# Transcript: The beauty, development, and mysteries of neurosurgery

## Description

Who is Vladimír Beneš?



Vladimír Beneš is a neurosurgeon and head of the neurosurgery clinic at the Central Military Hospital in Prague. He has been practicing neurosurgery for 40 years and has performed over 8,000 surgeries. He is considered one of the best in his field worldwide. He says that the global internet network is just a child's toy compared to a single human brain.

## Transcript

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**[00:10:00]** On the bottom left is Mrs. Ringenová's hand when she already had severe arthritis.

**[00:10:06]** Below that, Mr. Egas Monitz discovered it, and angiography is still used today,

**[00:10:11]** but he didn't get the Nobel Prize for this, even though he was nominated for angiography.

**[00:10:17]** He received it for leukotomy, which we'll get to later.

**[00:10:20]** Nicholson flew over One Flew Over the Cuckoo's Nest.

**[00:10:23]** The third image is the so-called EMI scanner, the predecessor of today's CT scan.

**[00:10:28]** Hounsfield and Cormack received the prize for that.

**[00:10:31]** On the right is the MRI, developed by Lather-Bull-Mansfield.

**[00:10:34]** So neurochoriol techniques didn't succeed here.

**[00:10:37]** And that's because we are, after all, more craftsmen,

**[00:10:40]** not so much scientists.

**[00:10:44]** What is specific about the central nervous system?

**[00:10:47]** The central nervous system is the brain and spinal cord. They do not regenerate.

**[00:10:50]** What is once damaged and lost there is lost forever.

**[00:10:54]** If I make a mistake, that mistake has permanent consequences.

**[00:10:58]** Also, the consequences of neurological disorders, whatever they are,

**[00:11:01]** are the greatest burden on any healthcare and social system.

**[00:11:06]** Because all those years are lost when the person can't do anything.

**[00:11:10]** After a stroke, half the body is paralyzed, and the person can live for 30 more years.

**[00:11:14]** This doesn't happen in any other field except neurology, and unfortunately,

**[00:11:18]** it's due to the lack of regeneration.

**[00:11:21]** There were experiments proving that the absence isn't absolute,

**[00:11:25]** but that it's lost, but we won't go into that here.

**[00:11:28]** So we only have one chance.

**[00:11:30]** I'm an orthopedist; if I mess it up, I can go back,

**[00:11:33]** break the bone again, and it will be different.

**[00:11:37]** We don't have that option. Unfortunately, we only have one.

**[00:11:41]** So we more or less end up in a preventive situation.

**[00:11:45]** When a person comes with a spinal cord injury and is completely paralyzed,

**[00:11:50]** I can't help them.

**[00:11:52]** But if they come with some compression

**[00:11:55]** and the damage is not complete or not present,

**[00:11:59]** then I can help. So we prefer to operate on healthy people.

**[00:12:02]** Which is very tricky, because you can cause more harm to healthy people.

**[00:12:06]** Because the usual complication of the surgery is exactly what we want to prevent.

**[00:12:10]** So we really get more into that preventive dilemma.

**[00:12:13]** We operate on your neck to prevent a stroke.

**[00:12:18]** And we close aneurysms to prevent bleeding.

**[00:12:22]** So we are currently much more focused on preventive thinking.

**[00:12:27]** And nowadays we have options because we have perfect diagnostics,

**[00:12:31]** more reconstructions and not like our predecessors' destructions.

**[00:12:35]** They only balanced pressures in the head.

**[00:12:38]** We have five major areas: oncology, all tumors, vessels,

**[00:12:43]** functional, which includes pain and epilepsy.

**[00:12:46]** Then we have the spine, which historically somewhat belongs to us,

**[00:12:50]** but more to orthopedics. And then we have injuries, which is a huge category.

**[00:12:54]** The injury area in neurosurgery has basically not changed in the last hundred years.

**[00:12:58]** We can't do much there.

**[00:13:01]** What someone injures themselves doing unprofessionally on the street, we just professionally finish.

**[00:13:05]** We really don't have many chances there.

**[00:13:08]** Unfortunately, most patient questions are about injuries.

**[00:13:11]** Grandpa had an injury five days ago, he's in the ER, who knows where.

**[00:13:15]** Can we do something for him? Unfortunately, every answer is short.

**[00:13:19]** We can't.

**[00:13:23]** Do you know who this is?

**[00:13:25]** Kundera. Yes, correct.

**[00:13:27]** In The Unbearable Lightness of Being, Kundera wrote

**[00:13:30]** that the first attempt at life is life itself. It's true,

**[00:13:33]** because time moves forward permanently and cannot return.

**[00:13:36]** So he beautifully defined neurosurgery.

**[00:13:39]** The bizarre thing is that in The Unbearable Lightness, the main hero is a neurosurgeon,

**[00:13:43]** who in 1860, a mutineer, comes to them,

**[00:13:46]** he returns first to the clinic, then they throw him out,

**[00:13:49]** and he ends up somewhere in the provinces, like in a factory.

**[00:13:53]** At our clinic, there was exactly such a person,

**[00:13:57]** who escaped, returned, and the communists paraded him around like a bear.

**[00:14:01]** then he was first sent to Karlák, from Karlák then somewhere to the borderlands

**[00:14:05]** and Kundera didn't know about him.

**[00:14:08]** He really completely made up his hero in The Unbearable Lightness,

**[00:14:12]** but he actually existed in flesh and blood as he was.

**[00:14:16]** I have it simple with neurosurgery.

**[00:14:20]** That's my dad, who died last year, and despite that, this is the son,

**[00:14:23]** and all three of us are neurosurgeons, all three of us have worked

**[00:14:27]** more or less at five workplaces. The young one started in Liberec, I in Ústí,

**[00:14:31]** then I went to dad's clinic in Střešovice, the young one now heads

**[00:14:35]** dad's children's clinic in Motol.

**[00:14:40]** Christmases at our place are depressing, or used to be for all three women because of the woodcutting,

**[00:14:44]** we could talk.

**[00:14:48]** And this is our team, I say it's a cluster

**[00:14:52]** of cooperating individuals, because surgeons naturally

**[00:14:56]** have big egos and therefore argue among themselves, but in the end,

**[00:15:00]** we always pull together. But an integral part of the team

**[00:15:04]** is the endovascular specialist, a radiologist who also performs endovascular procedures.

**[00:15:08]** We'll get to that later, there are several neurologists, there is

**[00:15:12]** a pain specialist, one who only does monitoring during operations,

**[00:15:16]** and so on, so about half the people are surgically oriented.

**[00:15:23]** But we function as one unit. Of course, there is a neurologist

**[00:15:27]** who takes care of the IGTI, because we have that IGT unit,

**[00:15:31]** things like that. We're up-to-date and we also have women, both are small,

**[00:15:35]** so they can get in there if they make a big hole in the head,

**[00:15:39]** and it must be admitted, they do well.

**[00:15:43]** Covid hit us, we profited from Covid like the whole healthcare system,

**[00:15:47]** because we said we couldn't work with a microscope,

**[00:15:50]** which is close to the patient, so they bought us exoscopes,

**[00:15:53]** that's a beautiful 3D screen, you wear glasses, they spent

**[00:15:57]** a lot of money on it, but they bought us two. You're still close to the patient,

**[00:16:01]** because your arms are long, but the bureaucrat listened and purchased it,

**[00:16:05]** then they also bought us a 30 million expensive screwdriver,

**[00:16:09]** you'll see it in a moment.

**[00:16:13]** So now, how did it develop?

**[00:16:17]** The 70s and 80s were marked by CT and especially MRI,

**[00:16:21]** and suddenly we knew what we were going to operate on, we could think it over beforehand,

**[00:16:25]** and there was nothing else but surgery. That caused

**[00:16:29]** the field to peak in the 90s. Those were the great heroes,

**[00:16:33]** those were the terrifying procedures we tried, what could be operated on,

**[00:16:37]** because there was no alternative. So that was the peak of surgical neurosurgery.

**[00:16:41]** But then radiosurgery came along, either the Cyberknife here,

**[00:16:45]** or the Gamma Knife at Homolka, then interventional neuroradiology,

**[00:16:49]** what can be done externally can be done externally, from the department,

**[00:16:53]** a surgical gown, much more potent pharmacology,

**[00:16:57]** a combination of all that, and suddenly a completely legitimate treatment morality appeared,

**[00:17:01]** which is to do nothing.

**[00:17:05]** That is the safest option for the patient, and honestly,

**[00:17:09]** when a patient comes in with no symptoms, and there are plenty,

**[00:17:13]** because almost everyone has a CT at home, anywhere you bump your head,

**[00:17:17]** bam, they scan you, bam, MRI, bam, to us.

**[00:17:21]** Currently, more than half of our patients have no symptoms,

**[00:17:25]** they come straight off the street, completely healthy, just for the exam, and a tumor is found by chance.

**[00:17:29]** Never, never do I operate on it right away.

**[00:17:33]** I always wait at least half a year or a year to see if it grows,

**[00:17:37]** or if it causes problems. If it doesn't cause problems,

**[00:17:41]** and if it doesn't grow, then why do it? That would be foolish.

**[00:17:45]** For women around 50, I also ask,

**[00:17:49]** if their gynecologist is giving them any pills,

**[00:17:53]** to look younger and more beautiful. It doesn't help with those, but a small meningioma,

**[00:17:57]** which is one of the most common tumors, actually benefits from that and it grows,

**[00:18:01]** so just stopping the hormones makes the woman better again and there's no need to do anything.

**[00:18:05]** So this is a completely legitimate treatment modality.

**[00:18:09]** Now, with the new modalities, they naturally have the opposite effect,

**[00:18:13]** because to justify surgery, which has complications,

**[00:18:17]** there's no point in denying it, we have to be better

**[00:18:21]** than radiosurgery, better than interventional neuroradiology.

**[00:18:25]** It still holds that surgery is the fastest,

**[00:18:29]** most effective, and most precise. Radiosurgical machines

**[00:18:33]** have a 50% isodose, which means that

**[00:18:37]** about 3-4 mm around the lesion still receives 50% of the dose.

**[00:18:41]** If I operated with a 3-4 mm error,

**[00:18:45]** I wouldn't fit into this slow approach and I certainly wouldn't be sitting here.

**[00:18:49]** I apologize that the slides are in English,

**[00:18:53]** but I hope you can handle it easily,

**[00:18:57]** I don't have the patience to translate them into Czech.

**[00:19:01]** This is what a radiosurgical machine looks like, this is the Cyberknife.

**[00:19:05]** At our hospital, the Gamma Knife is already a 70-year-old concept,

**[00:19:09]** where there are fixed emitters, you just put it in the beam and it shines.

**[00:19:13]** And this device can, for example, when shining on a lung carcinoma and the patient is breathing,

**[00:19:17]** it can irradiate the target with less than millimeter precision continuously.

**[00:19:23]** and the target won't escape. It's really a fascinating thing.

**[00:19:27]** And next to it are aneurysms,

**[00:19:31]** either there's already a little clip like this on it, which is permanent forever,

**[00:19:35]** and I never have to do anything with that aneurysm again in my life,

**[00:19:39]** or you can pack it with coils like this, but unfortunately it can recur,

**[00:19:43]** but people naturally prefer the puncture in the groin,

**[00:19:47]** even though it's not as effective.

**[00:19:49]** This is what it looks like in real life.

**[00:19:52]** You see the kilometers of wires in that aneurysm.

**[00:19:56]** The patient is the only one who must not go to the pool because they will never swim again.

**[00:20:00]** And this is what it looks like. After surgery, there's just that one clip and I still tend to shine a light on it, which is complete nonsense.

