Hans Myhre, Professor of Vascular Surgery at the University Hospital of Trondheim and inaugural President of the ESVS, talked to Vascular News about his career and the current state of vascular surgery in Europe.
More elderly patients, who are less tolerant to open techniques
Hans Myhre explained to Vascular News how his attention was first caught by vascular surgery. “When I started as a surgeon at Aker Hospital, University of Oslo, in 1967, Professor Sverre Vasli had recently been employed. He was a vascular surgeon and the one who really introduced modern vascular surgery in Norway. After a short period he asked me whether I was interested in working in vascular surgery, which I found attractive.
“I also like vascular surgery since you need to combine creativity with good technical skill. The result of a vascular operation is to a great deal dependent upon a technically perfect operation in addition, of course, to a correct indication for operating.”
Myhre then highlighted the important educational influences in his career. ”Professor Sverre Vasli was my first teacher in vascular surgery, teaching me the basic operations as well as advanced vascular surgery,” he said. “I would also say that other senior colleagues at the hospital taught me a lot especially in general surgery. In those days as a senior registrar you had to take care of everything including orthopaedic surgery, urology, thoracic and vascular surgery, gastroenterologic surgery, paediatric surgery and trauma. I found that extremely satisfactory, but I realise that today surgery is much more specialised and that my experience is history. I was a fellow for one year at the Methodist Hospital, Houston, Texas and was very much influenced by the late E. Stanley Crawford who was an excellent surgeon. He had the ability to simplify the operations very much. I was especially interested in his work on thoracoabdominal aortic aneurysms.”
Myhre started as professor and chief of the Department of Surgery in Trondheim in 1982. The medical faculty there was established in 1975 and therefore many of the surgical specialities had to be built up. “I had a lot of good colleagues so we made a fine team and after 20 years it is satisfactory to see that all surgical specialties are well established having a good standard.”
When asked about his scientific achievements Myhre said “I remember specifically the King Olav V gold medal for medical research, which I received together with my good friend professor Andries Kroese in 1979. This was based on early work with ultrasound in vascular diseases. Several of the observations were quite original and included basic physiology as well as clinical application.”
Myhre then describing his current activities: “I find it extremely satisfactory to be supervisor for other colleagues who take their PhD and I have supervised quite a few.”
At the moment Myhre is working on the following projects:
Several projects connected to the use of endovacular surgery.
Trondheim was the first centre in Norway to start endovascular surgery and has trained centres both in Scandinavia and outside. “My good colleagues, Dr Lundbom and Dr Hatlinghus, have been key people in this activity. Health authorities help to promote this work, which includes training and research. We are about to establish a ‘centre of excellence’ for endovascular techniques at our department. We were the first to apply this technique in Norway and several interesting scientific contributions have emerged. I also have been involved in the Eurostar register since it started and find that extremely useful and stimulating.”
The application of new ultrasound modalities (plaque movement) in the investigation of carotid artery stenosis.
Epidemiological study in the HUNT-investigations, a collaboration between the National Health Screening Service, the National Institute of Public Health and the Norwegian University of Science and Technology, Trondheim.
This investigation focuses on the county of Nord-Trøndelag. "We have included about 20,000 persons investigating the prevalence of intermittent claudication, critical limb ischaemia, the effect of smoking, lipids etc. "
Haemodynamic changes including cardiac function and spinal fluid dynamics during thoracoabdominal aortic surgery.
ESVS and other scientific societies
Myhre has been involved with many societies, but selected out the Royal Norwegian Society of Sciences, which was founded in 1760 in Trondheim, for special mention, as it was the first scientific society in Norway. Describing his involvement with the ESVS, Myhre said: “First of all I was the first president and was elected at the inaugural meeting in London in 1987. The first year there was a lot of things to do to get things running. I remember with pleasure the good cooperation with the secretary professor Hero van Urk who did a tremendous job. I think that the congress in Rotterdam was very good and I am happy to see that ESVS is growing and that it has become so successful. I have also been a trustee for the ESVS and finally member of the editorial board of the journal. So I have been heavily involved in the society from its very beginning.”
Myhre thinks that societies like the ESVS are of great importance for communication between doctors and professional people. “They represent a forum where you can exchange ideas, scientific work and get corrections, when necessary. The ESVS especially so, and some of the national societies, but this varies a bit, some are not that ambitious, while some are important.”
