Good evening.

Mr. President of the Asociación Médica Argentina, Dr. Miguel Galmés, Mr. President of the Asociación Argentina de Cirugía, Dr. Luis Sarotto, Members of the Academia, ladies and gentlemen,

It is a great honor and an enormous responsibility to have been elected president of such a prestigious institution as the Academia Argentina de Cirugía by my peers, and I am deeply grateful for this nomination.

This academy was created almost 112 years ago at a very particular historical moment in our country (a rich and migrant-receiving country). Buenos Aires was a thriving, cosmopolitan city with important medical advances. It was in this context that a group of surgeons, led by Dr. Daniel Cranwell, gathered at his home to found the Sociedad de Cirugía de Buenos Aires, the first association of surgeons in Argentina. Later, in 1939, it became Academia Argentina de Cirugía, following the guidelines of the French Academy of Surgery. However, for political reasons, it was forced to return to its original name in 1954, and it was not until 1969 that it took on its current name.

Personally, I had the privilege of knowing this Academia in 1981, when I attended the annual surgery course that included attendance to its sessions. I was impressed by the clarity of the concepts presented by the members and the quality of the discussions. I found it extremely interesting to listen to the outstanding and renowned surgeons of our country presenting their research and receiving feedback from their peers.

At that time, I used to ask my colleagues how they had come to occupy a place in the Academia, and the answers were diverse: “an academic life”, “heads of Department”, “those who have made fundamental contributions to surgery”, among others. I was very interested in attending the sessions to keep up to date with the advances and state-of-the-art in surgery especially because, at the end of my residency program at the Hospital Italiano de Buenos Aires, I practiced all the subspecialties of General Surgery.

Thanks to the invitation of Dr. Eduardo de Santibañes, I also participated in experimental projects such as pancreas and liver transplantation after completing my residency in General Surgery. I never imagined that I would ever occupy one of the seats reserved for academics, and even less so the seat I now occupy as president. This is a great responsibility and a challenge that I hope to fulfill with humility and dedication. I applied to join the Academia after many years as a surgeon and at the suggestion of my boss and friend, Dr. Eduardo de Santibañes, when I focused on a subspecialty defined as Hepatobiliary and Pancreatic Surgery and Liver Transplantation.

I have experienced most of the many and varied changes that have taken place over the last 40-50 years. Surgeons have moved from being the figures who, with their intervention, determined what could be done to help a patient, relying on few diagnostic elements and a surgical box, when surgical skill was understood as the necessary abilities to approach, resect and reconstruct with the least possible harm. Therefore, the role of surgeons as technicians was fundamental and this is how they were perceived by their patients: as “superior beings” in whom they placed all their faith. Nowadays, surgeons have the obligation (even if the law does not consider it so) to obtain optimal results, and if they do not, they will be questioned. Today, achieving good results not only depends on their skills, but also on their judgment, which is supported by diagnoses accurately made and increasingly dependent on technology, which has greatly contributed to the progress in the diagnosis and treatment of different diseases and has become an irreplaceable element to perform today’s complex procedures, which were not conceivable 45 years ago. In addition, surgeons work as a team with an endless number of connected specialties, which has led us to specialize or super-specialize in some areas of surgery, leaving aside others to such an extent that the specialist eventually becomes unfamiliar with them. Therefore, skill is still important for surgeons, but its reasonableness is far more important.

I would like to acknowledge that anesthesiology has undoubtedly been one of the fields with the greatest advances and thanks to which we can now perform highly complex and long-lasting surgical procedures.

With the advances that are already being developed in interventional procedures, robotic surgery and artificial intelligence, surgeons’ interventions are more uniform and lose their individuality, thus bringing us closer to what has been called the “democratization of surgery”. This would result in equal and optimal outcomes for all patients, which is a very laudable goal, but at what cost? If this continues to be for an exclusive group of patients who can access this benefit, we are not fulfilling the role public health should play with the entire population. And since I am getting into this field, I will go back to my beginnings as an attendee to the Academia meetings, where I noticed that the papers that were read corresponded almost exclusively to public hospitals, mostly from the city of Buenos Aires, while those that were not from that setting were almost exceptional. My teacher and Head of Department, Dr. Beverraggi, who along with other staff physicians at the HI were regular attendees and members of the Academia, was extremely pleased and happy each time a paper from his department was presented.