**[00:20:09]** Appearance compared side by side. When the clip is there, the result is basically the same.

**[00:20:16]** So today we explain it to people and they choose for themselves.

**[00:20:22]** It's the only correct approach. The patient should be responsible for themselves.

**[00:20:26]** What’s behind me, do what you want, that's absolutely wrong.

**[00:20:32]** Those TV ads, be yourself. Jesus, I always grow.

**[00:20:39]** That's encouraging absolute irresponsibility and recklessness.

**[00:20:44]** A person has to be a little bit teachable, behave as they should,

**[00:20:52]** and not just be themselves. So this is a no.

**[00:20:56]** Who put that there?

**[00:21:03]** This is a video, but they don't play it here.

**[00:21:06]** This is an aneurysm on the carotid artery, the white on the left, when I press my finger there,

**[00:21:11]** that's the optic nerve. And the video is unedited and it's really done

**[00:21:16]** in about twenty seconds. You dissect it out, put the clip on,

**[00:21:20]** close it, done. I send the patient home, never have to see them again.

**[00:21:25]** Of course, I'm exaggerating that I never want to see them again.

**[00:21:28]** This is our surgical team and this is our endovascular team,

**[00:21:31]** so we deal with them as friendly as possible.

**[00:21:35]** We treat them really as partners, but of course

**[00:21:40]** we keep the decision-making in our own hands because we are clinicians, while they are diagnosticians.

**[00:21:47]** So they know what they're doing, they do it excellently, they deliver perfect work,

**[00:21:51]** but no patient can pass through the clinic without both of us seeing and discussing them.

**[00:21:56]** We always discuss and always argue about what will be better,

**[00:21:59]** whether to operate, do nothing, or do endovascular treatment.

**[00:22:05]** You can probably see the tumors. This is a cluster of tumors called

**[00:22:09]** petroclival meningiomas and this is probably the most you can operate on a person.

**[00:22:14]** More help than this cannot be operated on. If 20 or 25 years ago I said,

**[00:22:19]** no, this is different surgery, nothing can be done with it,

**[00:22:22]** no one would blame me and no one would question it.

**[00:22:25]** But thanks to the new modalities and how we have developed

**[00:22:29]** Technologically, because we had to, now they are relatively

**[00:22:35]** common to operate with, though they still have quite a few complications,

**[00:22:39]** but we already know what and how to handle it. It doesn't matter if we do it with a microscope

**[00:22:44]** or an endoscope, exoscope, both are fine, both see well.

**[00:22:49]** And this is a young woman with a densk tumor, you can see the tumor there,

**[00:22:54]** she is 6 months pregnant, about 1.30m tall, and the tumor,

**[00:22:59]** because of hormonal changes during pregnancy,

**[00:23:04]** has the same receptors as breast carcinoma,

**[00:23:08]** so it was compensated here. The woman is in a wheelchair. They brought her in at 6 months

**[00:23:12]** and started discussing with the obstetricians.

**[00:23:17]** Deliver at 6 months, how long will the baby live?

**[00:23:22]** About 5-7 years, then it will die of pulmonary fibrosis because it is premature.

**[00:23:27]** Abort, they have medieval tools,

**[00:23:31]** they crush the baby and tear it apart. Horrible.

**[00:23:35]** In the end, we convinced her that we would operate while pregnant.

**[00:23:39]** Why not put her to sleep while pregnant? So we operated on her pregnant.

**[00:23:43]** This is what it looked like. There was a piece left over because our operating rooms

**[00:23:48]** are equipped with normal technology, with equipment worth millions,

**[00:23:53]** most people have no idea what it's for, but it's like Star Trek.

**[00:23:58]** There is an electrophysiologist who measures how the nervous system works

**[00:24:03]** and then issues warnings. The N wave disappears.

**[00:24:07]** So the N wave disappears, and I know what the N wave is.

**[00:24:11]** Then more disappears, and it starts to get nervous.

**[00:24:14]** The N wave disappears, that's already a small warning.

**[00:24:17]** Then there's an alarm, it screams, and this is how it ends,

**[00:24:20]** everyone is completely stunned, but no one knows what the N wave is.

**[00:24:24]** Really like Star Trek, how they look into galaxies, you know,

**[00:24:29]** and now the captain says, turn on deflectors to 350,

**[00:24:34]** and everyone is completely lost, but no one knows what deflectors are,

**[00:24:37]** or what 350 means, this is similar.

**[00:24:40]** And there was also the obstetrician, and you women know,

**[00:24:45]** that little fetal stethoscope.

**[00:24:48]** They discovered it in 1232 and used it to listen to the fetus.

**[00:24:54]** After 6 hours, they told us we should have stopped,

**[00:24:58]** so we left that little piece, which we later treated with radiation,

**[00:25:00]** the radiosurgery woman is really good.

**[00:25:03]** And the result, that's the mother, that's the child who spent 6 years with us.

**[00:25:07]** And the only complication is the father over there, who started drinking in the background.

**[00:25:13]** Those are the pleasant gifts of medicine.

**[00:25:17]** And this is about observation.

**[00:25:20]** On the left, you see a tumor on the auditory nerve,

**[00:25:23]** but the woman hears and is using that ear to talk on the phone.

**[00:25:25]** That's the first question when you come with such a tumor.

**[00:25:28]** And she's 97, 53 years old, works at the state opera,

**[00:25:33]** with the 8th nerve comes the 7th, that's human, it controls facial expression,

**[00:25:37]** so damaging it isn't difficult, one can do it easily,

**[00:25:41]** but then the face is crooked, drooling, she can't walk around the state opera like that.

**[00:25:45]** So we agreed not to do anything.

**[00:25:48]** In 2010, she went deaf in the other ear.

**[00:25:52]** She still hears with the ear with the tumor, and you see the tumor is smaller.

**[00:25:57]** On the bottom right is, I think, Zlon, she's 76,

**[00:26:00]** a lively old lady who does what she wants, how she wants,

**[00:26:05]** and she hears with the ear with the tumor,

**[00:26:09]** because the other ear is deaf.

**[00:26:11]** So the decision not to do anything was completely right.

**[00:26:14]** Unfortunately, this is a tumor that everyone likes to operate on,

**[00:26:17]** it's elegant, nice, but the complications are there,

**[00:26:20]** at least it usually destroys hearing.

**[00:26:23]** We often can't save that hearing.

**[00:26:25]** And you also risk the seventh nerve,

**[00:26:27]** and you risk the patient's life, as with every operation.

**[00:26:30]** And here, 53, 76, 23 years without major problems,

**[00:26:36]** and we even saved her hearing unknowingly, but still.

**[00:26:40]** So you have to think carefully.

**[00:26:42]** And here are the mistakes. Here are the complications.

**[00:26:45]** The public always thinks we mess up during surgery.

**[00:26:48]** Of course. But that can happen once.

**[00:26:51]** If you repeat it, then it's nonsense.

**[00:26:53]** Everyone is allowed one mistake.

**[00:26:55]** But here are management mistakes.

**[00:26:59]** And those are more dangerous.

**[00:27:01]** That I make a bad decision, but that bad decision

**[00:27:04]** I only understand afterwards.

**[00:27:06]** I never know it beforehand.

**[00:27:07]** That's where most mistakes happen.

**[00:27:09]** When someone chooses radiosurgery,

**[00:27:11]** the tumor grows, then it becomes almost inoperable.

**[00:27:15]** What are three arteriovenous malformations?

**[00:27:18]** On the right, three check-ups where the malformation is gone.

**[00:27:21]** One was treated with radiosurgery,

**[00:27:23]** One surgically, one endovascularly,

**[00:27:25]** that it is sealed.

**[00:27:27]** I don't care which method I choose.

**[00:27:30]** As long as I choose correctly.

**[00:27:32]** And achieve that result on the right

**[00:27:34]** and the person is back without problems

**[00:27:36]** in all their activities.

**[00:27:38]** So it's about decision-making.

**[00:27:40]** That's the main thing.

**[00:27:44]** The guy with the half-liter,

**[00:27:46]** that's John Garfield,

**[00:27:48]** who was knighted at the end,

**[00:27:50]** so he is Sir John Garfield.

**[00:27:52]** Unfortunately, he died before the war.

**[00:27:54]** And he was a master of how not to operate.

**[00:27:58]** Whatever we showed him,

**[00:28:00]** he said, well, I wouldn't do that.

**[00:28:02]** That's unnecessary.

**[00:28:04]** Don't do that, it's nonsense.

**[00:28:06]** He said you can teach a monkey to operate,

**[00:28:08]** but you can't teach it not to operate.

**[00:28:10]** And that's deeply true.

**[00:28:12]** Operating is basically a craft.

**[00:28:14]** There's really nothing special about it.

**[00:28:16]** You either can do it or you can't.

**[00:28:18]** And you have to be able to,

**[00:28:20]** otherwise you should become a dermatologist,

**[00:28:22]** or a neurologist.

**[00:28:26]** God forbid, an orthopedist,

**[00:28:28]** where it's less noticeable.

**[00:28:30]** And he always said,

**[00:28:32]** less is more and more is less.

**[00:28:34]** It's about leaving a piece of tumor

**[00:28:36]** right at the end.

**[00:28:38]** All surgical complications arise at the end

**[00:28:40]** of the operation, because then the surgeon doesn't continue,

**[00:28:42]** if something goes wrong.

**[00:28:44]** And those are the last tumor remnants,

**[00:28:46]** when a vessel is torn, a cranial nerve is damaged,

**[00:28:48]** or it goes somewhere it shouldn't.

**[00:28:50]** So, learn to be economical.

**[00:28:54]** And today, medicine is all about

**[00:28:56]** science and art.

**[00:28:58]** That's a popular term,

**[00:29:00]** Science and Art of Medicine.

**[00:29:02]** The science part is really simple,

**[00:29:04]** because you can read about it.

**[00:29:06]** You can study it.

**[00:29:08]** There are thousands of sources to learn from.

**[00:29:10]** But the art is individual.

**[00:29:12]** And that's your own territory.

**[00:29:16]** Still, it remains true that

**[00:29:18]** there is a fraction of patients

**[00:29:20]** where we can't do anything.

**[00:29:22]** We can't help them.

**[00:29:24]** On the other hand,

**[00:29:26]** we can harm anyone.

**[00:29:28]** And the most dangerous

**[00:29:30]** human activity is going to the hospital as a patient.

**[00:29:32]** Remember that.

**[00:29:36]** It's true, statistics prove it.

**[00:29:38]** 0.001 deaths per year.

**[00:29:40]** Because you come in,

**[00:29:42]** you're fine,

**[00:29:44]** but they patch you up.

**[00:29:46]** And once they patch you up,

**[00:29:48]** complications inevitably arise.

**[00:29:50]** This leads to more injections,

**[00:29:52]** then to cutting,

**[00:29:54]** when there's a corpse involved.

**[00:29:56]** Hospital. On the other hand, the two safest human activities are

**[00:30:00]** flying on a plane. The risk there is 0.X0 and Tprv 1

**[00:30:06]** and someone told me elevators are even safer.

