Interview: Velina Markovska
Prof. Dr. Nikola Kolev is the Head of the Department of General and Operative Surgery at MU-Varna and a surgeon at the First Clinic of Surgery at "St. Marina" University Hospital: "As far as I can see into the future my intentions are to work at "St. Marina" in Varna and to teach at Medical University - Varna. I have worked and specialised Visceral Transplant Surgery in Bern, Switzerland and Hanover, Germany, Boston, Pittsburgh and Miami – the USA, Milan, Italy. I have also done a number of training courses in Korea, Singapore and other countries. All this has given me the opportunity to get acquainted with the level of medicine in various parts of the world. Similar to any other field, in which there is a trend, fashion, various tendencies, in Medicine is just the same. I have already gained 18-year-long experience as a surgeon. Annually I perform about 300 surgeries."
Prof. Kolev, you have worked and specialized at leading clinics. What is the level of "St. Marina" in comparison with the world leaders?
Regarding the level of "St. Marina", I can say it is in no way inferior to modern global trends in medicine. The level consists of several components. Preparation of medical specialists is the longest and the most difficult component to be attained. Naturally, the management of a hospital establishment is a long and continuous process. Provided there is well-implemented management, in one step, the best equipment is purchased and the best work organization is created. Then everything that doctors need to do is to qualify. Precisely those trainings abroad help us to be capable of working adequately with high-tech equipment and organization of the medical activities, which has already been created at our hospital.
What is important for the professional growth of a surgeon?
It is of great benefit to a surgeon to get in touch with the great schools in specific areas such as the Oesophageal Surgery in Pittsburgh, the USA. We have already started performing such surgery. Thus the complex interventions can be standardized and more easily performed.
Then it is possible to treat patients adequately. When a surgeon is well- trained and well-educated he has more determination and reason in his work and acquired routine. He is able to overcome fear and operate at a high level. Specializations abroad really help us to achieve this. However, everything should be accompanied with a lot reading and theoretical training. The great amount of work is of crucial importance for great surgery. Surgery is similar to training sports. One has to perform multiple surgeries and read a lot in order to keep the good shape.
What kind of surgeries do you perform?
We operate all types of cancer in visceral organs. These are the internal organs of abdominal cavity, chest and pelvis. The trends in the modern development of surgery are related to methodologies, and methodologies are aimed at less traumatism, mini-invasive access and enlarging the volume of surgery. In surgery things are clear and standardized and not so complex.
Where does complexity in the treatment of oncological diseases come from?
Complexity in the treatment of cancer comes from the need for timely diagnosis, proper staging and preoperative treatment, choosing the right time to perform the surgery, post-operative treatment, monitoring, detection of recurrence or progression, as well as performing multistep surgery of different organs that might be affected by the oncological disease. Complexity is determined on the one hand, by the fact that this process involves specialists from different medical specialties, which is called multidisciplinarity. On the other hand, they apply a variety of weapons and methods, which is called multimodality. Precisely this great number of methods and the variety of specialists, respectively the numerous units, through which a patient has to pass and be treated at the same time, is the strategy and key to success in the treatment of cancer at our "St. Marina".
One of the units for complex behaviour in cancer is the detection of tumor aggression. It has been proven that advanced metastatic tumors are treated more successfully and the people have a better life span compared to early detected but aggressive tumors. At our hospital tumor aggression is detected through molecular profiled genetic tests. This in turn sets a new trend in the strategy for treatment of cancer, i.e. the individualized approach based on tumor aggression. Thus the sensitivity of the tumor to a particular type of treatment is determined and for each patient individually can be determined what method or set of methods can be applied - surgery, radiotherapy, chemotherapy. This is the power of modern approach.
What is the benefit from high-tech equipment in diagnostic imaging for surgery?
For the surgeon the time when he is to perform the treatment is of crucial importance, so that the patient can benefit from it. The surgeon's activities are radical and irreversible. That is why the modern equipment for preoperative and intraoperative staging of cancer, which is implemented through high-tech equipment, is very important for the precise work of the surgeon. "St. Marina" has such equipment and for us the benefit from surgery is absolutely evident in advance.