A tribute to Prof Gerhard Friederik Buess (1948-2010)

Minimally Invasive Surgery Training Centre, AIIMS, India

In 1981, a senior professor was performing a midnight emergency exploratory laparotomy for massive lower gastrointestinal bleeding from an unknown source. A surgical resident who was assisting the professor offered a suggestion. He suggested the use of flexible fiberopticgastroscope which the hospital had recently purchased to localise the site of bleeding. This pioneering "intraoperative colonoscopy" led to visualizing the bleeding polyp in the right colon and the performance of an appropriately directed and lifesaving resection. This surgical resident was Dr Gerhard Friederik Buess. Raw curiosity and ingenuity demonstrated by Gerhard Buess as a young surgical resident characterized his personality and forecast the essence of his professional career. He was criticized for misappropriating the hospital's valuable new gastroscope and he suddenly found that his career was in jeopardy. He was successful, however, in convincing his department chairman that the endoscopic discovery was an enormous benefit to the patient and therefore was a worthwhile application of the instrument. This singular experience undoubtedly brought endoscopy to his spiritual core.
Endoscopy then became his passion and career. Gerhard directed his curiosity, ingenuity, industry, and creativity to the field of gastrointestinal endoscopy and to its ultimate expression, the invention of a new endoscopic instrument and a new technique, the transanal endoscopic microscope and transanal endoscopic microsurgery.
Gerhard F. Buess was born on April 10, 1948 in Merklingen, Germany. His mother was a school teacher and his father was a technician for Mercedes Benz, and both parents contributed to his career choice of academics and technology. Following graduation from public schools in Merklingen he attended EberhardKarls University in Tuebingen and the Ludwig Maximilian University in Munich where he received his medical degree in 1972.His thesis was "Tissue Glue in Bone Surgery." Soon after (1973) he passed the Educational Commission for Foreign Medical Graduates (ECFMG) certification. He had successive surgical residencies in Bavaria and in the university hospital in Koeln-Lindenthal, qualifying as a surgeon in August, 1984.In December 1985he obtained his PhD on research and development of Transanal Endoscopic Microsurgery (TEM).At the age of 38,in 1986, he was appointed Professorof Surgery at the Clinic and Polyclinic forGeneral and Abdominal Surgery of the Johannes-Gutenberg-University in Mainz. He joined as Professor of Surgery at the Department of General Surgery of the Eberhard-Karls-University inTuebingen in July 1989 where heestablished a working group for minimally invasive surgery (MIC Tuebingen). He became Professor of Surgery and Director of the Section for Minimally Invasive Surgery in June 1994. In the same year Dr.Buess was also appointed head of the Department of Surgery at the Olympiapar Klinik, Munich. Whilemaintaining his academic appointment at the University ofTuebingen, he was appointed head of the Department ofMinimally Invasive Surgery at Helios Kliniken GmbH inMuelheim in June 2001, where he worked until October 2005. He received an honorary professorship of the Shandong Provincial Qianfoshan Hospital Jinan in 2006.
Gerhard Buess carriedout research throughout his whole working life. He has the credit of development of several techniques and technologies for surgery to his name. Within the fields of minimally invasive surgery and digestive surgery, the following need special mention -

  1. Development and clinical application of new systems foresophageal dilatation and stent placement (1978–1985)
  2. Introduction of transanal endoscopic microsurgery intoclinical practice, with the procedure being the firstendoscopic operation on the gastrointestinal tract (1983)
  3. Development of training models and a stepwise trainingsystem for TEM on an international level and clinicaltrials on TEM (1983–1989)
  4. Development of technology for and the technique ofendoscopic microsurgical dissection of the esophagus(EMDE) (1986–1989), with clinical introduction ofEMDE worldwide and the first endoscopic techniquefor resection of the esophagus (1989)
  5. Introduction of laparoscopic colonic and rectal resectionsinto routine clinical practice (1990)
  6. Development of instruments with multiple degrees offreedom and multifunctional instruments, automaticsuturing devices, the first robotic system, cameraholding and guiding systems, 3D vision systems, andcomplex simulation systems (1996)
  7. Development of technologies for and technique ofNOTEStransvaginal procedures with a rigid endoscope (2008)

During his professional career, Gerhard Buess has been a member of various surgical organisations including the

  1. German Society of Surgery
  2. German Association of Surgical Endoscopy(CAE)
  3. Steering Committee of the German Associationof Endoscopy and Visualisation Techniques (DGE-BV)
  4. Steering Committee of the Society for MinimallyInvasive Therapy (SMIT)and President in 1996
  5. European Association forEndoscopic Surgery and other interventional techniques(EAES) and President from 2005 to 2007
  6. President of the 10th World Congress of Endoscopic Surgery
  7. President of the Annual Congress of the EAES, Berlin, 2006.
  8. Steering Committee of the Societa` Italiana diChirurgiaEndoscopica (SICE)
  9. New EuropeanSurgical Academy (NESA)