**[00:30:12]** So if you want to live in a safe environment,

**[00:30:16]** get into an elevator in a tall apartment building and ride up and down.

**[00:30:20]** The risk is minimal. And if you have a heart attack there,

**[00:30:24]** you have to stay there and keep going up and down.

**[00:30:29]** Now, here we have evidence-based medicine, which you've heard of,

**[00:30:33]** medicine based on evidence. That's a great thing. There are randomized studies for that,

**[00:30:41]** Here is one of them, the one on the left. And the difference between the two curves,

**[00:30:45]** is endovascular and surgical treatment and aneurysm,

**[00:30:49]** is absolutely minimal. Even after 15 years, at the end, the curves

**[00:30:53]** have crossed because of endovascular recurrence.

**[00:30:57]** There was only one trial done, we also participated in it,

**[00:31:01]** so P005 is also thanks to us.

**[00:31:05]** And since then, everyone repeats,

**[00:31:10]** that endovascular treatment is better.

**[00:31:14]** Based on a single trial. Complete nonsense.

**[00:31:18]** For example, no one has proven that a parachute is useful.

**[00:31:23]** That's empirical. But there are people who jump, it doesn't open, and they survive.

**[00:31:27]** And there are people who jump, it opens, and they don't survive.

**[00:31:31]** To prove that a parachute makes sense when jumping from a height,

**[00:31:35]** I would have to take, I don't know, x groups, statistics would tell me,

**[00:31:39]** how many have to die, give them backpacks and only half would have parachutes,

**[00:31:43]** but I wouldn't know, throw them out of a plane at the same dew point,

**[00:31:48]** and then some uninvolved people would come, count the dead,

**[00:31:52]** but they wouldn't know who had a parachute. They would give it to statisticians,

**[00:31:56]** who would evaluate it, and beforehand we would say we want this difference,

**[00:32:00]** P005, and finally, when everything was processed, there would be some other

**[00:32:04]** independent committee, usually the top experts who organized it,

**[00:32:08]** they would open the envelope and say group A had parachutes

**[00:32:13]** and there were fewer deaths. That would be scientific proof

**[00:32:16]** that the parachute is useful. It could be done, I would find

**[00:32:20]** huge groups to use as groups,

**[00:32:24]** but unfortunately it probably won't happen. So this is similar.

**[00:32:28]** And it's a dogma, you have to be careful. Against that is

**[00:32:32]** individualized medicine, that's the girl on the right,

**[00:32:36]** that's a tumor in the deep brain structures, benign,

**[00:32:40]** she took cytarabine and strocitom. And she came to me,

**[00:32:44]** because she had seizures in her hand. It ended with her having her tendons cut at a high

**[00:32:48]** level here to relieve it, which led

**[00:32:52]** to nothing, she still had them. And we found this tumor,

**[00:32:56]** it's a terrible location and I didn't know the way. The yellow line,

**[00:33:00]** that's the motor pathway and there's no good spot around it.

**[00:33:04]** So the girl always came, I told her to give up. I eventually sent it to five friends abroad,

**[00:33:08]** to see what they would do, to get advice. One advised,

**[00:33:12]** he figured out a way in. So finally, after a year, the girl and I

**[00:33:16]** agreed to operate. The spot is the one below,

**[00:33:24]** There's no tumor anymore, and you see the girl is completely normal.

**[00:33:28]** No statistics can help with this.

**[00:33:32]** It's really completely individual and depends on the patient,

**[00:33:36]** because she was also scared, but in the end, it turned out well.

**[00:33:40]** And now those randomized studies you keep hearing about,

**[00:33:44]** they're not some extraordinary evidence. You just see that they are,

**[00:33:48]** it's not very visible, but they are fourth from the top, those randomized studies.

**[00:33:52]** And one proper randomized study costs around 50 million dollars,

**[00:33:56]** it's no salvation to do this and no nice idea to come up with.

**[00:34:00]** It actually sends all the journals back when you challenge it.

**[00:34:04]** The best evidence is when a meta-analysis is done,

**[00:34:08]** which means that according to exact rules, I gather everything

**[00:34:12]** published on the topic, recalculate it, and then publish it.

**[00:34:16]** That really holds up. And on top of that,

**[00:34:20]** there is evidence-based medicine, which stands in some contradiction

**[00:34:24]** to personalized medicine. It's just a summary, well, you see,

**[00:34:28]** I want to highlight this again, clinical expertise, meaning mine,

**[00:34:32]** the best from the publications and what the patient values.

**[00:34:38]** And only where these meet can I say, okay, this is it,

**[00:34:42]** here I have some scientific evidence.

**[00:34:46]** These are two other studies, about carotid arteries.

**[00:34:50]** You see again in the top right that the lines run very similarly,

**[00:34:54]** the difference is minimal, but still statistically clearly

**[00:34:58]** proved that surgery is better for carotid stenosis than standard treatment.

**[00:35:02]** Either we operate on you, or before the stenosis develops,

**[00:35:06]** we insert a kind of perforated tube, a stent,

**[00:35:14]** you can probably see what it looks like. Both methods are still used,

**[00:35:18]** we also use both, actually mixing them.

**[00:35:23]** We had about 600 plates that we cut

**[00:35:29]** and correlated the stenosis with diagnostic methods.

**[00:35:33]** That's the one in the bottom left. There is absolutely no correlation.

**[00:35:37]** So from the 80s, 90s, and the first two decades of the 2000s,

**[00:35:43]** about eight randomized studies, one costing tens of millions of dollars,

**[00:35:47]** were based absolutely on nothing. When we sent it

**[00:35:51]** to various journals, they returned it. No one wanted it,

**[00:35:54]** because saying that 250 million dollars was wasted,

**[00:35:57]** just like that, nix-di-nix, and that we operate on something somehow,

**[00:36:01]** based on absolutely wrong premises.

**[00:36:05]** Finally, one journal accepted it, so I waited to see

**[00:36:09]** what would happen, probably they will criticize us.

**[00:36:12]** Those randomized studies then become dogmas.

**[00:36:15]** Any dogma is wrong. See those three guys down there,

**[00:36:18]** they weren't any good guys. It doesn't matter if the dogma is green,

**[00:36:23]** black, brown, beige, it doesn't matter. It's dogma.

**[00:36:27]** The one on the top left is Karl Popper. Ever heard of him?

**[00:36:31]** He was a theorist of science, among other things a friend of Sigmund Freud,

**[00:36:35]** who had nothing to do with science, mind you,

**[00:36:38]** Freud is not science, it's religion, just like the three on the right.

**[00:36:43]** And he claimed that only a theory that can be falsified is scientific.

**[00:36:47]** That means one that I can question and disprove,

**[00:36:50]** and it has to be dynamic because it moves forward.

**[00:36:53]** And of course, that's obvious. I had the biggest problems under communism,

**[00:36:57]** because I always asked what would come after communism.

**[00:37:00]** And it was a trap. They didn't know. It was a very tricky question.

**[00:37:05]** Development moves forward, right? So it couldn't be the last stage.

**[00:37:09]** If they said, this is it, we will all be communists,

**[00:37:12]** I said, well that's religion, like the father, son, spirit, holy.

**[00:37:15]** That's a few differences. But in the end, they let me graduate.

**[00:37:19]** A cannon. That doesn't belong here, it's from some other lecture.

**[00:37:23]** And Kundera again. That's ignorance, the last thing,

**[00:37:27]** also old, as you can see. And this is a very general truth,

**[00:37:32]** which unfortunately applies strongly in medicine, that the only common trait

**[00:37:36]** of all predictions is that they are always wrong.

**[00:37:40]** And one should really take that into account in life.

**[00:37:44]** You can plan the surgery as best as possible, prepare it well.

**[00:37:49]** I spend more time looking at the images and thinking about what and how,

**[00:37:53]** and the actual execution must be boring. Plutonium.

**[00:37:57]** As soon as there's adventure, it's bad.

**[00:38:00]** Because adventure inherently carries risk. And who does this risk belong to?

**[00:38:04]** The patient. I won't cut myself.

**[00:38:09]** So you always have to keep that Kundera in mind.

**[00:38:13]** Now, about those randomized studies.

**[00:38:16]** They are like traffic signs or maps or something like that.

**[00:38:19]** They only tell you the general. Based on that basic knowledge,

**[00:38:23]** I can use it, but it won't tell me what it really looks like there.

**[00:38:27]** I have to get there. If the police tell me to drive 40,

**[00:38:31]** I have to get there to know if at 40 I'll either wreck the car

**[00:38:35]** or I'll be fine with everyone. That particular knowledge is

**[00:38:39]** absolutely essential. I can't get through here, even if the map says I can.

**[00:38:43]** Then it's about competencies. This defect down here,

**[00:38:47]** That's one in a million newborns.

**[00:38:51]** So here in the country, it appears about once every two years.

**[00:38:55]** How many people do you think should be able to treat this in this country?

**[00:38:59]** Every neurosurgeon.

**[00:39:03]** In the 90s, I did nine of them,

**[00:39:07]** they're all adults now and have children.

**[00:39:11]** Then endovascular specialists took over, and for years we sent cases to Paris

**[00:39:15]** to some expert who handled it for the whole Union.

**[00:39:19]** That was the only sensible approach. Doing one every half year,

**[00:39:23]** that has no basis. Now it's being done here.

**[00:39:27]** This was actually probably my eight biggest surgeries.

**[00:39:31]** So everyone must be able to assess and propose treatment,

**[00:39:35]** but far from everyone can actually do it.

**[00:39:39]** If a surgeon tells you they can handle it, that's not a good sign.

**[00:39:43]** Start getting nervous. And if they say they have no complications,

**[00:39:47]** what do you do?

**[00:39:51]** Run away. Surgery without complications doesn't exist.

**[00:39:55]** And if they say they have none, there are only two possibilities.

**[00:40:00]** Either they're lying, and you probably wouldn't let a dishonest person operate on you, right?

**[00:40:06]** Or they're completely clueless and unaware of it. I wouldn't want that either.

**[00:40:11]** So honestly admit, okay, we have 2% complications, nothing can be done about that.

**[00:40:17]** This was probably the biggest surgery I ever performed, in 1995, 1996.

**[00:40:24]** And I probably shouldn't be on call anymore.

**[00:40:27]** Then there's what I call the Playboy syndrome. That's especially bizarre.

**[00:40:31]** Our textbooks are full of such drawings. It's never a photo.

