patients what makes them feel uncomfortable and try to solve the issues."

"I think patients can teach doctors a lot about their work."

Noh doesn't just talk with his patients as part of his daily routine; he sincerely listens to what they say and ponder upon how to solve their problems.

For example, early in his medical career, Noh heard complaints about the nasogastric tube, which carries food and medicine to the patient's stomach through the nose before and after surgery.

Instead of just telling that his patients the pain and inconvenience from the tube is inevitable, he started thinking seriously about ways to alleviate them.

Gastric cancer patients used to have a flexible tube inserted through their nose and into their stomach because it was believed that keeping the digestive tract empty would help it recover more quickly. Until the early 2000s, few doctors doubted that the practice reduced the likelihood of infection and therefore helped in the patient's recovery.

Noh took it upon himself to examine the issue; and found that the tube indeed had little effect on patient's recovery.

So in 2002, he stopped using the tube.

He also got rid of the painful drains that doctors used to stick into the patient's flank area to remove secretions, after proving their ineffectiveness.

Doctors in other countries, including Richard Nelson, a colorectal surgeon at the University of Illinois College of Medicine, later published similar research results in medical journals.

"It was all for the patients," Noh said. "They helped me come up with better ways to treat them."

Empathy, communication skills and attention to patients' inconveniences are among the crucial qualities that are easily overlooked by doctors who often focus on surgical techniques and lab results, he said.

Sharing knowledge about gastric cancer treatment

Gastric cancer is the third leading cause of cancer death among Koreans after lung cancer and liver cancer, according to Statistics Korea.

There are 30,000 new gastric cancer patients each year in the country; and there are 950,000 such patients around the world, many of whom are Japanese and Chinese.

"There is a limit to the number of patients one doctor can treat," he said. "At some point, I realized that sharing my surgery know-how with other doctors here and abroad could be more meaningful than performing a few more surgical operations."

Led by Noh, Yonsei Cancer Center has been actively sharing information about gastric cancer treatment with other institutions. Since 2000, the center has participated in several international symposiums for gastric cancer treatment.

Noh said he wants to continue sharing his knowledge further in future symposiums by using an online platform. Since 2013, two online seminars have been successfully held under his direction. He expects online medical education to continue to grow.

"We are trying to build a global education network to treat gastric cancer patients," he said. "I believe it will make a big difference."