Furthermore, he was awarded an honorary fellowship ofthe Royal College of Surgeons of Edinburgh (FRCS Ed) in1991, Socio Corrispondente of the Societa` Italiana di Chirurgiain 1992, honorary member of the Serbian Society forEndoscopic Surgery (JUEH) in 2000, honorary member ofthe Asociacio´nEspan˜ola de Coloproctologia in 2007, honorarymember of the Cuban Society of Endoscopic Surgeryin 2010, and honorary member of Italian Society for EndoscopicSurgery (SICE) in 2010. He was a member of the Poolof Reviewers at the European Science Foundation, Strasbourg,France, and the Pool of Reviewers at the ItalianMinistry ‘‘dell’Istruzione, dell’Universita` e dellaRicerca.’’
The enormity of Professor D. Gerhard Buess's achievements can be judged by the several awards he recieved during his working life. His honours include the Jubilee prize of theGerman Association for Surgery in 1992, the Adalbert-Seifriz-Prize 1993 from the ‘‘VereinTechnologie-Transfer-Handwerke.V.,’’ the Rudolf-Schindler-Prize for the bestvideo, ‘‘Jahrestagung der DGEBV’’ in 1994, the Rick Satava Award in San Diego, USA, in 1998 and theInaugural Distinguished Recognition Award from theInternational Federation Societies of Endoscopic Surgeons(IFSES), Athens, Greece, 2007. However, he was especially proud ofthe award and recognition received from the German Society of Surgery (Deutsches Gesselschaft fur Chirurgie)in 1992 together with Dr.Muhe, as the two German surgeonswho first developed minimally invasive procedures(Buess, TEM, 1983) and laparoscopic cholecystectomy(Muhe 1985). This prize came after years of criticism ofand controversy over the clinical applications of suchtechniques.
Dr Gerhard Buess was founding and chief editor of the Journal of Minimally Invasive Therapy and Allied Technologies. Furthermore, he was co-editor or member of theeditorial board of Surgical Laparoscopy & Endoscopy,Endoskopieheute, Minimal Invasive Chirurgie, RivistaItaliana di Videochirurgia e Chirurgia Mini-invasiva,Langenbeck’s Archives of Surgery, Surgical Endoscopy,The International Journal of Medical Robotics and Computer Assisted Surgery, and Management &Krankenhaus.
During his working life, Dr.Buess wrote or edited 7 textbooks that focused on endoscopic and minimally invasive surgery; and as first author or co-author he wrote over 72 book chapters and 265 original articles and editorials; and he gave over 950 lectures in surgical and other medical conferences worldwide. He was one of the few living surgeons whose name has been included in all surgery textbooks for a surgical procedure he developed andfirst introduced into the clinical practice: transanal endoscopicmicrosurgery. He contributed much to the development of new technologies and their application tosurgery. He built a center for minimally invasive surgery renowned throughout the world: MIC Tuebingen. Spinoffs from this center can be found worldwide: from Germany to Italy, from Japan to India, from China to Cuba. Hundreds of surgeons visited this center from all over the world and most of them attended the training courses at MIC Tuebingen.
Prof MC Misra had a chance encounter with Prof Buess during his visit to Germany in 2006, which led on to his visiting the MIC Tuebingen and subsequent co-operation between the two centers and establishment of the Minimally Invasive Surgery Training Centre at AIIMS, New Delhi with help and technology transfer from MIC Tuebingen. Prof Gerhard F Buess wholeheartedly supported the establishment of Minimally Invasive Surgery Traqining Centre (MISTC) at the Department of Surgical Disciplines, AIIMS, New Delhi and the MISTC was inaugurated by Prof. Buess and Prof. B.M.L. Kapur on 26th March, 2007. This led on to further co-operation and participation in the clinical application of rigid instruments for trans-vaginal cholecystectomy in 2008.
Gerhard F. Buess died in Herrsching following a protracted illness on October 30, 2010 and the surgical community lost one of the surgical scientist, great innovator who boosted technical progress in surgery and pioneered the revolution of minimally invasive surgery.The world’s surgical scientific community will miss this manand his extraordinary visionary approach to medicine, surgery, andinnovative technologies.

We remember Late Prof. Buess on the occasion of 5th AIIMS Surgical Week 2011, International Conference Cum Live Operative Workshop (ENDOSURG 2011) being organized by the Department of Surgical Disciplines for taking Prof. Buess’s vision forward. That is the best tribute  to Prof. Buess’s memory .

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AIIMS Laparoscopic Surgery Training Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi

Virinder Kumar Bansal, Paras Singhal, Mahesh C Misra
Department of Surgical Disciplines

All India Institute of Medical Sciences, New Delhi, India