**[00:40:35]** It's always a drawing, beautifully illustrated.

**[00:40:38]** And I understand a young 35-40-year-old surgeon wanting to try it too.

**[00:40:43]** That's legitimate, I felt the same.

**[00:40:46]** But the likelihood that the operating room will look like the drawing

**[00:40:50]** is about as likely as meeting that lady over there

**[00:40:53]** in a yellow raincoat. Zero.

**[00:40:57]** Unfortunately, this caused a lot of problems, especially in the 90s,

**[00:41:01]** when surgery was the only option, but it still persists.

**[00:41:05]** Then there's the second type. You have a lecture and they show you MRIs of huge tumors

**[00:41:09]** and say difficult but possible. But they don't tell you what happens to the patients afterward.

**[00:41:14]** The value of that message is about the same as these trophies on...

**[00:41:20]** Maybe Konopiště, I don't know. Yeah, zero.

**[00:41:24]** So to be with Mrs. Medvěd, fine. Virtuoso factor.

**[00:41:28]** That's my friend Vrstevník, and once when we were having dinner,

**[00:41:32]** I asked him, Václav, how often do you train?

**[00:41:36]** He says he looks at me like I'm a complete idiot.

**[00:41:39]** He says, daily? Four hours every day.

**[00:41:43]** Plus he has twenty concerts, yeah. Always, always fiddling.

**[00:41:47]** He started playing the fiddle when he was three years old.

**[00:41:50]** When I was tearing off flies' legs, he was already playing concerts.

**[00:41:54]** When I started going for beers, he was already famous across the country.

**[00:41:58]** And when I was 25, just starting out, doing something trivial for the first time,

**[00:42:01]** he was already a world-famous virtuoso.

**[00:42:04]** And it's like in sports. If you learn a sport in childhood,

**[00:42:06]** you always do it completely differently than someone who learns it as an adult.

**[00:42:10]** Tennis is a clear example... You can tell at first glance.

**[00:42:14]** So I looked at him and thought,

**[00:42:17]** four hours, that's terrible.

**[00:42:22]** Then I asked him a tricky question.

**[00:42:26]** Václav, do you make mistakes?

**[00:42:29]** He looked at me again like I was a complete idiot.

**[00:42:32]** He said yes, of course. And from me,

**[00:42:35]** who is nowhere near as trained as he is,

**[00:42:38]** and nowhere near his talent,

**[00:42:41]** it's expected that I don't make mistakes.

**[00:42:44]** Keep that in mind and keep in mind,

**[00:42:47]** that hospitals are dangerous places.

**[00:42:50]** So how can someone learn?

**[00:42:53]** First is knowledge.

**[00:42:56]** You can read it, you can see it in autopsies,

**[00:42:59]** you can train it, and it's a kind of basic craft,

**[00:43:02]** the foundation. That's drawing.

**[00:43:05]** Dalí had to be able to draw perfectly,

**[00:43:08]** so he could then paint.

**[00:43:11]** So if someone doesn't have this, it's bad.

**[00:43:14]** Currently, this is most evident with us at FAMU.

**[00:43:17]** At FAMU, everyone is an artist, but no one knows the craft.

**[00:43:20]** For the last 20 years we've been producing there.

**[00:43:23]** And that's a tragedy. First the craft, then do your art.

**[00:43:26]** But they've all been convinced there that they're artists,

**[00:43:29]** and they'll be frustrated filmmakers,

**[00:43:32]** who make one nonsense film in their lifetime.

**[00:43:35]** Then comes the actual profession,

**[00:43:38]** where a person learns and gains confidence through repetition,

**[00:43:41]** until they draw such beautiful hands,

**[00:43:44]** That's definitely his wife,

**[00:43:47]** who has normal, perfect anatomy.

**[00:43:50]** But it's based on that drawing

**[00:43:53]** and on repeated practice.

**[00:43:56]** Only then does it go a step further,

**[00:44:00]** when a person starts thinking a bit differently.

**[00:44:03]** And that's mainly tumors, where the anatomy is distorted.

**[00:44:06]** With aneurysms, everything is anatomically as it should be.

**[00:44:09]** I can't get lost there, I can't fail to find it,

**[00:44:12]** I can't get confused.

**[00:44:15]** When tumors push structures somewhere else,

**[00:44:18]** I have to anticipate that it could be there,

**[00:44:21]** I have to actively look for it,

**[00:44:24]** or on the contrary, I have to try to avoid it.

**[00:44:27]** That's the development in neurosurgery.

**[00:44:30]** I'd almost say it's a development that's general

**[00:44:33]** in practically all professions.

**[00:44:36]** What is a good outcome for us?

**[00:44:39]** The first generation, our fathers,

**[00:44:42]** they simply had survival.

**[00:44:45]** The Americans even evaluated outcomes between the wars,

**[00:44:48]** whether the patient left the hospital alive.

**[00:44:51]** It didn't matter where to.

**[00:44:54]** Even if they were dying at the cemetery,

**[00:44:57]** they were still counted among the survivors.

**[00:45:00]** Then the second generation, that was my father,

**[00:45:03]** and almost until the year 2000,

**[00:45:06]** it was only about clinical outcome,

**[00:45:09]** whether the patient was paralyzed on one side, could speak, could see.

**[00:45:12]** That rough neurological symptomatology.

**[00:45:15]** For us, it's about quality of life.

**[00:45:18]** And to simplify it,

**[00:45:21]** if a gardener survives surgery,

**[00:45:24]** and will be a gardener, that's fine.

**[00:45:27]** But if a university professor survives surgery,

**[00:45:30]** and will be a gardener, then something's wrong.

**[00:45:33]** And neuropsychology sometimes goes into very detailed things.

**[00:45:36]** The last one who really got to me,

**[00:45:39]** was some 30-year-old architect.

**[00:45:42]** We operated on an aneurysm on his anterior communicating artery.

**[00:45:45]** He was completely normal.

**[00:45:48]** Everything was completely normal.

**[00:45:51]** Everything was completely normal.

**[00:45:54]** Everything was completely normal.

**[00:45:57]** Everything was completely normal.

**[00:46:00]** Everything was completely normal.

**[00:46:03]** Everything was completely normal.

**[00:46:06]** Everything was completely normal.

**[00:46:09]** Everything was completely normal.

**[00:46:12]** Everything was completely normal.

**[00:46:15]** Everything was completely normal.

**[00:46:18]** Everything was completely normal.

**[00:46:21]** Everything was completely normal.

**[00:46:24]** Everything was completely normal.

**[00:46:27]** Everything was completely normal.

**[00:46:30]** Everything was completely normal.

**[00:46:33]** Everything was completely normal.

**[00:46:36]** Everything was completely normal.

**[00:46:39]** Everything was completely normal.

**[00:46:42]** Everything was completely normal.

**[00:46:45]** Everything was completely normal.

**[00:46:48]** Everything was completely normal.

**[00:46:51]** Everything was completely normal.

**[00:46:54]** Everything was completely normal.

**[00:46:57]** Everything was completely normal.

**[00:47:00]** Everything was completely normal.

**[00:47:03]** Everything was completely normal.

**[00:47:06]** Everything was completely normal.

**[00:47:09]** Everything was completely normal.

**[00:47:12]** Everything was completely normal.

**[00:47:15]** Everything was completely normal.

**[00:47:18]** Everything was completely normal.

**[00:47:21]** Everything was completely normal.

**[00:47:24]** Everything was completely normal.

**[00:47:27]** Everything was completely normal.

**[00:47:30]** Everything was completely normal.

**[00:47:33]** Everything was completely normal.

**[00:47:36]** Everything was completely normal.

**[00:47:39]** Everything was completely normal.

**[00:47:42]** Everything was completely normal.

**[00:47:45]** Everything was completely normal.

**[00:47:48]** Everything was completely normal.

**[00:47:51]** Everything was completely normal.

**[00:47:54]** Everything was completely normal.

**[00:47:57]** Everything was completely normal.

**[00:48:00]** Everything was completely normal.

**[00:48:03]** Everything was completely normal.

**[00:48:06]** Everything was completely normal.

**[00:48:09]** Everything was completely normal.

**[00:48:12]** Everything was completely normal.

**[00:48:15]** Everything was completely normal.

**[00:48:18]** Everything was completely normal.

**[00:48:21]** Everything was completely normal.

**[00:48:24]** Everything was completely normal.

**[00:48:27]** Everything was completely normal.

**[00:48:30]** Everything was completely normal.

**[00:48:33]** Everything was completely normal.

**[00:48:36]** Everything was completely normal.

**[00:48:39]** Everything was completely normal.

**[00:48:42]** Everything was completely normal.

**[00:48:45]** Everything was completely normal.

**[00:48:48]** Everything was completely normal.

**[00:48:51]** Everything was completely normal.

**[00:48:54]** Everything was completely normal.

**[00:48:57]** Everything was completely normal.

**[00:49:00]** Everything was completely normal.

**[00:49:03]** Everything was completely normal.

**[00:49:06]** Everything was completely normal.

**[00:49:09]** Everything was completely normal.

**[00:49:12]** Everything was completely normal.

**[00:49:15]** Everything was completely normal.

**[00:49:18]** Everything was completely normal.

**[00:49:21]** Everything was completely normal.

**[00:49:24]** Everything was completely normal.

**[00:49:27]** Everything was completely normal.

**[00:49:30]** Everything was completely normal.

**[00:49:33]** Everything was completely normal.

**[00:49:36]** Everything was completely normal.

**[00:49:39]** Everything was completely normal.

**[00:49:42]** Everything was completely normal.

**[00:49:45]** Everything was completely normal.

**[00:49:48]** Everything was completely normal.

**[00:49:51]** Everything was completely normal.

**[00:49:54]** Everything was completely normal.

**[00:49:57]** Everything was completely normal.

**[00:50:00]** We have those robots, we had the first ones. Back in 1985, some Kelly at Mayo Clinic developed this nonsense,

**[00:50:07]** but for us, it was only to hit a small target deep in the brain.

**[00:50:14]** Today we have technology that makes this robot unnecessary, we can do it much simpler,

**[00:50:20]** so those robots really have minimal effect as an extended arm here.

**[00:50:27]** However, in urology, in vascular surgery, where it's routine, it's good there.

**[00:50:32]** This is our expensive screwdriver. This is a CT scan, the spine is scanned, luckily the arm guides it

**[00:50:39]** and you just screw in the screw, and the screw fits exactly as it should. Great.

**[00:50:45]** I have two minor objections. First, it takes time. Second, if I have a spine surgeon

**[00:50:53]** who knows what he's doing, he can screw in the screw without 30 million worth of equipment.

**[00:50:58]** And third, they put in the vertical screws, but the one that connects them has to be hammered in

**[00:51:03]** in the usual way, which the robot can't do. So they're playing with it, guys,

**[00:51:08]** but I don't know if it's any breakthrough. Neurotransplantation. Why isn't brain transplantation possible?