Myhre also carried out the work that led to the formation of the Norwegian Society for Vascular Surgery and paved the way for the foundation of the specialty in Norway in 1986. Reflecting on this, Myhre said:
“In most countries where vascular surgery has been established there have been problems. There is always opposition from some groups, for instance thoracic surgeons, who in the beginning did some vascular surgery but then concentrated on CABG, putting vascular surgery more or less aside. So vascular surgeons – doing carotids, aneurysms, distal bypasses etc – needed their own base. In Norway we applied once and were turned down, second time we were accepted. Denmark was the first country in Scandinavia to establish vascular surgery as a speciality in 1982, then Norway.”
Vascular surgery in Norway
Like most specialties vascular surgery is a subspeciality based on general surgery. One has to become a specialist in general surgery first and then three years of training are required at a recognised centre for vascular surgery. A list of operations must be included in the application to become a specialist. At the moment there is no formal examination. In Norway, most specialties are subspecialties based on general surgery. That includes urology, gastroenterologic surgery, vascular surgery, thoracic surgery and paediatric surgery.
According to Myhre, in Norway the relationship between vascular surgeons and interventional radiologists is “absolutely excellent”. “We are working together on interventions including treatment of aneurysms. On a regular basis we work together with them in the angiography suite and sometimes they come to the operating theatre to assist us with for instance with operations where we use a combination of open and endovascular techniques. I think this combination of skill and experience is a key to success for many endovascular procedures,” said Myhre. “Vascular surgeons should be able to do endovascular procedures – although it is not my intention to say that surgeons should take over routine angioplasty. Having different specialities, we are dependant upon each other.”
“We are already approaching 48 hours in Norway. I have mixed feelings about this. I’m 63, but young people have different priorities to what we had – more time off, more time with the family, less time in hospital – they are probably right. Although there are more doctors coming into the system, the trend is that people are not putting all their efforts and time into the job.
“A recent publication stated that if you do simulated operations – in real operations, operation time is reduced, fewer mistakes are made and you achieve a better dissection.” The challenge is to compensate for the loss of long hours. “As the working hours decrease there will be less operations per individual surgeon. Hands-on courses will be more important in the future. Perhaps this could include training on mechanical models, animal models and on simulators. If you can train a pilot by using a simulator one should be able to train a surgeon to some extent as well. I think endovascular techniques are well suited for these sort of training modalities. We are working with these problems together with our centre for laparoscopic surgery. However, it still creates the problem of patients seeing different surgeons all the time. The most important part of our work is perhaps not only to focus on the vascular lesion, but to get an impression of the patient as an individual and thereafter to find out what is the right therapy for him or her. But then you need experience and intuition, which again to a great extent is based on hard work.”
Myhre summed up by saying, “I am concerned about the 48-hour working week but not pessimistic. I also think that vascular surgeons need rotation in the angiography lab for a certain period. They should be taking part in angiography as well as intervention.”
“As the baby-boom generation grows older, we will have, for instance in Norway, a doubling of the population over 67 years of age by 2050. Also the incidence of diabetes is unfortunately increasing. It seems that people are doing less exercise and that the smoking habits have not changed significantly. Therefore I have a feeling that the need for vascular surgery will not decrease in the near future. I think we must put more effort in prophylaxis to counteract this tendency. The smoking habits among teenagers, especially females, are worrying and I think that one really need some major projects to influence the smoking habits,” said Myhre.
“Perhaps medical treatment will improve in the future. Regarding genetic therapy I think we have a long way to go, but I am convinced minimally invasive techniques will have a dominating role in the future.
“In the long run I have the feeling it will be possible to replace many of the open techniques, as is happening in urology and GI surgery (laparoscopic). There are many reasons for this:
1958, 65–66 Norwegian Army, Degree Captain
Education and Academic Degrees
1964 Graduated at Medical School, University of Oslo
1971 ECFMG examination
1975 Thesis for the Academic Degree “Doctor of Medicine” (PhD) University of Oslo.
“Reactive Hyperemia of the Lower Limbs. Experimental and Clinical Studies”. This was the first thesis from Department of Surgery, Aker Hospital, University of Oslo.
1991–93 Education in medical management, Norwegian Medical Association (MEDLED).
