An Interview with Dr. Diana Gabriela Maldonado Pintado

Dr. Pintado was born in Puebla, Mexico in 1979. At the age of 21, she moved to Mexico City to study Medicine at LaSalle’s University where she embarked on an educational journey that would eventually lead her to become one of the world’s most acclaimed bariatric and robotic surgeons globally.

She completed her residency in General Surgery at Angeles Pedregal Hospital in Mexico City, creating at the end of her residency the first Fellowship in Bariatric Surgery in Mexico, with the official endorsement by LaSalle´s University in 2010. She is an Associate Professor of the “Bariatric and Advanced Gastrointestinal Surgery Fellowship”.

She was also a Staff Surgeon member at the first free government program for bariatric surgery at Ruben Leñero’s Hospital in Mexico City from 2013-17, where more than 2000 procedures have been performed since 2009, as well as active participation in educational activities with fellows and performing innovative bariatric procedures with Professor Andrés Sánchez-Pernaute including the first SADI-S cases in Mexico in 2015 (“single anastomosis duodeno-ileal bypass with sleeve,” a surgical technique to treat severe obesity), and performing RYGB (“Roux-en-Y” gastric bypass, a technique to create a smaller stomach pouch at the top of the stomach), gastric sleeve, OAGB (“one-anastomosis gastric bypass,” a surgery to bypass the small intestine), mini-gastric bypass and revisional bariatric surgery.

Dr. Pintado has a keen interest in robotic bariatric surgery and was the first bariatric surgeon to perform a Robotic 3-arm long BPD limb RYGB at Angeles Pedregal Hospital in 2017 and performed the first Ambulatory Bariclip® Robotic Surgery in 2021. She has participated as faculty in several national and international courses in advanced bariatric surgery and congresses associated with educational organizations such as the IBC, IFSO, ASMBS, CMCOEM, AMCG, AMCE, and SMHAP since 2011.

1. How did you discover your interest in surgery, and later bariatric/robotic surgery?

From an early age, I had a great interest in all physical motor coordination activities. I need to mention that I had the privilege to have a great education from my mother. She was an artist, a professional pianist, concert performer, and teacher of music for children, creating her own method to teach. She was invited internationally to teach her method of teaching and created the first Children´s Chamber Orchestra in Puebla in the early 1980s. She was very active in her multiple jobs and had a great ability to multi-task with a focus on our education, taking us to several classes of dance (ballet, flamenco, Olympic gymnastics), sports (bike, swimming, horse riding, tennis), technical activities (weave, embroidery, design and clothes confection, hairstyling) and of course the Arts (singing, playing violin and piano, solfeggio, painting, drawing, chess, theater).

Also, I was a member of the Scouts for 10 years where I enjoyed camping and learning Morse code……ha-ha. As a young girl, I enjoyed fixing old telephones, toys, machines, and tying knots. In the last year of high school, I selected the topics of Humanism and Medicine to study in detail as I didn’t like Mathematics or Politics.

During medical school I always knew that I would choose a surgical specialty and, in my internship, (returning to Puebla for one year), I had the opportunity to participate in several laparoscopic surgeries with many surgeons, as there were no residents at this time. I helped in the first “Robotic Surgery Course” in the Beneficencia Española of Puebla, where the first robotic arm called AESOP® (Automated Endoscopic System for Optimal Positioning), a voice-activated endoscope, allowing the surgeon to control the camera by their voice. This happened in 2003. This was my first exposure, not just to the surgical field but also to robotic surgery. I am a great believer in the aphorism that “things happen in life for a reason”.

Following this internship, I chose to come back to Mexico City to start my Residency in General Surgery at Angeles Pedregal Hospital, supported by LaSalle´s University where my interest in laparoscopic, robotic, and bariatric surgery was solidified. I learned from many great pioneers and skilled laparoscopic surgeons, and at the end of my residency, I was coached by them to create one of the first one-year official university fellowship programs in bariatric surgery in 2010 in Mexico endorsed by LaSalle´s University. I am now an Associate Professor of this “Bariatric and Advanced Gastrointestinal Surgery Fellowship”, along with my mentors Dr. Armando Castillo González and Dr. Salvador Medina González, both highly acclaimed surgeons based at Angeles Pedregal Hospital. They both were invited in 2015 by the Angeles Group to be certified in robotic surgery in the Hermann Memorial Hospital in Houston, Texas and I had the opportunity to go with them to certify me as docking, and then as a gastrointestinal robotic surgeon. In 2017 I did the certification in robotic bariatric surgery in Colombia with Intuitive Surgical, performing the first Robotic 3-arm long BPD limb RYGB at Angeles Pedregal Hospital on July 6^th, 2017, and performing the first-ever Ambulatory BariClip® Robotic Surgery on August 15^th, 2021 with Dr. Moises Jacobs from Miami, Florida and the Bariclip team in Mexico.