**[00:51:15]** Or is it possible? That's the catch. But why isn't it possible?

**[00:51:29]** Why isn't it possible? Anyone? Well, you know, I told you. The person is the brain.

**[00:51:51]** So it would never be a brain transplant, but a body transplant.

**[00:51:57]** The brain would be the recipient, the body the donor. Children, victims would have the genetic makeup of that body,

**[00:52:04]** which fortunately isn't an issue yet. This idiot on top, unfortunately,

**[00:52:09]** is really a neurosurgeon. I asked Italian friends and they all just looked at me.

**[00:52:13]** You know how it is, right? I don't know, I don't want to. Then one got a bit serious,

**[00:52:17]** like he did it in Milan. He even did an eye transplant, which is the same nonsense,

**[00:52:22]** because the optic nerve is part of the central system, so it doesn't work.

**[00:52:26]** And he had it well thought out. I always laughed when it appeared in our newspapers.

**[00:52:31]** He said he would cool it to nine degrees. We did that in America.

**[00:52:35]** We cooled a baboon to nine degrees, put it on extracorporeal circulation,

**[00:52:39]** and left for three hours. Then we restarted it, warmed it up, and the baboon was a normal baboon,

**[00:52:45]** just like before. It was even used on humans, some Boterel started it in the 50s.

**[00:52:51]** So no miracle. He made a sharp cut, great, had those heads prepared,

**[00:52:57]** where they switch the heads. I don't know why he didn't want to use it, to put it on the body,

**[00:53:03]** but on that Russian he had prepared. And it's not a problem to keep some muscles alive,

**[00:53:09]** some bone, some vessel, that's easy, but there's the spinal cord.

**[00:53:13]** And that won't regenerate. But that was invented by a crazy guy.

**[00:53:17]** He claimed that in the cold he would put fusogens between the two stumps.

**[00:53:23]** And that already sounded like fusogens, that's something. Do you know what fusogen was?

**[00:53:30]** Ethylene glycol. Do you know what that is? Ethylene glycol.

**[00:53:36]** Fridex. So the cure for all diseases is Fridex.

**[00:53:41]** When it started, I said they would do it in China.

**[00:53:44]** Of course, they didn't do it even in China, but they were already prepared there.

**[00:53:48]** But these two-headed animals have been around since the 1950s.

**[00:53:51]** That's nothing new. And they live only a few weeks.

**[00:53:57]** So not organ, but tissue transplantation, and that's much more interesting.

**[00:54:03]** And unfortunately, I think we made a mistake there.

**[00:54:06]** Hormonal, that's the pituitary gland, which is impractical,

**[00:54:10]** because we can produce those hormones synthetically.

**[00:54:13]** Humoral. There is a system in the body that produces dopamine.

**[00:54:17]** Its deficiency causes Parkinson's syndrome.

**[00:54:20]** You probably all know it, the tremors, the dementia.

**[00:54:24]** And it can be very well modeled using some kind of kainic acid.

**[00:54:30]** In the 1980s, tissue transplants appeared,

**[00:54:35]** where rats were induced with Parkinson's syndrome,

**[00:54:40]** thus their centers producing dopamine were destroyed,

**[00:54:44]** which are deep in the thalamus, and it worked.

**[00:54:48]** They received either embryonic nervous tissue or later stem cells.

**[00:54:52]** This is a diagram of the experiment and it was excellent.

**[00:54:56]** The rats really improved. It wasn't quite the same with monkeys.

**[00:55:00]** Still, by the late 1990s, it reached clinical medicine.

**[00:55:04]** Here in the country, we did about three.

**[00:55:07]** And suddenly it didn't work in the clinic.

**[00:55:11]** So we quietly abandoned it. Completely quietly.

**[00:55:15]** And in human arrogance, we immediately jumped to circuits and pathways.

**[00:55:21]** That's something completely different.

**[00:55:25]** We started working directly on spinal cord injuries.

**[00:55:28]** The green are axons that grew beyond the injury level,

**[00:55:32]** which is roughly in the middle.

**[00:55:34]** Of course, that can't produce any function at all.

**[00:55:38]** And now it was spinal cord injuries, amyotrophic lateral sclerosis,

**[00:55:42]** multiple sclerosis, stroke.

**[00:55:45]** All kinds of things, and stem cells started being injected into those people.

**[00:55:49]** When it appeared in Rudé Právo here,

**[00:55:52]** my phone didn't stop ringing.

**[00:55:55]** Almost all 600 wheelchair users in the country called,

**[00:55:58]** asking if we would do it for them too. They wanted it.

**[00:56:01]** People were willing to do anything for it.

**[00:56:04]** Currently, it's probably only done in China, somewhere in Panama,

**[00:56:07]** and in some developed countries.

**[00:56:10]** There might be a trial between Israel and America, and that's all.

**[00:56:15]** But it's a great business,

**[00:56:18]** because the person is willing to do anything for it.

**[00:56:21]** Just for that hope, they're willing to do anything.

**[00:56:24]** Fortunately, it ended with us.

**[00:56:27]** We couldn't manage the dopamine,

**[00:56:30]** which is logical, simple, and plain.

**[00:56:33]** So we went for this instead.

**[00:56:36]** It's like not building a wheelbarrow,

**[00:56:39]** we can't do that, so let's build a rocket right away.

**[00:56:42]** Completely wrong.

**[00:56:45]** You can imagine a few such cells,

**[00:56:48]** surviving between those two giant bones,

**[00:56:51]** hiding somewhere there.

**[00:56:54]** But they charge ten grand or whatever for it.

**[00:56:57]** So this really is the way to go.

**[00:57:00]** I could have said, I was sitting somewhere with Honza Pirk,

**[00:57:03]** and I told him, Honza, in the myocardium, those stem cells,

**[00:57:06]** they'll probably make you that stupid muscle,

**[00:57:09]** which is here.

**[00:57:12]** Honza looked at me and said, you're an idiot.

**[00:57:15]** And he said, no one will do it.

**[00:57:18]** Then he was silent for a moment and said,

**[00:57:21]** hey, try the mosku, it probably does something, you know.

**[00:57:24]** And he said, that's even more stupid.

**[00:57:27]** They just don't work.

**[00:57:30]** They have only one use.

**[00:57:33]** Here's Míša, a spinal tumor, this was supposed to be a video too.

**[00:57:36]** But the white part is the tracts.

**[00:57:39]** And there are millions of axons going down,

**[00:57:42]** millions going up.

**[00:57:45]** Each axon has a very specific function.

**[00:57:48]** For a single muscle fiber, for example.

**[00:57:51]** Up to a single neuron,

**[00:57:54]** which evaluates sensitivity.

**[00:57:57]** And how do theoretical things imagine hitting that?

**[00:58:00]** A nerve regenerates one millimeter per day.

**[00:58:03]** This is, let's say,

**[00:58:06]** the upper cervical spinal cord somewhere here,

**[00:58:09]** so the motor neuron is.

**[00:58:12]** It will grow here for three quarters of a year.

**[00:58:15]** One year after the injury, 7% of the motoneurons in the brain remain.

**[00:58:18]** Because they have no function, they die.

**[00:58:21]** The neuromuscular junctions, that's the other end,

**[00:58:24]** one meter further, one and a half years later,

**[00:58:27]** they die at a rate of 1% per day.

**[00:58:30]** So even if, it wouldn't have anywhere to grow, buddy.

**[00:58:33]** There are so many things working against it,

**[00:58:36]** and it was immediately thrown into the clinic

**[00:58:39]** and sold directly to those people.

**[00:58:42]** The only place where it seems it might somewhat work,

**[00:58:45]** stem cells, is stroke.

**[00:58:48]** The center of the ischemia is dead brain,

**[00:58:51]** but the surrounding area has blood flow that keeps

**[00:58:54]** the neurons alive,

**[00:58:57]** but they are no longer able to function.

**[00:59:00]** And when stem cells are transplanted around it,

**[00:59:03]** they produce extremely potent growth factors

**[00:59:06]** and it recovers.

**[00:59:09]** I saw a fantastic video where a person who was supposed to be paralyzed on one side,

**[00:59:12]** was moving almost normally.

**[00:59:15]** There are about three centers in America running this,

**[00:59:18]** and roughly 80 people have been treated in such trials,

**[00:59:21]** so it's nothing to be seriously afraid of,

**[00:59:24]** but it is some hope that something might emerge.

**[00:59:28]** Are we running out of time somewhere?

**[00:59:31]** Or something?

**[00:59:34]** Ah, you wanted me to speed up.

**[00:59:37]** Neuroprosthetics are really nice,

**[00:59:40]** replacing the function with some neuroprosthetic.

**[00:59:43]** We have computers, we have everything possible.

**[00:59:46]** The one on the left is a blind person with 26 wires on the visual cortex.

**[00:59:49]** With 26 points, you can already compose a portrait,

**[00:59:52]** where you recognize the person, it's fascinating.

**[00:59:55]** I first saw it in 1985, he was driving a car.

**[01:00:00]** He honks entering the garage. I can't do that.

**[01:00:03]** And the blind person drives like that.

**[01:00:06]** Yeah, but I saw him in front of London, always the same.

**[01:00:09]** But no repeats.

**[01:00:12]** My friend Falikante recently worked with Americans

**[01:00:15]** on much finer electrodes, they inserted many more.

**[01:00:18]** They had a blind natural sciences doctor,

**[01:00:21]** who somehow got burned by some crap,

**[01:00:24]** and they managed the most,

**[01:00:27]** that the woman could tell on the computer,

**[01:00:30]** whether the screen was white or black.

**[01:00:33]** It was fascinating for her,

**[01:00:36]** because when the electrodes rotted, she went into depression,

**[01:00:39]** because it stopped working.

**[01:00:42]** Next to cochlears, right, not the usual cochlear implant,

**[01:00:45]** but all the way to the brainstem.

**[01:00:48]** I saw videos where two deafblind people talk on a bench about Shakespeare.

**[01:00:51]** That's fascinating, right.

**[01:00:54]** I would do about ten of those.

**[01:00:57]** I met one at tennis, he was there with his grandmother,

**[01:01:00]** and Pepíček was standing with his back to us, and I said,

**[01:01:03]** so, how's Pepíček, how does he hear?

**[01:01:06]** And he said, it's great, professor, look.

**[01:01:09]** And he shouted, Pepík. All the Pepíks in Prague 6 and 5 turned around,

**[01:01:12]** only our Pepíček kept staring the other way.

**[01:01:15]** That has mostly been abandoned now.

**[01:01:18]** All those artificial movements.

**[01:01:21]** All those artificial movements.

**[01:01:24]** All those artificial movements.

**[01:01:27]** All those artificial movements.

**[01:01:30]** All those artificial movements.

**[01:01:33]** All those artificial movements.

**[01:01:36]** All those artificial movements.

**[01:01:39]** All those artificial movements.

**[01:01:42]** All those artificial movements.

**[01:01:45]** All those artificial movements.

**[01:01:48]** All those artificial movements.

**[01:01:51]** All those artificial movements.

**[01:01:54]** All those artificial movements.

**[01:01:57]** All those artificial movements.

**[01:02:00]** All those artificial movements.

**[01:02:03]** All those artificial movements.

**[01:02:06]** All those artificial movements.

**[01:02:09]** All those artificial movements.

**[01:02:12]** All those artificial movements.

**[01:02:15]** All those artificial movements.

**[01:02:18]** All those artificial movements.

**[01:02:21]** All those artificial movements.

**[01:02:24]** All those artificial movements.

**[01:02:27]** All those artificial movements.

**[01:02:30]** All those artificial movements.

**[01:02:33]** All those artificial movements.

**[01:02:36]** All those artificial movements.

**[01:02:39]** All those artificial movements.

**[01:02:42]** All those artificial movements.

**[01:02:45]** All those artificial movements.

**[01:02:48]** All those artificial movements.

**[01:02:51]** All those artificial movements.

**[01:02:54]** All those artificial movements.

**[01:02:57]** All those artificial movements.

**[01:03:00]** All those artificial movements.

**[01:03:03]** All those artificial movements.

**[01:03:06]** All those artificial movements.

**[01:03:09]** All those artificial movements.

**[01:03:12]** All those artificial movements.

**[01:03:15]** All those artificial movements.

**[01:03:18]** All those artificial movements.

**[01:03:21]** All those artificial movements.

**[01:03:24]** All those artificial movements.

**[01:03:27]** All those artificial movements.

**[01:03:30]** All those artificial movements.

**[01:03:33]** All those artificial movements.

**[01:03:36]** All those artificial movements.

**[01:03:39]** All those artificial movements.

**[01:03:42]** All those artificial movements.

**[01:03:45]** All those artificial movements.

**[01:03:48]** All those artificial movements.

**[01:03:51]** All those artificial movements.

**[01:03:54]** All those artificial movements.

**[01:03:57]** All those artificial movements.

**[01:04:00]** All those artificial movements.

**[01:04:03]** All those artificial movements.

**[01:04:06]** All those artificial movements.

**[01:04:09]** All those artificial movements.

**[01:04:12]** All those artificial movements.

**[01:04:15]** All those artificial movements.

**[01:04:18]** All those artificial movements.

**[01:04:21]** All those artificial movements.

**[01:04:24]** All those artificial movements.

**[01:04:27]** All those artificial movements.

**[01:04:30]** All those artificial movements.

**[01:04:33]** All those artificial movements.

**[01:04:36]** All those artificial movements.