1999 Master degree Arts History
1964–65 Internship Aust–Agder County Hospital, Arendal
1967–73 Resident and fellow, Department of Surgery, Aker Hospital, University of Oslo
1973–76 Senior resident, Department of Vascular Surgery, Aker Hospital, University of Oslo
1976–77 Fellow in cardiovascular surgery and clinical lecturer in surgery, Department of Surgery, Baylor College of Medicine, Texas Medical Center, Houston, Texas
1977–82 Senior consultant surgeon, Department of Vascular Surgery, Aker Hospital, University of Oslo (During work as consultant, Aker Hospital, Myhre also was the leader of the Vascular Laboratory)
1982 Senior resident, Department of Cardiac Surgery, Ullevål Hospital, University of Oslo
Dec 1982 Professor and Chairman, Department of Surgery, University Hospital of Trondheim
1992–93 Professor and Medical Director, University Hospital of Trondheim
1993–96 Professor and Director of Surgery, University Hospital of Trondheim
1996–2000 Professor and Surgeon-in-Chief, Department of Surgery, University Hospital of Trondheim
2001 Professor and Director of Research and Development, University Hospital of Trondheim
2002 Professor of Vascular Surgery, University Hospital of Trondheim
1973 Specialist in general surgery
1982 Specialist in thoracic and cardiovascular surgery
1986 Specialist in vascular surgery
Awards for Scientific Work
1979 His Majesty King Olav V gold medal for scientific work, University of Oslo “Ultrasound as a diagnostic tool in patients with Peripheral Atherosclerosis”
1988 The Nedron Price for best contribution at the annual meeting of the Norwegian Surgical Society (Vascular)
1991 Award for the best scientific contribution at the annual conference of the European Society for Vascular Surgery
1991 The Acrel medal. Swedish Surgical Society
1992 Award for the best scientific contribution at the annual meeting of the Norwegian Surgical Society (Vascular)
1994 Award for the best scientific contribution at the annual meeting of the Norwegian Surgical Society (Vascular)
1994 Distinguised International Visiting Professors Award. Society for Clinical Vascular Surgery, Tucson, Arizona. (Invited speaker)
1996 Award for the best scientific contribution at the annual meeting of the Norwegian Surgical Society (Vascular)
1998 Award for the best scientific contribution at the annual meeting of the Norwegian Society for Vascular Surgery (Vascular)
1997 Award for the best scientific contribution at the second annual meeting of the Scandinavian Association for Vascular Surgery (SAVS)
2001 Honorary member The Norwegian Surgical Society
2002 Award for the best scientific contribution at the annual meeting of the Norwegian Surgical Society (Vascular)
Professional Society Affiliations
Member of the Norwegian Surgical Society (Honorary member since 2001)
Chairman, Section of Vascular Surgery, Scandinavian Surgical Society, 1987–91
Chairman for the Norwegian Board of Vascular Surgery, 1986–93
Active member the European Society for surgical research
Member of the national working group regarding open heart surgery, 1983
Fellow of the Scientific Council of the International College of Angiology
Member of the national registry for trauma and surgical diseases
Member of the national working group for introduction of DRG in Norway 1985–87
Member of the board of Michael E. DeBakey International Surgical Society 1992–98
Member of the Norwegian Council of Cardiovascular Diseases from 1984–92 (member of the working group and the scientific committee
Vice president The Norwegian Society for Thoracic and Vascular Surgery, 1981–84
First president of the European Society for Vascular Surgery 1987–88
Member of the Scandinavian Society for Cerebrovascular Diseases
Member of the European working group on Critical Limb Ischemia 1991–94
Vice-president of the Norwegian Society for Vascular Surgery
Trustee, European Society for Vascular Surgery 1992–2002
Member of Scientific Committee of the International Union of Angiology 1993–
Norwegian delegate International Union of Angiology 1992–2000
Norwegian representative of The Board and Division of Vascular Surgery UEMS 1994–2002
Vice chairman, program for medical technology the Norwegian University of Science and Technology, 1994–99
Member of the research council, Medical Faculty NTNU, 1994–97
Member of Faculty Board, NTNU, 1988–
Member of Court of Examiners, Board of Vascular Surgery, UEMS
Member of the Norwegian Medical Association
Member of the Board SINTEF Unimed, Norway, 1995–
Member of the Board, SMM (The Norwegian Center for Health Technology Assessment) 1997–
Leader of a committee for planning of operating departments. Ministry of Health
Member of “The Royal Norwegian Society of Sciences”, 1994–
Chairman of the Steering Committee for the project “Operating department of the future” since 1998
Leader of project “3D-ultrasound – vascular surgery”, research project between SINTEF Unimed and the University Hospital of Trondheim
Member of the Steering Committee of the Centre for Surgical Intervention, The National Hospital, since 1999
Member of a project on hospital management in cooperation with SINTEF Unimed since 2001