We have witnessed a paradigm shift over the past 40 years. During the years of my professional practice, I have noticed that the State has neglected its fundamental responsibility in the education, defense, and health of the population, or has poorly done so. In particular, the healthcare system has been affected by the lack of clear policies and by politicization of public hospitals, leading to delays in adopting technological advances and innovations in this field. As a result, there have been unexplained inequalities in the access to medical procedures, with some patients facing long waits for basic treatments, while others can receive complex procedures, such as transplants.

Evidently, in recent decades our country has deteriorated in all aspects, and medical institutions have not been the exception. Although its members have made efforts to avoid this, the examples are vertical, and the general behavior of society makes these isolated efforts insufficient. Unfortunately, we have got used to copying what happens in other countries and we often do it with delay. However, we should recall that, in the last century, some of the most important Nobel Prizes were awarded to Argentine scientists, as Bernardo Houssay in 1947, Luis Federico Leloir in Chemistry in 1970, and César Milstein in 1984, who, unlike the previous ones, developed his research in the United Kingdom.

The surrounding reality is not strange to us, and we know that the lower number of attendees to the sessions has worsened over the years. My predecessors in the presidency have extensively referred to the reasons for this lower participation, including super specialization, lack of motivation of young people, ease of access to information and medical updates, as well as the location of venue in a critical area of the city with traffic problems for the last few years. Although the Bylaw modifications introduced have been useful in maintaining attendance, the pandemic and the restrictions imposed resulted in closing face-to-face sessions. I thank the authorities that preceded me for enabling online sessions to continue with the activities of the Academia and thus achieve greater participation while maintaining the quality. As Albert Einstein stated: “In times of crisis, only imagination is more important than knowledge.”

I have not mentioned anything about leadership in my presentation, because so much has been said in congresses and conferences lately that I would find it redundant, but I do want to mention another quote from Albert Einstein in this regard: “Setting an example is not the main thing in influencing others; it is the only thing.” To begin this year’s sessions, the Board of Directors has considered holding hybrid sessions (face-to-face and online), which would seem to be the ideal situation. However, a new drawback arises: the difficulty in financing this modality, which is much more expensive than either online or face-to-face sessions. In addition, nowadays the economic resources of the Academia are almost exclusively made up of membership dues which are not enough to cover all the seats and becomes a serious inconvenience for the present and future.

But, as the Austrian storyteller and playwright (and physician) Arthur Schnitzler stated: “Being prepared is important, knowing how to wait is even more important, but seizing the right moment is the key to life.” Therefore, we should try to further encourage communication with surgeons in general. We will try to continue with hybrid sessions, depending on the attendance and the possibility of funding; moreover, we will emphasize the dissemination of our activities through the different social networks. Artificial intelligence, which is making rapid progress, will also be a tool to be considered to incorporate its possibilities into the activities of the Academia. Finally, we will work on genuine sources of funding that do not depend on occasional donations.

This year I will be accompanied in the Board of Directors by Dr. Jorge Latif, as Vice-president; Manuel Montesinos will continue to be Secretary General; Marcelo Lenz Virreira, Annual Secretary; Irene Altuna, Treasurer; Carlos Vaccaro, Director of Publishing and Press; Fernando Iudica, Director of Library and Archives; and Emilio Quiñonez and Hugo Zandalazini, Board Members.

First, I want to thank my parents first for giving me life and teaching me the value of effort and work: from my father I inherited my vocation. I would also like to thank all the surgeons at the Hospital Italiano where I was trained and worked, since they were a guide in my first years as a surgeon, always present for consultation; to Dr. Enrique Beveraggi and Dr. Eduardo de Santibañes; to my partner as resident and chief, and friend, Dr. Demetrio Cavadas; to those who dared follow me in the adventure to Hospital El Cruce, Dr. Emilio Quiñonez, Dr. Marcelo Lenz Virreira and Dr. Magalí Chahdi Beltrame; to the former and current residents who encourage me in this activity and, finally, to my wife, children and siblings.

Thank you all for your attention and trust. I am sure that together we can overcome any difficulties and continue advancing the academic and scientific excellence of our Institution.