**[01:04:39]** All those artificial movements.

**[01:04:42]** All those artificial movements.

**[01:04:45]** All those artificial movements.

**[01:04:48]** All those artificial movements.

**[01:04:51]** All those artificial movements.

**[01:04:54]** All those artificial movements.

**[01:04:57]** All those artificial movements.

**[01:05:00]** All those artificial movements.

**[01:05:03]** All those artificial movements.

**[01:05:06]** All those artificial movements.

**[01:05:09]** All those artificial movements.

**[01:05:12]** All those artificial movements.

**[01:05:15]** All those artificial movements.

**[01:05:18]** All those artificial movements.

**[01:05:21]** All those artificial movements.

**[01:05:24]** All those artificial movements.

**[01:05:27]** All those artificial movements.

**[01:05:30]** All those artificial movements.

**[01:05:33]** All those artificial movements.

**[01:05:36]** All those artificial movements.

**[01:05:39]** All those artificial movements.

**[01:05:42]** All those artificial movements.

**[01:05:45]** All those artificial movements.

**[01:05:48]** All those artificial movements.

**[01:05:51]** All those artificial movements.

**[01:05:54]** All those artificial movements.

**[01:05:57]** All those artificial movements.

**[01:06:00]** All those artificial movements.

**[01:06:03]** All those artificial movements.

**[01:06:06]** All those artificial movements.

**[01:06:09]** All those artificial movements.

**[01:06:12]** All those artificial movements.

**[01:06:15]** All those artificial movements.

**[01:06:18]** All those artificial movements.

**[01:06:21]** All those artificial movements.

**[01:06:24]** All those artificial movements.

**[01:06:27]** All those artificial movements.

**[01:06:30]** All those artificial movements.

**[01:06:33]** All those artificial movements.

**[01:06:36]** All those artificial movements.

**[01:06:39]** All those artificial movements.

**[01:06:42]** All those artificial movements.

**[01:06:45]** All those artificial movements.

**[01:06:48]** All those artificial movements.

**[01:06:51]** All those artificial movements.

**[01:06:54]** All those artificial movements.

**[01:06:57]** All those artificial movements.

**[01:07:00]** All those artificial movements.

**[01:07:03]** All those artificial movements.

**[01:07:06]** All those artificial movements.

**[01:07:09]** All those artificial movements.

**[01:07:12]** All those artificial movements.

**[01:07:15]** All those artificial movements.

**[01:07:18]** All those artificial movements.

**[01:07:21]** All those artificial movements.

**[01:07:24]** All those artificial movements.

**[01:07:27]** All those artificial movements.

**[01:07:30]** All those artificial movements.

**[01:07:33]** All those artificial movements.

**[01:07:36]** All those artificial movements.

**[01:07:39]** All those artificial movements.

**[01:07:42]** All those artificial movements.

**[01:07:45]** All those artificial movements.

**[01:07:48]** All those artificial movements.

**[01:07:51]** All those artificial movements.

**[01:07:54]** All those artificial movements.

**[01:07:57]** All those artificial movements.

**[01:08:00]** All those artificial movements.

**[01:08:03]** All those artificial movements.

**[01:08:06]** All those artificial movements.

**[01:08:09]** All those artificial movements.

**[01:08:12]** All those artificial movements.

**[01:08:15]** All those artificial movements.

**[01:08:18]** All those artificial movements.

**[01:08:21]** All those artificial movements.

**[01:08:24]** All those artificial movements.

**[01:08:27]** All those artificial movements.

**[01:08:30]** All those artificial movements.

**[01:08:33]** All those artificial movements.

**[01:08:36]** All those artificial movements.

**[01:08:39]** All those artificial movements.

**[01:08:42]** All those artificial movements.

**[01:08:45]** All those artificial movements.

**[01:08:48]** All those artificial movements.

**[01:08:51]** All those artificial movements.

**[01:08:54]** All those artificial movements.

**[01:08:57]** All those artificial movements.

**[01:09:00]** All those artificial movements.

**[01:09:03]** All those artificial movements.

**[01:09:06]** All those artificial movements.

**[01:09:09]** All those artificial movements.

**[01:09:12]** All those artificial movements.

**[01:09:15]** All those artificial movements.

**[01:09:18]** All those artificial movements.

**[01:09:21]** All those artificial movements.

**[01:09:24]** All those artificial movements.

**[01:09:27]** All those artificial movements.

**[01:09:30]** All those artificial movements.

**[01:09:33]** All those artificial movements.

**[01:09:36]** All those artificial movements.

**[01:09:39]** All those artificial movements.

**[01:09:42]** All those artificial movements.

**[01:09:45]** All those artificial movements.

**[01:09:48]** All those artificial movements.

**[01:09:51]** All those artificial movements.

**[01:09:54]** All those artificial movements.

**[01:09:57]** All those artificial movements.

**[01:10:00]** I can't do it at all. I don't know if it's 3% or 30, 90. No idea.

**[01:10:10]** Human and artificial intelligence. We keep hearing about artificial intelligence.

**[01:10:14]** Nonsense. That's not artificial intelligence.

**[01:10:18]** It's just a simple machine that ran through tours in a resume,

**[01:10:24]** which I sometimes hear on TV.

**[01:10:27]** That's the one that cracked Enigma during World War II.

**[01:10:31]** A colleague of mine, who is into medicine and math,

**[01:10:35]** told me that in reality all computers,

**[01:10:38]** are basically based on this Turing machine

**[01:10:42]** and that is really a machine.

**[01:10:45]** It's nothing that could invent anything.

**[01:10:48]** Even if we refine intelligence,

**[01:10:51]** the simplest definition I found was from Ivan Havel,

**[01:10:54]** the ability to solve a problem, tie shoelaces, anything.

**[01:10:58]** And defining intelligence is the same problem

**[01:11:03]** as defining consciousness. There is basically no solid definition.

**[01:11:07]** So artificial intelligence will never have individuality,

**[01:11:13]** never have any creativity, never have any intuition,

**[01:11:17]** which only humans have, it will never be able to calculate

**[01:11:21]** predictive error, it will just do what we tell it to do.

**[01:11:25]** If you know Professor Mařík, we had several

**[01:11:29]** discussions about this with him. He claimed that to that machine

**[01:11:36]** something biological, some carbon, needs to be added.

**[01:11:40]** That's exactly the opposite. To the biological,

**[01:11:43]** something technological needs to be added.

**[01:11:46]** So we don't need silicon brains, but we need carbon brains.

**[01:11:50]** We hope the Indians will make them too. And in fact the connection

**[01:11:55]** between humans and technology, you are connected to technology.

**[01:11:59]** Yeah, all the time. Uncle Google tells you everything.

**[01:12:03]** So I don't know why Elon Musk should still be ahead of me.

**[01:12:08]** It's enough that it's so out there. But still, there will be some

**[01:12:12]** possibilities and it will be very tricky,

**[01:12:16]** because if those chips really worked,

**[01:12:20]** and armies love all that research, right, those are the kind of

**[01:12:23]** Schwarzeneggers who have a telescope instead of one eye.

**[01:12:27]** You've seen those movies. So you can imagine,

**[01:12:31]** a factory owner comes to me and wants ten rocket scientists by the next day.

**[01:12:34]** Well, I'll catch ten cowherds,

**[01:12:38]** put a chip in their heads and deliver ten rocket scientists the next day.

**[01:12:42]** That's not entirely unimaginable in the future.

**[01:12:46]** The research won't stop because it has its merit,

**[01:12:51]** it has its medical merit, but unfortunately the misuse

**[01:12:55]** is incredibly possible. Genetics is the same. So far it is not

**[01:12:59]** in practical use. So far, anything we do with genetics

**[01:13:03]** in tumors by name, it only tells us about prognosis.

**[01:13:07]** Nothing for treatment. Fine, we can quite accurately say prognosis,

**[01:13:11]** but suddenly it will be in use and suddenly we'll pour

**[01:13:15]** into something like, like the designers from Bay Big example.

**[01:13:19]** So a red-haired Brunhilda from Mecklenburg, to be up to date,

**[01:13:23]** right, will want a black guy and not a little Helmut,

**[01:13:28]** so she can give birth. We'll arrange a black guy too.

**[01:13:33]** Virtual reality is the same. Do you remember the film

**[01:13:37]** Antonio's Enlargement? It's from the 60s and already there

**[01:13:41]** virtual reality is there, where he didn't know if at the end

**[01:13:45]** they were playing tennis like mimes. The ball flies out of bounds

**[01:13:49]** and the boy is so confused he doesn't know what's real and what's not,

**[01:13:53]** and finally after hesitating, you knew it,

**[01:13:57]** he goes for the ball and throws it back to them. And exactly in this situation

**[01:14:01]** we appear, and there are many people who really, our

**[01:14:05]** instrument nurses, used to talk with us during breaks,

**[01:14:09]** now they take their phones and everyone is into it.

**[01:14:13]** I suspect they are texting each other, which is silly,

**[01:14:17]** but hard to say. Then there's Aldo and Zaxly,

**[01:14:21]** the end of civilization, that came out here, those are the alphas, betas, gammas,

**[01:14:25]** alphas command, gammas sweep the yards, and if we could

**[01:14:29]** control this, well, who would want to be a gamma? Probably no one.

**[01:14:33]** That's pretty much the bad side.

**[01:14:37]** So for the future, research, no matter which

**[01:14:41]** areas I mentioned, is about ethics.

**[01:14:45]** It's no longer about technology, about what is possible or not,

**[01:14:49]** but about ethics, and luckily we all have, except for the idiots here,

**[01:14:53]** built inside us what is right and what is wrong, and that's

**[01:14:57]** what we should follow and behave accordingly not only to others,

**[01:15:01]** but also to ourselves.

**[01:15:05]** Bottom right is the brain,

**[01:15:09]** top left is the universe, and these are comparable

**[01:15:13]** entities. The only ones. Nothing else exists.

**[01:15:17]** And the last picture, on the left, is a kind of children's toy,

**[01:15:21]** a leporello, a little toy. That's the global internet network.

**[01:15:25]** It can't be compared. One brain has a capacity far,

**[01:15:29]** far greater than that...

**[01:15:33]** Still or not? It's up to you. How tired are you?

**[01:15:41]** We still have a few slides, so we'll continue after the discussion.

**[01:15:45]** We would really like it if you could maybe skip

**[01:15:49]** to your personal stuff,

**[01:15:53]** to the PR, to the broadsides and such. That would definitely be a bit different.

**[01:15:57]** But it's up to you. If someone is already dying there, say so.

**[01:16:01]** I think I'm looking at the questions. So I'll take it quickly.

**[01:16:05]** You've answered a lot of them.

**[01:16:09]** What's the name of the Dutch Minister of Education?

**[01:16:13]** The Spanish president?

**[01:16:17]** The Brazilian prime minister? Did someone get it right?

**[01:16:23]** Do you think anyone outside our country knows,

**[01:16:27]** who the president is?

**[01:16:31]** Maybe some Austrian, maybe some Slovak,

**[01:16:35]** but otherwise, let's not get carried away and realize,

**[01:16:39]** that beyond our borders are other countries.

**[01:16:43]** On this map, you can hardly find the Czech Republic.

**[01:16:47]** If you do, it's right next to Slovakia.

**[01:16:51]** So, whether we like it or not, we really aren't the center of the world,

**[01:16:55]** but we're all equally insignificant. So let's learn to live with that

**[01:16:59]** and don't be frustrated or think everyone is constantly watching

**[01:17:03]** what we're doing. Nobody cares. Just like we don't care

**[01:17:07]** what's happening in Fiji.

**[01:17:11]** However, from my point of view, this is something completely different.

**[01:17:15]** This is a neurosurgical map showing the number of neurosurgeons

**[01:17:19]** balanced. Australia, because it has an English system, shrinks.

**[01:17:23]** Russia is tiny up there, which is nice,

**[01:17:27]** but that's because they lie and don't want to pay $15 per head

**[01:17:31]** to the world organization, so they claim to have 150 neurosurgeons,

**[01:17:35]** while they actually have only 300 in St. Petersburg.

**[01:17:39]** But what expands is China, India, and all of Europe.

**[01:17:43]** There we can see the Czech Republic. It expands the most. Japan has

**[01:17:47]** one neurosurgeon per 10,000 inhabitants.

**[01:17:51]** They really depend on each other now; it can't be otherwise.

**[01:17:55]** What is a global tragedy, though, is how Africa disappears.

**[01:17:59]** There is one per 8 million, and that's really something that shouldn't be,

**[01:18:03]** because this is again a burden of trauma and death.

**[01:18:07]** Look how Africa suddenly expands, how huge it becomes.

**[01:18:11]** So the discrepancy is huge, and they can't even keep up with treating injuries there.

**[01:18:15]** The second problem for them is hydrocephalus.

**[01:18:19]** They can't keep up with that either. And tumors are handled there by

**[01:18:23]** diagnosing them at best and then sending patients home to die.

**[01:18:27]** It's truly horrifying. A resident from Abuja took me to the airport in Nigeria. I asked him, how many surgeries

