In Memoriam: Prof. Dr. med. Ugo Fisch

3.3.31-12.12.19

Prof. Dr. med. Ugo Fisch (1931 – 2019)

Ugo Fisch

Am 12. Dezember des vergangenen Jahres 2019 ist Prof. Ugo Fisch in seinem Haus in Erlenbach im 89. Lebensjahr verstorben. Damit ist einer der grössten Chirurgen unserer Zeit, ein Pionier der modernen Ohr- und lateralen Schädelbasischirurgie, langjähriger Direktor der ORL-Klinik am USZ und begnadeter Didakt endgültig von uns gegangen.

Nach seiner Gymnasialzeit im Tessin hat sich Ugo Fisch für das Medizinstudium in Zürich entschieden, das er 1958 mit dem Staatsexamen beendete. Nach Abschluss seiner Dissertation zum Thema der Blutgerinnung erhielt er von Prof. Luzius Rüedi – seinem späteren Mentor – an der ORL-Klinik Zürich eine Weiterbildungsstelle. Schon nach 7 Monaten ORL begab sich Ugo Fisch von 1959–1961 in die USA als Research Fellow an das Johns Hopkins Hospital in Baltimore und an die Universität von Chicago. Zunächst lag das wissenschaftliche Interesse in der Kopf-Halschirurgie, dies führte zu seiner Habilitation zum Thema der Lymphographischen Untersuchungen über das zervikale Lymphsystem. Mit Hilfe der Sandoz-Stifung und auf Anraten seines Mentors, Luzius Rüedi wurde der junge Oberarzt Ugo Fisch 1966 nach Los Angeles an die House Ear Clinic geschickt. Fast gleichzeitig weilte der junge Oberarzt in der Neurochirurgie, Gazi Yasargil ebenfalls in den USA, um sich in der Mikrochirurgie der Hirngefässe auszubilden. Zugleich wurde am USZ der junge Privatdozent Anton Valavanis beauftragt, eine Neuro-Radiologie aufzubauen.

Nach Ugo's Rückkehr und weiteren Oberarzttätigkeit nun mit Schwerpunkt in der Ohrchirurgie wurde er 1970 – damals 39 jährig – zum Klinikdirektor und Ordinarius am USZ für die nächsten fast 30 Jahre gewählt.

Ugo Fisch hatte während seines gesamten Berufslebens alle Details der Otologie und der seitlichen Schädelbasischirurgie mit den damals fortschrittlichsten technischen Mitteln studiert. Seine Familie bestätigte denn auch, dass es fast keinen Tag gab, an dem er nicht an Wochenenden oder in den Ferien Zeit verbrachte, um Zeichnungen für seine Bücher oder wissenschaftlichen Arbeiten anzufertigen, über neue Ideen nachzudenken, in der Anatomie neue chirurgische Zugänge zu üben oder von ihm oder seinen Mitarbeitern verfasste Manuskripte zu überarbeiten. Ich selber kann mich gut erinnern, dass meine sorgfältig erstellen Publikationsvorschläge jeweils von seinem Bleistift geschwärzt retourniert wurden.

Seine meistbeachteten Arbeiten betrafen die Behandlung der Schädelbasistumoren. Die dazu notwendige Diagnostik und Vorbehandlung führte er zusammen mit seinem Kollegen und Freund Prof. Anton Valavanis durch. Nächtelang studierte und standardisierte er die Zugänge für Tumoren, die bisher als inoperabel galten.
Im Grenzgebiet mit der Neurochirurgie profitierte er von der Zusammenarbeit und Konkurrenz mit Prof. Gazi Yasargil und optimierte die Zugänge zur mittleren Schädelgrube und dem inneren Gehörgang. Die von Ugo Fisch beschriebenen Techniken publizierte er 1988 im Buch «Microsurgery of the Skull Base»,  neben dem Mittelohrchirurgie-Lehrbuch einem noch heute gültigen Standardwerk. Dadurch erlangte die Zürcher ORL-Klinik Weltruhm, wodurch einerseits zahlreiche Patienten aus aller Welt zugewiesen wurden (sie haben geduldig stundenlang auf die Visite gewartet) und andererseits lernbegierige Fellows aus allen Kontinenten nach Zürich pilgerten.  Ich habe nicht gezählt, wie viele Fotoapparate ich bedienen durfte, da die Gastärzte immer ein Foto mit Ugo zusammen mitnehmen wollten.

Während man sich auf den Chefvisiten keine Fehler bei der Patientenvorstellung erlauben konnte, war die jeweilige Zeit als Privatassistent zeitlich zwar herausfordernd, inhaltlich aber extrem lehrreich. Selber müde nach langen Eingriffen nahm er sich dennoch die Zeit, Röntgenbilder zu beurteilen, Akten zu besprechen und die wartenden Angehörigen in verschiedensten Landessprachen mit grosser Empathie über den Verlauf aufzuklären.

