In the past, being able to adjust quickly intraoperative was the mark of a good surgeon, who goes through procedures blind, never knowing what to expect.

“That’s the notion of a good surgeon before,” according to Dr Ricardo Quintos II, a pioneer in imaging-guided procedures in the Philippines.

Today, with technology so much a part of medical practice, things are much different. “I say a better surgeon is someone who comes in with eyes wide open,” Dr Quintos tells MIMS in an exclusive interview. The more competent surgeon knows what to expect, and consequently, what to do.

In large part, this is because of technology that enables surgeons to visualize what will happen before and during procedures.

Better prepared

One of the best arguments about using imaging-guided procedures, Dr Quintos stressed, is that surgeons can prepare beforehand thereby avoiding, or at least minimizing, complications. The more prepared, the less the complications.

“Complications will be rarer,” said the founding chairman of the National Kidney and Transplant Institute’s iVASC. He added that studies have proven this to be true. “If you’re doing it, you expect…you see it beforehand, then you will have better surgery.”

He added that even surgery training today uses a lot of simulations, with some hospitals having devices that make virtual patients. “You can plan the surgery even before the [actual] procedure. So that when you do the procedure, you know exactly what to expect, what you’re going to do. You are better prepared.”

Moreover, when surgeons can prepare in advance they usually have better outcomes.

“We have proven… we have shown that our data, our outcomes are much better. Less complications, less mortality. Less cost,” the renowned vascular surgeon pointed out.

Patient safety

Since learning how to perform ultrasound-guided procedures, Dr Quintos vowed never to go back to doing surgery blind. In the past, this was the only way to go because there were no machines, no high-tech equipment.

But safety is the second argument why imaging-guided surgery is the better option. It is now the standard of care worldwide, the physician pointed out.

While it is true that many hospitals are still hesitant to adopt ultrasound-guided procedures primarily because of cost, the vascular surgeon said it must be pushed for the sake of patient safety. “It should be mandatory.”

Dr. Ricardo Quintos II: We are experiencing a renaissance in surgery.
Dr. Ricardo Quintos II: We are experiencing a renaissance in surgery.


Going at it blind may have been permissible in the past, since there was no other option, but there is now new technology to guide and direct medical practitioners to perform procedures safely.

It’s very dangerous, Dr Quintos said of operations done blind. And he will never ever go back to that method when there are means to visualize what needs to be done to ensure patient safety.

As to medical institutions who remain hesitant in adopting the technology, Dr Quintos had this to say: “If you do not mandate that you will do it with ultrasound, then your institution is not safe. That is the argument.”

He added that for surgeons joining medical facilities who still do not practice imaging-guided procedures, it is their job to convince the hospital administrator, and the institution in general, to make such procedures mandatory, precisely for the patient’s safety. Besides, part of a physician’s advocacy should be to uplift the settings they are in through their skills and knowledge.

Not relying on other eyes

A third argument for imaging-guided procedures is the added skill of radiology. This means not having to send out for ultrasound service. There are two advantages to this – as the clinical person, “you know exactly what to look for. You don’t need to read through a jumble of words and try to imagine what he [radiologist] saw.”

While sonography has always been operator-dependent, and therefore subjective to a certain extent, Dr Quintos said this subjectivity can be removed with the surgeon himself doing the ultrasound to see better.

He explained that complications usually arise due to uncertainties. A surgeon using ultrasound prior to and during the procedure eliminates surprises because of the ability to visualize the area that will be worked on.

The vascular surgeon enthused they were in a “renaissance” now and traditionalists and naysayers will soon have to embrace this methodology if they do not want to get left behind. MIMS