**[01:18:31]** do you perform? I said, none. He said, wait, wait.

**[01:18:39]** He says, well, we'll do a diagnosis and then send him back to the village.

**[01:18:43]** Terrible. Terrible. So we organize

**[01:18:47]** various courses, like these arrows show, and we really prioritize

**[01:18:51]** Africa, Indonesia, and these regions, but of course there are travel ones too.

**[01:18:55]** For example, this is Mombasa. There we inserted,

**[01:18:59]** these were life-saving, when we inserted that tumor, which is on the lower left,

**[01:19:03]** that's good, that's saranda, but it was some kind of hemagipariciton,

**[01:19:07]** the bone was growing like this, so they had two drills, which we broke within

**[01:19:11]** moments, so I revived the saw, it's old, it's the one on the left,

**[01:19:15]** that you pull like this. And we tore that too,

**[01:19:19]** we let them do it, it was that Black guy, you see, us white guys were slacking,

**[01:19:23]** but they didn't have air conditioning, it was hot, so the Black guy was pulling.

**[01:19:27]** So he tore it, but in the end we somehow managed.

**[01:19:31]** And now, when our hunting group is working,

**[01:19:35]** I realized that in five-million Mombasa now no one

**[01:19:39]** can do a craniotomy, get into the head,

**[01:19:43]** because they have nothing to do it with. Two drills in iron, the only saw is torn.

**[01:19:47]** It's terrible, when you realize this.

**[01:19:51]** I was once in Indonesia on Sulawesi,

**[01:19:55]** and a friend asked me if I could...

**[01:20:00]** He ate something bad, got dysentery, and asked me

**[01:20:06]** to watch over three hospitals where he had a contract.

**[01:20:09]** I didn't stop for three days, I went from one to another

**[01:20:13]** and drilled their epidural hematomas.

**[01:20:16]** It was horrible.

**[01:20:18]** And here, when we finished the course, this Můra came to me,

**[01:20:22]** asking to take a photo together. I didn't understand why, but I agreed.

**[01:20:29]** She went to the OR, she's from Sudan, yet the black guy still wore a muzzle.

**[01:20:37]** They were strange people there.

**[01:20:40]** In China, no one will get me anymore,

**[01:20:42]** because they are bastards who just suck knowledge out of you and pretend.

**[01:20:46]** And covid pushed us into the web space, which you have too,

**[01:20:52]** but it's a synthesis.

**[01:20:54]** On one hand an advantage, on the other a disadvantage,

**[01:20:57]** for such a course 60-70 people come,

**[01:21:00]** if they are deadbeats, then it's 20.

**[01:21:04]** And here you have a thousand if you do it well.

**[01:21:08]** No fee, no hotel, no plane ticket.

**[01:21:11]** So it has its perks, so we organize it under this academy,

**[01:21:16]** which we founded after some world organization no longer wanted us.

**[01:21:22]** And we do it once every two months, now it's possible to travel for that,

**[01:21:26]** so the teaching should start again now.

**[01:21:29]** But where are we going?

**[01:21:31]** We have 16 workplaces,

**[01:21:34]** so we have too many neurosurgeons,

**[01:21:37]** and unfortunately too many young ones,

**[01:21:39]** because those who will retire are not that many, 3-4,

**[01:21:43]** but between 30 and 40 there is a surplus of neurosurgeons.

**[01:21:47]** So we have one per 50,000 people.

**[01:21:49]** We claim we have less, but that's not true,

**[01:21:51]** we have one per 50,000.

**[01:21:53]** That already means such a dilution of patients,

**[01:21:56]** such a dilution of experience,

**[01:21:58]** that basically no one can learn it properly,

**[01:22:02]** which is really terribly bad.

**[01:22:05]** And of course the outcome depends on volume.

**[01:22:09]** The more I do, the better the results will be.

**[01:22:12]** That's logical.

**[01:22:14]** So endocrinologists for pituitary adenoma

**[01:22:16]** first wanted 100 pituitaries per year from us,

**[01:22:19]** then only 50, and now only 30.

**[01:22:21]** Why do you think 50 is the optimal number?

**[01:22:28]** That's once a week.

**[01:22:30]** That makes it routine, that makes it safe.

**[01:22:33]** If I do it once a year, then for me it will be...

**[01:22:39]** And now look at how it looks here.

**[01:22:41]** These are meningiomas, the most common benign tumors,

**[01:22:45]** so the simplest complications.

**[01:22:48]** Here are the Czech workplaces, all anonymized.

**[01:22:53]** And you see that about half meet the 30 per year.

**[01:22:57]** Meanwhile, the first half could easily absorb the second half.

**[01:23:01]** And going to a place like Rybitví to have a tumor operated on,

**[01:23:05]** when they did one per year, a person probably wouldn't want that.

**[01:23:10]** It's even worse with the pituitary.

**[01:23:13]** There, only the first two,

**[01:23:16]** well, the second and third, meet it.

**[01:23:19]** But going to a place like Hrob, you'd be stuck there.

**[01:23:24]** These are not trivial operations.

**[01:23:27]** So unfortunately this has developed here.

**[01:23:30]** But since we are an egalitarian state, we are all the same.

**[01:23:34]** When I do 100 basal meningiomas a year,

**[01:23:38]** that idiot over there from some random place tells me,

**[01:23:41]** he does it just as well as I do, because he does one a year.

**[01:23:45]** And I have to pretend, yes, fine, you do it well.

**[01:23:48]** I can't tell him he's an idiot. That's not possible.

**[01:23:51]** So in this, it's a matter for patients to seek out.

**[01:23:55]** You have the comprehensive choice of doctor,

**[01:23:58]** don't be local patients,

**[01:24:01]** here you have me, treat me, take care of yourself.

**[01:24:04]** But not for too many like that, who have ČVUT?

**[01:24:08]** No one? One.

**[01:24:12]** They always study it online. Completely.

**[01:24:15]** Their own disease, so they know more about it than I do, right?

**[01:24:18]** And now they test me. And you, professor, haven't you read,

**[01:24:21]** what came out yesterday in the Rwanda Daily?

**[01:24:24]** And if I admit I haven't, it's bad.

**[01:24:27]** There are few of those significant ones, but they exist.

**[01:24:30]** And on top of all that, since there are many of us, we have the European Working Time Directive.

**[01:24:34]** Remember that autistic guy who was our prime minister, Špidla?

**[01:24:39]** He brought back 10 points when he returned from Brussels,

**[01:24:43]** which he called his miracle.

**[01:24:46]** The first miracle was the Working Time Directive.

**[01:24:49]** Miracle number 10 was sunscreen for workers.

**[01:24:53]** Really, Laplanders put it on their chins so they can ski better, right?

**[01:24:57]** Because what else would it be for, right?

**[01:25:00]** And he brought this, 42 and a half hours now.

**[01:25:04]** We have continuous operation, so people are on duty.

**[01:25:07]** If someone serves a weekend shift, they then don't come for 10 days,

**[01:25:11]** because they have compensatory time off and must stay home and absorb family life impressions.

**[01:25:17]** In those 24 hours, you must rest 11 hours straight.

**[01:25:22]** We tried it at home with my wife.

**[01:25:24]** We lay down in the garden and decided to count 11 hours of rest.

**[01:25:28]** After five minutes we started fidgeting,

**[01:25:31]** after ten we argued, and after fifteen we logically went to do something.

**[01:25:36]** And we wanted to be full of family life impressions.

**[01:25:40]** At some conference in Japan, a Japanese man asked an American,

**[01:25:44]** how to endure, they have 80 hours, Japanese have no limits,

**[01:25:47]** they do about 110, 115.

**[01:25:49]** And the American gave a huge rant about how terrible it is, how bad it is,

**[01:25:53]** because they really exist in professional, well-documented articles,

**[01:25:56]** that it worsened care during those 40 hours.

**[01:25:59]** Because the people simply aren't there.

**[01:26:02]** So I thought, should I sign up and say that we in Europe have it figured out,

**[01:26:05]** then I couldn't find the leader.

**[01:26:07]** So currently it looks like this: one admits you,

**[01:26:10]** another prescribes your medication, a third orders tests,

**[01:26:13]** a fourth prepares you for surgery, the fifth operates on you,

**[01:26:17]** the sixth takes care of you in intensive care,

**[01:26:20]** and the seventh writes your discharge report.

**[01:26:23]** And do you know what that person knows about you?

**[01:26:25]** Absolutely nothing.

**[01:26:27]** Nothing at all, they just write it for a colleague and so on.

**[01:26:30]** That kind of attending doctor no longer exists,

**[01:26:32]** because they don't meet there.

**[01:26:34]** They're at home, lying there like that,

**[01:26:37]** absorbing impressions from family, from life,

**[01:26:39]** I never understood what that is.

**[01:26:43]** I don't know.

**[01:26:45]** Are we supposed to watch out for ourselves, or what?

**[01:26:49]** And then some introduced shift work,

**[01:26:51]** which is a complete tragedy for medicine,

**[01:26:53]** because people develop the mentality of assembly line workers,

**[01:26:56]** and they don't care about anything.

**[01:26:58]** And now the working time directive,

**[01:27:00]** when I decided on this because it really annoys me,

**[01:27:03]** applies to everyone here, even the army.