My interest in robotic bariatric surgery stems from the precision of the approach; the surgeons can control the different instruments themselves during the surgery, and there is better coordination between the right and left hand, and also with the hand of the assistant when using the 3^rd arm, which you can control with your foot. The most superior feature of robotics surgery is the great 3D camera vision and avoidance of tremors which happens in conventional laparoscopic surgery. I always tell my fellows that camera control is the most important part of the surgery. I explain even if the best surgeon in the world can´t see well, he can´t progress in the surgery in the correct or worse mistakes go undetected, akin to trying to write on a paper in a moving car; you can do it for sure, but you won’t be able to have the same results as if you are on a stable table and writing slowly and with precision.

All this information for me is very important, as we are offering the best and safest surgeries to our patients, and new technologies are helping us make great advances to facilitate more minimally invasive techniques to offer a faster and better recovery for our patients. Medicine is changing, and I like to be at the forefront of the new technologies which was what my mother encouraged me to do.

2. What is the biggest advancement in robotic surgery that you´ve seen since you began practice?

Over the last 10 years, it is difficult to have a high volume of bariatric patients who can pay for robotic surgery in private hospitals in Mexico given that insurance providers do not cover it. The current leading robotic surgery platform is the DaVinci® platform which is produced by Intuitive Surgical. There are several iterations of this platform including the Single Port (SP) DaVinci®. All of the platforms are expensive but with time the cost of these robots is likely to decrease. I have had plenty of opportunities to work with other robotic surgeons in my private hospital and also, and I have given talks about robotics in bariatric surgery at national and international meetings. One of my most memorable presentations was a talk about the different platforms in robotic surgery. I decided to prepare my talk by visiting Krakow, Poland in 2019 to visit the unit of my friend, Dr. Tomasz Rogula. He is a robotic & bariatric surgeon and President & Founder of the International Bariatric Club. I gained experience in the Senhance® Robotic System (by Transenterix), and in 2020 I visited the headquarters of CMR Surgical based in Cambridge, UK to learn about the Versius® robotic system. I also have attended talks by Dr. Manuel Galvao Neto from Brazil, about “Endo-Robotics”, and I know that they are working with companies to create new robotic endoscopic devices to improve the minimally invasive procedures in our patients. I have also visited the “Center for the Future of Surgery” headed by Professor Santiago Horgan at the University of California San Diego where the team is working daily with companies to develop new technologies.

During the COVID-19 pandemic my friend and Director of the International Bariatric Club Global Education, Dr. Haris Khwaja from England, asked me to give a talk during the IBCOxford Webinars, about “Utilization of the Robot on COVID-19 Wards – Is this Realistic?” I presented several videos about different robots helping patients in the hospital from performing patient observations, to giving patients food and medications as well as facilitating virtual communication from the medical staff with the patient to avoid close contact. Indeed, the pandemics provided the catalyst to big technological advancement including virtual global education. Currently, there are over 20 companies designing new robotic platforms in surgery, and I am sure within a decade robotic surgery will evolve further. In addition, there is also a steady growth in 5G technology globally which will allow safer telesurgery. This may prove to be useful for academic courses with live robotic surgeries performed across time zones, and why not astronauts and space travelers in the long future?

3. With such great leadership roles, such as being Director of IBC Latin America, what skills do you think medical students should focus on if they aspire to similar roles of leadership in their future?

Everybody is different and has different skills, opportunities for training, and academics in their workplace. These opportunities also depend on if one has trained in a public or a private hospital as well as the country's health systems. The best opportunities arise from working with experienced surgeons. I firmly believe one should participate in all the academic activities at local, regional, national, and international where opportunities to lead may arise.

