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Hello, good evening. Good afternoon. Good morning. Good day, wherever you are in the world and welcome to the Blackboard Academy of Surgical Skills. My name is David Regan. I'm a retired cardiac surgeon and now a professor in the Medical Education Research and Development Unit with the Faculty of Medicine at the University of in Kuala Lumpur. We are coming to you live at nine o'clock in the evening in Kuala Lumpur and my co produced this evening. Ish is 1/4 year student here at the Faculty of Medicine who wants to do cardiac surgery. Joining us later on is Fellow Sense, Mr Chris Caddy, who's a plastic surgeon, retired from Sheffield and re ex council member of the Royal College of Surgeons of Edinburgh, who accredit our program. This would not be possible if it weren't for me. We've been working together with me now for nine on three years and it's enabled us to reach over 804,000, 285 registrants in 100 and 35 countries. And this evening is no exception. Welcome to those of you who have answered in the questions. This is your first time. I hope it's not your last as we're going to be switching platforms. But tonight, we have people from Albania, Bangladesh, Egypt, Ireland, Libya, Malaysia, Nigeria, Poland, Romania, Sri Lanka, Uganda, UK, and Yemen to name a few. And that would not be possible without the reach of me. And we're extremely grateful for them taking us from a Facebook page to a platform that's enabled us to reach the globe. What is really good news is that we're now gonna seamlessly transfer to a new platform called I Echo that works in a very similar way. It was established by Pros Ros White's colleague, a hepatologist who emigrated to New Mexico, set up the program and they have a satellite office in India. This is being done with her blessing and in conjunction with the Academy of Medicine of Malaysia. And I'm extremely grateful to Prof Rosti for the introduction and supporting the Black Art Academy. We hope to get face to face do is running very soon and I'm delighted that we're increasing our numbers of sensor Gerald who is a colorectal surgeon now, a professor at Sunway University and a also spent 20 years in the Ministry of Health of Malaysia is retired surgeon and is joining us as a sense as well. The Black Bar Academy is gaining movement and I am extremely grateful to everybody for the enthusiasm and help going forward in the future. Tonight is the last demonstration that I'm going to do on the metal platform. And I wanted to make it a summary of what we've learned so far and add a little bit to it. I would like to encourage you to put questions in the chat room and have invited Vanish to interrupt me and ask questions. I know Rinku has got a burning question this evening and I'll address that as we go through, I'd like to go back to why the Black Bell Academy. And this is the called the Book of Five Rings, written by Miyu Musashi. He's an undefeated samurai warrior from the 16 forties and he had some basic principles for learning the art, think of what is right and true practice and cultivate the science. Become acquainted with the arts, know the principles of the crafts, understand the harm and benefit in everything. Learn to see everything accurately, become aware of what is not obvious, be careful even in small matters and do not do anything useless. I think those rules aptly apply to surgery and I believe a good surgeon can operate in any part of the body provided they know the anatomy when I started as an sho back in 1987 at the Roy United Hospital in bath, I was given a knife. I'd pass my primary Fr CS and told there's your list. Get on with it. Passing the primary FL CS in those days meant that you knew your anatomy. But it was Abdu Khazim Al Sahari, that actually said this as well. He was the famous surgeon of the Ottoman Empire and said before practicing surgery, one should gain knowledge of anatomy and the function of organs so that he or she will understand their shape, connections and borders. I think surgeons should become thoroughly familiar with nerves, muscles, bones, arteries and veins. If one does not comprehend the anatomy and physiology, one cannot, can commit a mistake which will result in the death of a patient. He went on to say he had seen someone in size a swelling in the neck thinking it was an abscess when it was an aneurysm and the patient died on the spot. But of course, the other famous surgeon that you've heard me quote and talk about is Lloyd Barclay Mohan, his bus adorns the top of the staircase of the old entrance of the Leeds General Infirmary on Great George Street in Leeds in Yorkshire in the United Kingdom. I always encouraged the junior staff to go up the stairs and doff their cap to him. He said there are surgeons who operate upon the canine principle of savage attack and the biting and tearing of tissues are terrible to witness. These are they who operate with one eye on the clock and who judge the beauty of any procedure by the fewness of the minutes which it has taken to complete. I recall my first instruction as a cardiac surgeon doing my first coronary artery bypass grafts. It was just be quick, Lloyd Barclay Mohan goes on to say there are other surgeons who believe in the right hand who use the utmost gentleness and who deal lovingly with every tissue. They touch the scalpel is indeed an instrument of most precious use in some hands. A royal scepter in others, but a rude mattock, the perfect surgeon must have the heart of a lion in the hand of the lady, never the claws of a lion and the heart of the sheep. An operation is done quick enough when it is done, right? Every movement should tell every action should achieve something. A manipulation through requires to be carried out should not be half done or hesitantly done. It should be deliberate, firm, intentional and final, infinite gentleness, scrupulous care, light handling and purposeful, effective quiet movements which are no more than a caress are all necessary. If an operation is to be the work of an artist and not merely a curer of flesh. As I said, he regarded his hands as a handsome servants of his brain. And the only part of the story that I didn't like was he cast his hands in Brons to me that brought ego into it. And for me, somewhat sully is his reputation, but there is some very important things to bear in mind. And before we dissect, I'd like you to reflect on these elements as I show you. Now, the gentleness and the likenesses touch starts with you being aware of your own physical needs. If you're hungry, if you're angry, if you're late or you're tired, stop and think because you need to be of quiet mind because it's your behavior and your actions in theater that will ripple like waves across a pond and have a huge impact.