In today's world, we often see a conundrum between glamorous showcasing and the core contribution to the matter. This phenomenon has also found its way into the scientific community due to the intrusion of patent attitudes, overshadowing the core values of deep, dedicated work that brings more satisfaction than fame or recognition.

The importance of nurturing skills from the ground up is undeniable. While outward manifestations of talent (like "flying flowers") may attract attention and appreciation, the foundation of true strength and success lies in the unglamorous task of nourishing the core ("water to the roots"). The initial investment of time, effort, and dedication forms the bedrock of skill development, and it is this solid foundation that results in the most impressive and lasting outcomes, even though they may remain unseen.

When we turn our attention to the field of surgical science, we see new technologies pushing the boundaries, with some aiming to replace traditional gold-standard open approaches. However, real-world data suggests that this is still far from being fully realized.

Here are some key points to ponder as we choose the path of wisdom:

• "Seeing is believing." In complex cases, open surgery provides a direct, unimpeded view that minimally invasive techniques simply cannot replicate. As the saying goes, "The devil is in the details," and open surgery allows for meticulous attention to these intricate aspects.
• This "hands-on" approach is invaluable in identifying subtle abnormalities and assessing the extent of disease. Sometimes, to truly understand the situation, you just need to "get your hands dirty."
• Open surgery "gives all options on the table" and allows surgeons to adapt as needed, rather than being constrained by the limitations of smaller incisions.
• "You have to learn to walk before you can run." The foundational skills of tissue handling, dissection, and hemostasis are best learned through direct, open experience. It is in these moments where surgeons truly "learn the ropes" and develop the judgment necessary for all surgical approaches.
• "Why buy the cow when you can get the milk for free?" In straightforward cases or resource-limited settings, the upfront costs of minimally invasive technology may outweigh its benefits. This reminds us that "one size doesn't fit all." The surgical approach should always be tailored to the individual patient.

We must emphasize that while minimally invasive surgery (such as laparoscopic and robotic techniques) is a remarkable advancement, it’s not a matter of one replacing the other. Rather, it is about understanding when each approach is most appropriate—a true case of "horses for courses."

Recent Case: A recent example of our work involves an open pancreatoduodenectomy after almost a dozen minimally invasive pancreatoduodenectomies for pancreatic cancer. Despite the complex nature of the procedure, the patient was discharged on postoperative day five.