By the time I completed my General Surgery residency, minimally invasive surgery had become my language. Laparoscopy was no longer something I was learning. It had become the way I thought.
Every operation became an exercise in improving visualization, reducing trauma, accelerating recovery, and challenging traditional surgical thinking. Looking back today, I realize I graduated at exactly the right moment in history. The world of surgery was changing. And another revolution was quietly beginning.
Obesity surgery.
Meeting Mitiku Belachew
Immediately after graduating as the top resident in my General Surgery program, I was invited to attend an advanced bariatric surgery course in Mexico City. It brought together some of the country's leading surgeons who believed that obesity surgery would eventually become one of the most important disciplines in modern medicine.
Among the international faculty was one of the true pioneers of bariatric surgery: Dr. Mitiku Belachew — the visionary behind the original BioEnterics Adjustable Gastric Band, one of the first devices that offered patients a less invasive alternative to traditional bariatric procedures.
At that time, bariatric surgery was almost unknown. Very few surgeons performed it. Even fewer performed it laparoscopically. Most obesity operations around the world were still being performed through large open incisions. During that course we performed fourteen gastric band procedures. Looking back today, those fourteen operations represented much more than surgical cases. They represented the beginning of a new specialty.
A new way of thinking about obesity
I remember being fascinated by the procedure — not because it was simple, but because it challenged everything surgeons believed about obesity. For decades obesity had been viewed primarily as a problem of willpower. Patients were told to eat less, exercise more, try harder. Yet many continued to struggle despite tremendous effort.
The gastric band introduced an entirely different way of thinking. Perhaps obesity was not simply a failure of discipline. Perhaps it was a disease deserving scientific treatment. That idea fascinated me.
I did not choose bariatric surgery because I was searching for obesity. I chose it because I was searching for innovation. Obesity became my mission later.
The patient I did not recognize
The turning point came with my very first bariatric patient. She was an internationally recognized public figure. Out of respect for her privacy, I have never revealed her identity.
Several months after surgery I saw her again. I walked past her without recognizing her. The physical transformation was extraordinary. But what affected me most was not the weight loss. It was the confidence. The health. The happiness. The new life she had regained.
That moment changed me. For the first time I understood that bariatric surgery was not simply another operation. It was one of the few procedures in medicine capable of transforming almost every aspect of a person's life — health, mobility, self-esteem, relationships, longevity, hope.
I remember thinking to myself: this is going to change medicine forever. Years later, that prediction proved correct.
BioEnterics and the early devices
As my experience grew, another opportunity appeared. BioEnterics approached me to become involved with the clinical development of several emerging technologies. Together we helped pioneer the clinical use of the BioEnterics Intragastric Balloon — at a time when placing a gastric balloon endoscopically represented an entirely new concept.
We performed the first several hundred gastric balloon procedures in Mexico. Those early experiences helped establish protocols that would later influence physicians throughout Latin America and beyond.
Innovation continued accelerating. We also became involved in the introduction of adjustable gastric banding, training directly with the engineers and innovators responsible for developing the technology. We performed more than fifty of the earliest gastric band procedures — among the first in the region.
More importantly, we helped standardize the operative technique. Every case taught us something. How to position the band. How to avoid complications. How to improve outcomes. How to make the procedure reproducible. Those lessons later became part of the educational programs we developed for surgeons from around the world.
Teaching across North America
As our experience increased, teaching became an increasingly important part of my career. When the LAP-BAND eventually received approval in the United States, many American surgeons had little or no practical experience with the procedure. By that time we had already accumulated extensive clinical experience. That placed us in a unique position.
Surgeons began traveling to learn from us. Others invited us to travel to their hospitals. Soon I found myself performing live operations and proctoring surgeons throughout the United States and Canada.
Over the following years I trained hundreds of surgeons at institutions including UCLA, the Cleveland Clinic, the University of Pittsburgh, the University of Illinois at Chicago, Lenox Hill Hospital in New York, and numerous other academic and community hospitals across North America. At one point I became one of the youngest traveling bariatric surgeons performing live operations across the United States.
Teaching forced me to refine every movement. Every explanation. Every decision. You cannot teach excellence unless you first understand excellence yourself.
Research as practice
During those same years I presented our growing experience at nearly every major scientific meeting. Every year we returned with larger patient series. Hundreds of patients became thousands. Those presentations included meetings of the American Society for Metabolic and Bariatric Surgery, the American College of Surgeons, and scientific conferences organized by leaders such as Dr. Philip Schauer at the Cleveland Clinic.
Research became inseparable from clinical practice. Every patient became an opportunity to learn. Every innovation became an opportunity to publish. Every publication became an opportunity to improve care around the world.
Looking back today, I realize that the bariatric revolution transformed me as much as I helped transform it. I entered the field searching for innovation. I discovered purpose.