We all learn from each other and the idea of having a leadership role is not just to get a line on your CV, but the most important objective should be to inspire the current and the next generation to do things in the best possible way for our patients using evidence-based surgery. I recommend “listening” more than “talking”, and then you can learn from everybody following which you can formulate your own opinions about an operation or decisions about how to manage your patient. With age, experience grows to make one a better doctor, surgeon, leader, and person.

A good friend told me “Don´t let anyone stop you” – this is the best advice I have ever received. One must have the resilience to be a surgeon and leader with the aim that everything you desire can happen with time if you are constant and focused. Finally, we should always consider the benefits of our knowledge for the patients. This will help ensure better results and makes us better professional which brings more opportunities.

4. What advice would you give aspiring female surgeons?

My advice would be not just for female surgeons, but for all surgeons. One must be very focused on doing the right things every time, work hard to overcome your technical weakness, and exploit your strengths. Always try to help other surgeons keen to learn so they too can become excellent surgeons and inspirational leaders. Hard work is the common thread to success in surgery and there are no shortcuts. I am delighted to see the working culture for female surgeons is changing adding to the diversity in the operating room.

5. What are your thoughts on the balance between being a wife/mom and a surgeon?

In my case I am single and a mom to two wonderful, adopted cats which I love. I have always been and still am very focused on my career. I am still not ready for the idea to become a wife or mom and am still waiting for someone who can share the same passion for our profession and can walk in the future together but with mutual independence, respect and freedom. In my case, I have and still travel a lot because of meetings, surgeries in other cities, and giving talks which makes it difficult to find someone who can understand this lifestyle. With respect to motherhood, priorities will change, and need to coordinate family time with professional activities.

I know a lot of female surgeons my age, some of them have a similar personal life to mine, and others have great families. In both cases, I see them happy and enjoying the path they have chosen. In my opinion, the important thing is to be happy with the lifestyle you have chosen and don´t worry about time. You can do everything you want in life with the correct planning if good decisions are made at the right time. Bariatric surgery in the private sector is very much an elective surgical specialty which is very helpful in terms of coordinating schedules. You always have the option to say “no” when you do not have the time to treat some patient, and then can refer the patient to another surgeon who you trust. It is important to know how to delegate responsibilities to other people and work as a team, consider the team as a family, and also consider your family as another great team.

6. What are your future career goals? Where do you want to go from here?

Currently, I am availing several opportunities in medical tourism in Mexico and new technologies like Bariclip®. I hope to continue my practice at the Angeles Pedregal Hospital in Mexico City, where I have had a long association since 2006. I am currently also working with Dr. Ariel Ortiz Lagardere, the Director of the International Institute of Metabolic Medicine (IIMM) in Tijuana, Mexico. His unit has established a unique collaboration with the University of California San Diego (UCSD). Together with Professor Santiago Horgan at UCSD and the Center for the Future of Surgery (CFS), at UCSD we are working on many academic activities including the new CFS unit at the IIMM in collaboration with the UCSD, UBC, IBC-Oxford Academy & Medtronic. I also hope to spend part of my time helping in the coordination of many different courses that we are planning in my role as the Director of Academics at IIMM, developing bariatric surgery but also minimally invasive surgery, endoscopy, and robotic surgery. I always aspire to develop a new weight loss surgical procedure in the future, or some new discovery, which will help a lot of patients. I do feel with my experience and determination I am getting closer to realizing this aim every day.

 About the Interviewer: Tamilarasy (Tami) Vasanthakumaran - she/hers

Tami has recently graduated with commendation from the Global Clinical Scholars Research Training program at Harvard Medical School. Born and raised in North America to Sri Lankan immigrant parents, her decision to study medicine in India was influenced by a childhood trip to distribute funds she raised for victims of the 2004 Tsunami. Tami aspires to become the first surgeon in her family and work towards overcoming disparities in the field of surgery at a community and global level. She is a member of the Global Surgery Lab (University of British Columbia, Canada) and is a research leader of multiple international projects at the Online Research Club (Nagasaki University, Japan). She currently serves as Associate Resource Development Coordinator in the AWS National Medical Student Committee and is excited to play her part to transcend gender inequities, foster intersectionality, and create an inclusive space among women of all levels in the surgical field around the world.