Preface：There is a saying by a western wise man: Knowledge assembles a circle; those you have known stay in the circle and the unknown outside the circle. As you attain more knowledge, the unknown grows bigger.

Accumulating experience in the field of spine triggers more and more difficulties, which had aroused my eager to study at the most outstanding hospitals. Thanks to Gloryren, I eventually had the opportunity to be a visiting doctor at Orthopedics Department of Sch?n Klinik München Harlaching in Germany after communicating with the hospital for several times. From October 2018 to November 2018, I spent six enjoyable weeks at the hospital.

I set off from Hongkong on a non-stop flight of Lufthansa. After 12 hours flight, I finally arrived in Munich. Since it was my first visit to Germany, I had a little concern. But Gloryren had already planned out my accommodation and the route. Therefore, after going through complex traffic in Munich, I succeeded in getting to where I would stay. This emboldened me with no doubt.

The next morning, I showed up at the hospital. The secretary of spine department gave a detailed introduction on some do’s and don’ts and asked a doctor to show me around. In such delightful atmosphere I began my study which I looked forward for a long time. Due to privacy protection, photos of any information of the patients in the operating room are prohibited.

Impression of Munich

Munich is the capital of the federal state of Bavaria. With a population of more than one million, it is the third-largest city of Germany. It is one of the major centers of economy, culture, technology and traffic. Straddling the banks of the River Isar (a tributary of the Danube) north of the Bavarian Alps, it is the seat of the Bavarian administrative region of Upper Bavaria. It is characterized by continental climate and large temperature difference between day and night. Munich has one of the largest  city public traffic system, including U-Bahn, S-Bahn, Trambahn and bus. Munich is divided into 16 rings according to the region. Within the 3 ring, it is called the inner zone of Munich. It is the main working and business district in Munich, and it is also the area with most attractions. There are many public transportation systems. The hospital and my place of accommodation were located in the inner zone, so it was convenient to go to the hospital every day.

The hospital doesn’t work at weekend, so I could visit places of interest in my spare time. The environment in Germany is quite beautiful. No matter it was a walk in a city garden, or a visit to the outskirt of the city, I would be surprised and impressed by the environmental protection. Every sight could capture a colorful picture.

Sch?n Klinik München Harlaching

Sch?n Klinik München Harlaching is the largest orthopedics hospital in Germany, with focus on orthopedics, neurology and physical rehabilitation. The hospital has the FIFA Medical Center of Excellence, the designated orthopedic treatment center for Bayern State football players and Olympic athletes, and the official center of the AOSpine Association of Spinal Surgery. It is one of the best and most authoritative orthopedic diseases centers in Germany and the world. The most famous fields of the hospital are spine surgery, foot and ankle surgery, and sports medicine.

The environment of the hospital is very beautiful. It looks like a garden. The hospital has two entrances. One is for emergency department and the other is for outpatient department

Overview of the hospital (photo from the website of Sch?n Klinik München Harlaching)

Outpatient department and inpatient building

Emergency department

Garden inside the hospital

The design of the entire hospital deeply reflects humanistic care. In addition to the comfortable and spacious medical environment,  small details of each corner fully reflect people-oriented concept. Like the clinic below, the doorway of the room opens in the direction of the corridor, and the corridor is marked to remind people of the position to avoid accidental collisions. Although this is a very simple design, it is very practical.

Spine surgery department

There are 4 operating rooms in the spine surgery department with more than 10 operations per day and beyond 3,000 operations per year. Lumbar spine surgery accounts for about 70% of all surgery, most of which are done under microscope or spinal endoscope. All open surgery requiring spinal decompression is performed under a microscope, thus maximizing the safety of decompression.

Currently there are 4 directors in spine surgery department, and each director has his own strengths. The most famous one is Professor Mayer. If you are interested in him, you can search for his resume. He is almost the earliest to start a spine surgery with a microscope. He has always emphasized the importance of minimally invasive treatment, and he is the one who invented  Mini-ALIF surgery, which reduces the trauma of anterior surgery to the minimum. Professor Mayer is very kind. He would tell us the detailed information of the patient, the surgical strategy and important points of the operation when he performed the operation. Other professors and surgeons are very friendly. They would introduce surgical plans of that day in detail and show the details of the surgery. You could always ask questions during the operation, and you would usually get patient answers. If there were special circumstances during the operation, they would offer an analysis of the cause and corresponding treatment, and at the same time summarize the measures to prevent such situations, and carefully answer our questions.

Photo with Prof. Mayer

Photo with Prof. Mehren

A workman must sharpen his tools if he wants to get things done well. During the stay I could finally have a better understanding of advanced equipment and all range of tools. In addition to a fixed Zeiss microscope, C-arm, etc., each room has a variety of automatic hooks, etc., which not only demands less operators, but also reduces the chance of human error.

In addition to advanced tools, there are also some small items that are very practical. For example, the following mask, which has a thin layer of sponge on the upper end, is of great significance to people wearing glasses like me, and your glasses won’t blur after wearing the mask. From this detail, you can realize that they are striving for perfection in all aspects of surgery.

Here, the spine surgery is usually completed by two surgeons. When anesthesia starts, the surgeons have already waited in the operating room. The position of patients is directly placed by the surgeon. Even Prof. Mayer does the same, because the assistant surgeons are often an intern or a surgeon from other departments. Usually they do not have much experience in this area. An operation is mostly done by the surgeons directly. Assistant surgeons have little effect on the operation. This is somewhat different from the domestic situation.

During the study here, through deep communication with German spine surgeons, I’ve learned their rigorous clinical thinking, minimally invasive and precise way of treatment, and surgical techniques which pursue higher standard. This tour enabled me to have a better understanding of Germans’ highly rigorous and practical spirit of work and humanistic and geographical knowledge of Germany. I’ve gained a lot while my knowledge and horizons were being broadened here.

In the end, I would like to express my appreciation to Gloryren for providing me with such a precious study opportunity.