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Hello, good evening. Good afternoon. Good morning. Good day. Wherever you are in the world and welcome to the Black Belt Academy of Surgical Skills. My name is David o'regan. I'm a retired cardiac surgeon and now a professor in the Medical Education Research and Development Unit of the Faculty of Medicine at the University of Malay. We're coming to you live from Kuala Lumpur and my colleague s 1/4 year medical student here in the Faculty of Medicine is on production and will field questions. We're also joined by our sense, a Chris Caddy in the United Kingdom who will join us in conversation at the end. Thanks to med, all we are now reaching 135 countries around the world. Tonight, 59 people have registered from 33 countries and I got rather excited because I looked at this list and often wondered, can I go from A to Z almost Australia, Belgium, China Democratic Republic of Congo is the first time they've joined Egypt, France, Ghana, India, Jordan, Kenya Lebanon, Malta. I'm afraid we skip O and Q but we've got Peru, Sierra Leone, Tunisia, Uganda, Venezuela. Now, why? And Zimbabwe, I think this is an incredible testament to the reach of me and thank them very much for their support. Tonight, we are going to talk about advanced surgical skills. The most advanced thing you can do are the basics consistently. And I'd like to read to you a piece of prose offered by a new sense. Professor Zaleha Abdullah Madi, who is a professor of zingy at the National University of Malaysia. And she wrote this very poignant piece, martial arts and surgery share an intrinsic blend of precision and artistic prowess. Both requiring mastery of movement control and fluid execution. In martial mouths. Every strike block and movement must be executed with precision. Too much force or deviation from form can lead to inefficiency, vulnerability or injury. Similarly, in surgery, each incision, suture and maneuver demands meticulous accuracy where even the slightest miscalculation can have significant consequences. Both disciplines transcend technical skill to become a form of art. A seasoned martial artist moves with grace, seamlessly, blending power and control. Much like a surgeon whose hands perform complex procedures with fluidity and finesse. This artistry is home for years of practice where repetition transforms technique into instinct, allowing both martial artists and surgeons to operate with an effortless or or meditative flow. Furthermore, just as martial artists adapt their techniques based on their opponents movements, surgeons must adjust dynamically to each patient's unique anatomy and unexpected surgical challenges. This adaptability reflects not just skill but a deep understanding of the craft where science meets intuition and precision becomes art. Ultimately, both martial arts and surgery are testaments to the human discipline and mastery. Whether in the operating room on the dojo, the pursuit of excellence is defined not just by mechanical skill, but by an artistic sensibility that turns precision into an elegant expression of expertise. Prof you said that beautifully well, but it's not just the technical that we talk about in surgery. And what we talk about in the Black Belt Academy is mind like water. Meera cer a reflection in water is the symbol of a clear calm mind in harmony with its surroundings. The highest level of training in martial art before we actually draw the sword. Let me put you in the right frame of mind. I've previously s said you should try and empty your mind of daily thoughts, close your eyes, think of something pleasant, something that has happened or that you wish to happen. Let your shoulders relax. It is most important to be relaxed before and during practice. Remember if you throw a rock into a pond, it makes a splash only for a second. Then every drop of water returns to previous stillness as nothing had happened. This is most important. The draw of the sword must be appear out of nowhere in effect. Now you see it now you don't, I don't want you to think this is done by trick or speed. It's something hard to explain. The best way I know to explain the appearance of the katana in is to compare it with hunting. Have you ever been hunting or deep in the forest? Sitting very quietly, everything stops and you can hear a pin drop, the noise of the forest starts up again. Everything as it was with you as quiet and relaxed as possible. You can see nothing unusual. Your eyes look all around and out of nowhere, A deer or small animal appears as if it had materialized from thin air. Now this is ei the movement becomes so natural that the sword just seems to materialize from your hand. Imagine applying the art of drawing the sword to using surgical instruments. You enter a totally different realm of thinking and practice. When I was practicing on Sunday, the sword has to be held above my head, one hand's breath before this is the position before every strike in the 11th. Carter. The first break is down to the chin. The sword comes back up, the same path resets, comes down the other side and now it's down to the shoulder, it comes up the same path you reset and now it comes down again to the abdomen, come up, reset, bring it down. And now the most difficult cut of all is a 180 degrees horizontal slice across the belly. And at the same time, you bring it up again and break it down. Sounds simple. Far from it because every move is precise. And you'll notice that the sense they describe exactly where the blade ends, the path that travels the direction it travels. But also you can't have the blade too angulated or too straight. If you get the technique wrong, you will not cut it is that level of precision that the sense can see from the end of the room and it would stop you there, come and move your sword from there, which enables you to kill me to there where you can't approach that distance is literally two centimeters. Can anybody think of any surgical trainer that has ever picked you up on that detail? And as I do a systematic review of O SAT scores fundamentally, I think there's something missing. It is implied the flow and the rhythm that how you get there is not described, not measured and hence O SAT becomes very subjected indeed. So let us start the most advanced thing you can do is attend to the basics consistently. And what we mean by that is that you understand the various elements that build up every movement and for advance stitching, this is particularly important with that in mind. I would like to uh