Changing leadership roles in medicine

Vascular surgeon Sabine Wipper and her team developed a new technique to replace the thoracoabdominal aorta using extracorporeal circulation. In our interview she talks about her work and the current leadership challenges chiefs of medicine face in this decade.

You are a vascular surgeon –
what is it exactly that you do?

As a vascular surgeon, I am working on all kinds of arterial and sometimes on venous vessels besides the coronary arteries and the intracranial cerebral vessels.  I do both open repair by replacing the vessel using a graft, reconstructing, or repairing the vessel with sutures and biological material. I also do interventional treatment where the vessels are relined from inside with stents or stent grafts using x-ray.

My speciality is complex open aortic surgery, including replacement of the thoracoabdominal aorta using extracorporeal circulation. I was specially trained for these procedures in Houston and I am working actually part time in Oslo in the Department of Cardiothoracic surgery to perform these procedures there.

Furthermore I am leading several research groups for translational experimental studies in pigs. I was trained at the Institute for Surgical research in Munich as a medical student where I finalized also my doctoral thesis. In Hamburg I was the head of our research lab in cardiac surgery and I am actually still performing several experimental studies to different topics.


And most recently, you have developed a new method
of replacing the aorta?

That is correct. We developed a new technique to replace the thoracoabdominal aorta without needing extracorporeal circulation and without opening the thorax. The new hybrid graft can reduce perioperative mortality and morbidity by combining open and endovascular treatment techniques. The procedure is thereby less invasive, has fewer side effects and patients recover faster. Furthermore this new technique might reduce the postoperative risk of paraplegia due to spinal cord ischemia. The graft was evaluated in the experimental setting and we are currently waiting for first-in man implantation.

Further current projects are focused on spinal cord protection. I am leading a collaborative research group with Hamburg, Leipzig, Oslo, and Houston.


What are the current leadership
challenges in your position?

So far, my leadership experience lies mainly with post-doctoral candidates and postgraduate students in large-scale research work such as the large animal laboratory. The challenge is to find motivated people for the animal trials. These extremely complex, time-consuming studies require enormous organisational skills and stamina – qualities that are hard to find in graduates today. There is a lot of interest from post-doctorates, though, but for a post-doc  thesis, you need several dissertations, which again takes a long time. The crucial currency in this is publication credits. In order do award them fairly, topics and tasks need to be agreed in advance and distributed evenly.

On an organisational level, there is not much to delegate, unfortunately, as we practically have to do all the administrative work by ourselves: from pre- and post-operative documentation to securing the funds and resources with all the paperwork included – I have to do all that myself.

Once we get to head of department level, administrative and business responsibilities take on a bigger part. Besides leading the research and teaching, chiefs usually only do the highly complex surgeries and the patients with private insurance. In that role, it is important to put together a good team with complementing specialisations to have all areas covered. However, the chief still needs to be the most qualified surgeon in their department.


How have leadership roles in medicine
changed in the last decades?

Especially the chief positions have changed in that they have considerably more responsibilities at comparatively lower salaries. A chief’s main responsibility these days is to lead a functioning, profitable business. In addition to that, students and junior staff have become much more demanding.


Have collaborative skills become
more important, too?

Yes, to a certain degree team skills are important. Above all, you need to build strong interdisciplinary networks. The majority of surgeries today are collaborations between different departments.

For example, I always need a cardiac surgeon to attend my vascular surgeries even though I originally trained in cardiac surgery. In addition to that, I have to work closely with internal specialists as my patients usually multimorbid.


How do you fund your research projects
and what do you need to keep in mind?

There are grants you can apply for with different prerequisites from the German and European Research Societies, for example. It is hard to secure any funds from them, though, as most of their budget goes into basic oncology research. Translational research does not get much support.

Today it is crucial to write research proposals jointly with a network of centres – single centres rarely are successful with their proposals. I have secured my funds mainly through research prizes or I work with medical tech companies. For instance, I have developed the hybrid thoracoabdominal aortic prosthesis I mentioned earlier with the company that will now produce it.

The downside of this arrangement is that you cannot accept any additional private funding and you have to concede to the company all rights to the patents granted for what you developed. The rules are quite strict, even for talks or lectures you give on the subject. And then, the regulatory approval process is very laborious and lengthy, of course.


How has digitalisation and AI changed your field of work or
how do you think it will change?

Quite a bit. The clinic has become paperless, all information has been digitalised and there is more and more tech in the OR. For instance, there is a trend towards radiation-free operations. Research is concentrating on new virtual visualisation methods for endovascular procedures without using x-rays to save the surgeons from radiation exposure. Within the next ten years, CT imagery will be turned into a 3D image so the surgeon can do a virtual procedure in 3D. There is a group in Lübeck working on this at the moment.

There are no examples of applied AI in my field yet that I know of. There are developments, however, in procedure visualisation: When you plan a surgery, a program could accurately predict the kind of prosthesis, tools, wires and material needed and how to angle everything. We are not quite there yet, though.