Ein Kreis schloss sich 2015, 48 Jahre nach seinem ersten Besuch in Los Angeles als Ugo den House/Hitselberger Lifetime Achievement Award der American Neurotological Society verliehen bekam. Daneben war er Träger zahlreicher weiterer Medaillen und Auszeichnungen und Mitbegründer der EAONO Europäischen Akademie für Otologie und Neuro-Otologie und wurde auch Ehrenmitglied unserer Gesellschaft.

Weitere Höhepunkte waren die Implantation des schweizweit ersten Cochlea Implantats 1977,  das er zusammen mit den Dr. Thomas Spillmann und Prof. Norbert Dillier entwickelte, und die weltweit erste Implantation eines aktiven Mittelohrimplantates 1996.

Seine unzähligen Operationen hielt er videographisch in 3D fest, damals eine Sensation. Seit 1970 führte er jährlich praktische Ohr-und Schädelbasis-Kurse in der Anatomie durch, die nun von mir und Alex Huber weitergeführt werden. Dort konnten und können weiterhin Jahr für Jahr interessierte Chirurgen seine Zugänge erlernen. Kurz vor der Jahrtausendwende richtete er die Website www.fimf.ch ein und stellte kostenlos eine grosse Anzahl chirurgischer Videos zur Verfügung und diskutierte aktuelle klinische Fälle mit Mitgliedern der FIMF-Familie. Nach seiner aktiven Zeit am USZ schloss er sich Daniel Simmen und Hansruedi Briner an der Hirslandenklinik Zürich an und führte mit mir eine gemeinsame Sprechstunde am Luzerner Kantonsspital durch. Danach betreute er fast täglich zahlreiche Anfragen online aus seinem Heim in Erlenbach oder seinem Landhaus in Südfrankreich.

Er lehrte uns 4 zentrale Bedingungen für die erfolgreiche ärztliche Tätigkeit:

  • die unbegrenzte Passion für die Arbeit
  • eine klar strukturierte und schrittweise Vorgehensweise (there are no shortcuts – es gibt keine Abkürzungen beim Operieren)
  • den Mut, sich auch den schwierigen (chirurgischen) Problemen zu stellen
  • und den Pioniergeist, immer wieder nach neuen Möglichkeiten zu suchen

 

Möge dieser Geist uns für immer inspirieren.

Thomas Linder, Luzern, Switzerland

 

Mourning Professor Ugo Fisch

One of the greatest surgeons of our time, the main founder and mentor of modern otoneurology and lateral skull base microsurgery, the founder of the“International Fisch Microsurgery Foundation(www.FIMF.ch), the winner of the Charles Balance Medal of the British skull base surgery society, Honorary Doctor of the University of Liège (Belgium), Honorary Fellow of the American College of Surgeons, Royal College of Surgeons of England and the Royal Society of Medicine in London. the founding member und former Chairman of the European Academy of Otology & Neuro-Otolgy (EAONO), Honary Member of the Swiss ENT Association (SGORL), Former Director of Otolaryngology-Head and Neck Surgery at the University of Zurich, Professor Ugo Fisch passed away at his home in Erlenbach, Switzerland, on December 12, 2019. Borne on March 3, 1931, he was 88 years old. On December 20, 2019, his family members and former friends held a farewell ceremony at the Protestant church near his hometown.

Professor Ugo Fisch had studied during his entire professional life all the technical details of otology and lateral skull base surgery with the most advanced technical means at that time. His family confirmed that there was almost no single day that he did not spend time on weekends or during vacations to make drawings for this books or papers, thinking of new ideas or reviewing papers written by himself or staff members. Following his residency training under the guidance of Luzius Rüedi in Zürich, he performed research in Baltimore, visited multiple times the House Ear Institute in Los Angeles and worked closely with Prof. Gazi Yasargil, the chairman of neurosurgery in Zürich as well as Prof. Anton Valavanis, the chairman of (interventional) neuroradiology in Zürich to understand and appreciate the difficulties and challenges of advanced otology and how to approach intra- as well as extradural lesions at the skull base, which were previously considered inoperable or did have a high morbidity or even mortality. Inventing the concept of subtotal petrosectomy, in 1967 he resolved the middle ear cleft as a potential danger to the subarachnoid space, as it has been mentioned by Charles Balance at the beginning of last century when dealing with CSF leaks. He also developed new concepts in middle ear surgery, including tympanoplasty techniques, mastoidectomy, stapes surgery and all types of ossiculoplasties and continuously evaluated and published his own results. He has developed and improved more than 30 types of surgical instruments with excellent performance and specially designed for otology and lateral skull base surgery. He worked very closely with the initial dental drill company (BienAir) and continuously improved the drills for temporal bone surgery, he worked with Swiss Airspace companies in the development of surgical microscopes being better balanced, operating tables rolling smoothly with the head at their center and the surgeon’s chair moving with ease by electric and not mechanical force. Initially with Leibinger company and later in close collaboration with Storz and Kurz, he invented the Fisch series of ossicular prosthesis based on the characteristics of acoustic conduction and vibration. It had formed a Fisch Surgical Technique Philosophy with distinct ideas and technical characteristics. He and his team have treated a large number of patients, especially those considered inoperable at that time. Due to its stable surgical results, repeatability and safety, Fisch instruments and prosthesis are still widely used by the otolaryngologists and neurosurgeons worldwide. Some of the technical aspects may change over time with the development of minimal invasive techniques and progress of equipment and instruments related to newer engineering technology. However, these new ideas have to stand the test to outperform the surgical philosophy contained in the Fisch philosophy and techniques and over 300 articles.