**[01:27:05]** If we invaded Ukraine,

**[01:27:07]** at 9 p.m. we'd say,

**[01:27:08]** "No, you can't anymore today,

**[01:27:09]** you have to go to your families, live your lives, and rest."

**[01:27:14]** So.

**[01:27:16]** Abroad, it doesn't apply to the seniors.

**[01:27:18]** That means in Germany, a professor comes to work

**[01:27:21]** and performs a craniotomy,

**[01:27:23]** that's the approach the junior should be learning.

**[01:27:25]** Then a mature second-in-command comes,

**[01:27:27]** full of impressions from family life,

**[01:27:29]** and for 6 hours, he must not interfere, just assist.

**[01:27:32]** After 6 hours, he waves goodbye and leaves,

**[01:27:35]** and the professor finishes the operation by himself until evening.

**[01:27:41]** A friend got fined in Germany, in Něchov,

**[01:27:46]** because of a woman from the magistrate who said,

**[01:27:48]** 'Professor, your doctors have been here too long.'

**[01:27:51]** He said, 'Well, they enjoy it,' and kicked her out.

**[01:27:53]** I would have done exactly the same.

**[01:27:55]** The woman was back a week later with a 15,000 euro fine.

**[01:27:59]** A friend in Lausanne fired two second-year residents,

**[01:28:02]** who were worthless, they sued him,

**[01:28:04]** claiming he held them hostage, and they won the case.

**[01:28:08]** An 80,000 franc fine, the boss 40,000, the other four 10,000 each.

**[01:28:13]** That would have financially ruined me, right?

**[01:28:15]** This really happens.

**[01:28:17]** And before, we had 32,000 hours to train one surgeon.

**[01:28:20]** Now we have 11,000 hours.

**[01:28:22]** It’s impossible.

**[01:28:24]** I can only teach them to take off a glove.

**[01:28:25]** Nothing more. Terrible.

**[01:28:28]** And that’s why our people should have been,

**[01:28:30]** right? Yes.

**[01:28:34]** They should have been required to go abroad,

**[01:28:36]** even simple Honza went abroad.

**[01:28:38]** I don’t know why they keep shouting here,

**[01:28:42]** That’s nonsense, they go abroad to learn something.

**[01:28:44]** They’ll come back with some Brunhilda

**[01:28:46]** and half a kingdom.

**[01:28:48]** And they’ll learn the language too.

**[01:28:51]** No, we want to keep them here.

**[01:28:53]** But now they’ll find jobs, because everyone needs them, right?

**[01:28:55]** We’ll get through this,

**[01:28:58]** how we dreamed of money,

**[01:29:00]** what we published,

**[01:29:02]** and how.

**[01:29:04]** This, what we’re playing with today in anatomy.

**[01:29:05]** These are some accreditations.

**[01:29:08]** I’ll just show you one thing.

**[01:29:10]** This nonsense, we’re stupid too,

**[01:29:12]** because it has to be fun.

**[01:29:14]** These are dogs that have the same nations as humans.

**[01:29:19]** They have the disadvantage that after such a tumor,

**[01:29:21]** a person would spend a week in intensive care,

**[01:29:23]** machines would do everything for them.

**[01:29:25]** The dog has to guard the house at night.

**[01:29:28]** This is my best publication.

**[01:29:30]** It took effort to get it published,

**[01:29:32]** because I meant it as a joke.

**[01:29:34]** And no one wanted it,

**[01:29:36]** even though the heads and editors of the two best journals

**[01:29:38]** said yes, and gladly.

**[01:29:40]** In the end, we managed to publish it

**[01:29:42]** and our results are better than the veterinarians'.

**[01:29:47]** This is a bit about beetles now.

**[01:29:49]** The feeling, the endorphins, as they like to say now,

**[01:29:58]** it's exactly the same when...

**[01:30:00]** Špotáková throws the javelin far, when Jirka Labus has a good premiere,

**[01:30:06]** when I remove a tumor like this one, the one down here, from the upper cervical spinal cord,

**[01:30:10]** or when I discover a new beetle and it's a new species.

**[01:30:13]** It doesn't matter, it repeats, it's the same, and really medicine,

**[01:30:18]** especially surgery, is very similar in this to theater,

**[01:30:22]** and sports, because the mechanism of a one-time performance is there too,

**[01:30:29]** and the body reacts to it, you can go to the OR,

**[01:30:32]** you might need to pee, you sit down at the microscope and forget about it.

**[01:30:38]** This was the Beetle exhibition at Nerudovka, unfortunately it's no longer there.

**[01:30:42]** These are two beetles described by a friend and named after my granddaughters.

**[01:30:45]** One is for Zuzana, the other for Eliška, and I am properly proud of that.

**[01:30:50]** This is the second publication I'm proud of,

**[01:30:52]** we caught this with Olda Kajzer somewhere in Sintian.

**[01:30:56]** A friend from the Prague Museum said it's a new species and asked me to describe it,

**[01:30:58]** I said describe it, but with the Kajzers you make a co-author,

**[01:31:01]** so you see that Oldřich Kajzer is truly a renowned professional entomologist.

**[01:31:07]** But the biggest fun is when we gather, this was in Tůr,

**[01:31:11]** they have a good neuroanatomical lab there,

**[01:31:13]** so we play around there with friends, one way or another.

**[01:31:19]** This is what conferences look like, almost annoying,

**[01:31:22]** but this is nice, when you get somewhere on a trip,

**[01:31:26]** like this there, and here I was learning,

**[01:31:30]** this is where I became a spine surgeon,

**[01:31:32]** but I didn't have the courage to take the first cervical vertebra home.

**[01:31:36]** This was in Vary, it was very bizarre,

**[01:31:38]** how you walk there on the red carpet to the pup,

**[01:31:41]** and some guy was waving at me a lot,

**[01:31:43]** asking me to sign for him, so I went over and told him,

**[01:31:45]** no, I signed first, I have nothing to do with this,

**[01:31:49]** I'm just a guest here.

**[01:31:50]** Finally, I said, please, you operated on my dad,

**[01:31:53]** so I signed for him.

**[01:31:56]** And this is the last one, it's kind of from all the traveling and everything else,

**[01:31:59]** it's really nice,

**[01:32:02]** to end up at home in your own garden with your own dog and wife,

**[01:32:06]** but to be honest, when I sit there like that,

**[01:32:09]** I'm already thinking about where I'll go next.

**[01:32:13]** Right?

**[01:32:15]** Thank you.

**[01:32:20]** May I stand up?

**[01:32:21]** Thank you very much.

**[01:32:22]** For getting me all choked up.

**[01:32:25]** I hope you enjoyed it as much as I did,

**[01:32:28]** and I'll borrow that and now we'll take it very, very, very fast.

**[01:32:33]** So, we look forward to your questions, but we look forward to your questions,

**[01:32:38]** which will come in our discussion that we are organizing.

**[01:32:42]** Give us feedback on how you liked the breakfast,

**[01:32:45]** just like you always do through the slide.

**[01:32:48]** I saw that three quarters of you have never been to a breakfast,

**[01:32:50]** so stars will appear there soon, so please give them to us, we'd appreciate it.

**[01:32:54]** Let's skip ahead.

**[01:32:56]** Great if you take some time to reflect on it.

**[01:32:59]** We always learn a lot of new information,

**[01:33:01]** what was your aha moment, what you didn't know.

**[01:33:04]** Try to talk with the people you shared the breakfast with.

**[01:33:07]** It will definitely help you, so that's one thing.

**[01:33:10]** If you want to talk with us,

**[01:33:12]** on the fourth of August from four p.m.,

**[01:33:14]** we have another chance to meet with the professor here.

**[01:33:18]** I invite guests continuously.

**[01:33:22]** This topic is a bit more complicated,

**[01:33:25]** but so far I have confirmed Honza Tyl,

**[01:33:27]** who was, among others, a guest and is currently working on digital people.

**[01:33:31]** He talks about artificial intelligence, so this controversy will be useful to me.

**[01:33:36]** We also talk with Professor Mařík and Jaroslav Petr,

**[01:33:41]** who actually worked in genetics and were also mentioned here.

**[01:33:44]** So let's see what we can achieve.

**[01:33:45]** So on August 4th, if you want to chat with us,

**[01:33:48]** it's definitely good to know.

**[01:33:50]** Book of the month, August, cold therapy,

**[01:33:53]** keep following Edu.

**[01:33:55]** Well, this is some personal PR of mine.

**[01:33:58]** And the next breakfast, on August 18th,

**[01:34:00]** we'll continue a bit about the body,

**[01:34:04]** about how to build health

**[01:34:06]** and especially how to create an environment around you

**[01:34:09]** so that ideally you don't have to keep going to the gym,

**[01:34:13]** but rather burn up to 1500 calories a day

**[01:34:16]** just through a normal environment you have around you,

**[01:34:19]** without having to go anywhere or hit the gym.

**[01:34:23]** Vlado Zlatoš is not only someone who knows a lot about this,

**[01:34:26]** he's also an entrepreneur, a person who invented,

**[01:34:29]** Nesedu, if you know that chair.

**[01:34:32]** So Vlado Zlatoš will join us on 18.8. from 8:30.

**[01:34:36]** Here at Magenta Experience Center or on Red Button EDU,

**[01:34:41]** or in the virtual world, I'll be looking forward to it.

**[01:34:43]** Professor, thank you very much once again.

**[01:34:45]** Thank you too.

**[01:34:46]** Thank you, take care, goodbye and see you.