The document explores the concept of creativity in surgery, framing it as a process shaped by the interaction of three elements: domain, field, and person. It references historical figures like Leonardo da Vinci and the evolution of genetic understanding through key scientific discoveries, emphasizing that surgical creativity results from collaborative efforts rather than individual genius. It concludes with the notion that creative ideas are built on past knowledge and experiences, affirming Edison’s belief that creativity is predominantly hard work.

1. Creativity in Surgery
Tirone E. David
University of Toronto

4. CREATIVITY
1. Genius theory

5. Leonardo da Vinci
1452 - 1519

6. Works of Leonardo da Vinci

8. CREATIVITY
1. Genius theory
2. Stepwise, logical evolution of new
ideas, products, operative procedures,
etc…

9. Model of the DNA
Watson & Crick
Nature 1953; 171:737-8

10. "Father of Genetics"
Gregor Mendel Son of a farmer who became a
catholic monk, conducted an
experiment that involved growing
thousands of pea plants, which
1822-1884
led to the discovery of genes. His
ideas were published in 1866 but
went largely unrecognized until
1900.

11. Virulent
+ = Death
Frederick Griffith Pneumococcus
1881 - 1941
Non-virulent
+ = Live
Pneumococcus
Heated virulent
+ = Live
Pneumococcus
Non-virulent +
Experiments with + heated virulent = Death
Pneumococcus in 1928 Pneumococci

12. Non-virulent
++ = Death
Oswald Avery heated
1877 - 1955 virulent
Pneumococci +
Non-virulent
Virulent with
destroyed lipids,
+ ribonucleic acids, = Death
carbohydrates,
and proteins
Non-virulent +
Virulent with
+ destroyed = Live
deoxyribonucleic
Experiments with acids
Pneumococcus in 1935

13. Erwin Chargaff In 1950 he concluded that there must
1905-2002 be as many types of DNA as there are
different species. The number of
purine
bases (adenine and guanine) was equal
to the number of pyrimidine bases
(cytosine and thymine). The number of
adenine bases was equal to the number
of thymine bases and the number of
guanine bases was equal the number of
cytosine bases.
Chargaff’s rule: A = T, and G = C

14. Linus Pauling
1901-1994
In May 1951, he described the structures of a
number of proteins, including the structure of
the single most important basic form of protein
chain, the alpha helix (a hydrogen-bonded
helical chain that is a structural component of
most proteins).

15. Cavendish Laboratory Randall’s Laboratory
Cambridge King’s College
James Francis Rosalind Maurice
Watson Crick Franklin Wilkins
1928- 1916-2004 1920-58 1916-2004

16. Rosalind Franklin Franklin’s x-ray
1920-58 diffraction of DNA

17. Watson and Crick
Original Model of
DNA
Nature, 1953

18. Nobel Prize of Physiology or Medicine
1962
Francis Crick James Watson Maurice Wilkins
1/3 prize 1/3 prize 1/3 prize

19. Rosalind Franklin
Died in 1958 at 37 years Franklin’s x-rays
of age of ovarian cancer diffraction of DNA

20. 1953 – Watson & Crick
1952 - Franklin
1951 - Pauling
1950 - Chargaff
1935 - Avery
1928 - Griffith
1866 - Mendel

21. Leonardo da Vinci
“The Paragon of Creativity”

22. Thomas Alva Edison
1847 - 1931
“Creativity is 1% inspiration
and 99% perspiration”

23. Creative People
Skillful
Self-motivated
Knowledgeable

25. Creativity results from the interaction of
a system composed of three elements:
Domain
Field
Person

26. Domain is an area of our culture
Examples of domains:
Medicine
Heart valve surgery
Mitral valve surgery

27. Field = gatekeepers of a domain
Without the assessment of competent outsiders there is no
reliable way to decide whether the claims of a self-styled
creative person are valid.

28. Person
The individual that is able to create a new idea, product, or
an operation

29. Left Ventricular Rupture After
MVR
Treasure RL et al. Chest 1974;66:511

30. Left Ventricular Rupture After
MVR

31. Reconstruction of the Mitral Annulus

32. Reconstruction of the Base of the LV

33. Reconstruction of the Base of the LV

34. Reconstruction of the Base of the LV

35. Reconstruction of the Base of the LV

36. Reconstruction of the Base of the LV

37. Reconstruction of the Base of the LV

38. Post-Acute Myocardial Infarction VSD
Repair by Infarct Exclusion

39. Post-Acute Myocardial Infarction VSD
Repair by Infarct Exclusion

40. Endocardial patch for LV rupture
Reconstruction the mitral annulus
Reconstruction of the base of the heart
Reconstruction of the LV wall

41. Peer-reviewed publications
Left ventricular rupture after mitral valve replacement: endocardial repair with
pericardial patch.
David TE. J Thorac Cardiovasc Surg. 1987 Jun;93(6):935-6
Reconstruction of the mitral anulus.
David TE, Feindel CM. Circulation. 1987 Sep;76(3 Pt 2):III102-
Postinfarction ventricular septal rupture: repair by endocardial patch with infarct
exclusion.
David TE, Dale L, Sun Z. J Thorac Cardiovasc Surg. 1995 Nov;110(5):1315-22
.... Plus 28 other publications on this topic

42. Surgical Creativity
• A process that unfolds during a lifetime

43. Mitral Valve Surgery
LV function after MV repair is better than after MVR
Gore-Tex for replacement of chordae tendineae
Techniques of MV repair in Barlow’s valves

44. Aortic Valve Surgery
Stentless aortic valves

45. Aortic Valve Surgery
Aortic valve sparing operations

46. Creativity results from the interaction of
a system composed of three elements:
Domain
Field
Person

47. Surgical Creativity
Arises from the synergy of many sources and
not from the mind of a single person

48. Outliers:
Albert Einstein
IQ 150
Christopher Langan
IQ 195

49. Christopher Langan
Born in San Francisco, 1952
“The smartest man in America"
IQ = 195 - 210
He rose to prominence in 1999
while working as a bar bouncer
in Long Island
The Cognitive-Theoretic Model
of the Universe

50. Gladwell:
“No one –not even rock stars,
not professional athletes, not
software millionaires, and not
even geniuses – ever makes
it alone”

51. The End of Europe’s Middle Age
Florence, Italy – Renaissance’s Birthplace

52. Where do creative ideas come from?
Come from the past
Come from previous knowledge and experiences
Creative works begin in continuity with the past

53. Surgical Creativity
Arises from the synergy of many sources and
not from the mind of a single person

56. “Creativity is 1% inspiration
and 99% perspiration”
Thomas Edison

57. Thank you