Professor Ugo Fisch established the Zurich temporal bone and lateral skull base surgery training courses almost 30 years ago and invented the recording and presentation of 3D clinical and teaching videos at a time when almost no one was interested in 3D for medical purpose. His idea was always to teach in small classes step by step, providing surgeon’s guidelines and manuscripts, books with lots of drawings highlighting every detail and to ensure that the tutors at his courses were enthusiastic sharing their own experience and teaching the younger participants. He personally lectured 25 training courses before he handed them over to Prof. Thomas Linder, one of his scholars.. The colleagues who have participated in the courses were all touched by Professor Fisch's responsible attitude and working enthusiasm for 10 hours in a row. His two main surgery books, 《microsurgery of the skull base》 and 《tympanoplasty, mastoidectomy and stages surgery》, explain the key points of each operation step by step with an amazing accuracy and detailed surgical drawings. In 1998, he established the website www.fimf.ch and posted a large number of anatomical and clinical surgical videos free of charge and discussed current clinical cases with members of the FIMF family. Thousands of doctors from all over the world have received direct guidance from Professor Fisch, either during his active time at the University of Zürich, later in Luzern or by providing an ongoing 3 months training fellowship in Luzern since 2005. At the same time, FIMF training branches have been established in China, Brazil, the United States, South Africa and other countries. All these efforts have greatly reduced the learning difficulties, making the Fisch Surgical Technique System a technology that can be mastered and repeated by ordinary doctors, irrespective if they provide surgeries in well developed or poorly equipped third world countries throughout the world
Professor Fisch had a very noble and determined personality, which enabled him to gather the best equipment resources at that time, organize the best surgical team including residents and fellows, anesthesiologists, nurses, engineers and researchers at the University of Zurich, unite his colleagues in the Neurosurgery and Neuroradiology departments such as Prof. Yasragil and Prof. Valavanis to carry out multi-disciplinary cooperation or to define the proper responsibilities between the temporal bone surgeon and neurosurgeon in an effort to provide the best treatment to all patients at the University of Zurich hospital. Since 1970, Professor Fisch has been the director of Otolaryngology Department of University of Zurich hospital for 30 years; in 1970, the first European annual conference on internal auditory tract microsurgery, led by Ugo Fisch and participated by William house, was held in Zurich. In 1988, the first International congress of skull base microsurgery was held in Zurich and Ugo Fisch, M. Gazi Yasargil and Anton Valavanis established the International Skull Base Association. After his retirement from the University he joined Prof. Daniel Simmen and Hansruedi Briner at the Hirslanden-Center in Zürich and also collaborated with Prof. Thomas Linder in Luzern seeking to help patients for many more years. Professor Fisch's outstanding work made the University of Zurich the center of neuro-otology and skull base surgery in the world at that time and the current Chairman, Prof. Alexander Huber is one of his previous student’s as there are many more chairpersons worldwide who had engaged with Prof. Fisch during his active time. A large number of colleagues and even patients contacted with him still after his retirement, asked for advice and were impressed by his fast and serious reply to every email. This habit has been maintained until one month before his death.

Professor Fisch was always very friendly to Chinese surgeons. Since the first Chinese fellows, Dr. Jincheng Zhao and Zhengmin Wang went to Zürich in the 1980s, many more Chinese otologists came to study in Zurich and Luzern supported by the FIMF foundation. Most of them have grown up to be the backbone of otology and skull surgery in China. Professor Fisch and his successor, Prof. Thomas Linder, have also visited China many times. Up to now, many universities and hospitals in China have maintained good cooperative relations with Zurich University and Luzern state hospital. FIMF has established many training centers in Shanghai, Jinan, Beijing, Weifang, Shenzhen and other places. In 2014, Professor Fisch was announced as an honorary professor of Peking Union Medical College, Chinese Academy of Medical Sciences.

Professor Ugo Fisch's death is a great loss to the world's otoneurology and skull base surgery circle. We have lost a great mentor, sincere colleagues and dear friend. Doctors and academic organizations around the world have spontaneously organized various forms of memorial activities. His great achievements and noble personality are always worthy of our remembrance and always inspire us to meditate on the subject, perfect the surgical techniques and care for patients.

Professor Ugo Fisch's spirit lasts forever!


Edited by Guodong Feng, Peking, China and Thomas Linder, Luzern, Switzerland