SURGICAL PERSPECTIVE Music and Surgery: A Literary Reappraisal Demetrios Moris, MD, Spiridon Vernadakis, MD, PhD, FEBS, Dimitrios Linos, MD, PhD, FACS Music’s the medicine of the mind. dJohn A Logan This quote encapsulates our personal thinking about music. Music is an art whose medium is sound and silence. As surgeons and musicians, it is intriguing for us to investigate the possible correlation and “osmosis” between music and surgery and the contribution to the mental and scientific aspects of the surgeon’s personality. HISTORY The involvement of music in medicine dates back to the 6th century, when Greek philosopher Pythagoras described music as contributing to the natural harmony of the mind and body. In 1914, intraoperative music was provided to ameliorate the anxiety and fear of patients before a surgical operation. 1 Many personalities are known to be both musicians and physicians, with Auenbrugger and Laennec providing brilliant examples. Theodor Billroth, who laid the foun- dation for modern abdominal surgery with his pioneering operations, was also an excellent musician. 1,2 THE SURGEON AND THE MUSICIAN: A MATTER OF MIND Playing a musical instrument is a complex activity that requires the coordination and development of many cognitive skills, such as the translation of virtually perceived musical stimuli (notes) into appropriate and precise movements, leading to an acceptable auditory result. Musical performance involves several brain areas, including the motor, sensory, and auditory cortices, the anterior portion of the corpus callosum, and the cere- bellum. 3 The latter is of great importance because it con- tributes to coordination, precision, and accurate timing of movement by receiving input from sensory systems in the brain and spinal cord and integrating them to fine tune motor activity. Accessory areas in the inferior frontal area (music reading), the inferior temporal cortex (vol- ume), and the superior parietal area (rhythm) are also involved. 3 Research on musicians’ brains revealed struc- tural and functional brain specializations when compared with nonmusicians. 2,4,5 Playing music and performing surgery appear to have several cognitive skills in common, including accuracy in the translation of motor command to performance; integration and effective interaction of multimodal sen- sory and motor information; synchronization and coordi- nation between eye and hand; spatial visualization and adaptation for space, time, and rhythm; low reaction time; and efficient mental vigilance. Therefore, it is not completely biased and medically absurd to consider that musicians and surgeons might have some brain specializa- tions in common, and that experience in playing music can help in performing surgery. It is important to emphasize the role of mental prac- tice, a common way of practicing for musicians, in sur- gery. This “mental preconditioning’’ has been found to facilitate skill-learning procedure and performance. 6 It has been demonstrated that a performer who practices a skill, such as playing a musical instrument, using mental imagery in advance, will perform, on average, at least half a standard deviation better than someone who does not use mental imagery. 6 This is attributed to the fact that mental imagery activates neural trails similar to those used in the actual performance of a given skill. 6,7 This effect is commonly used by surgeons in their preparation for a case. By mentally practicing the surgical task before- hand, surgeons might need to spend less time physically present in the simulation laboratory, as they flatten their learning curve faster using the described kind of “mental simulation center’’ in their brains. 7 THE SURGEON AND THE MUSICIAN: THE METAPHOR Considering this relationship figuratively, we should ima- gine a tripartite concept of the art entirety, including the artist, the masterpiece, and the aim of the latter. In music, the artist is the musician/performer or orchestra leader, the masterpiece is the interpretation or the composition, and the aim is to “heal” the listener to keep his “mental homeostasis.” In surgery, the artist is the surgeon, the masterpiece is the operation, and the aim is to treat the patient to keep his physical homeostasis. To perform music or surgery, there are many principles that should be met to achieve their aims. First, both Disclosure Information: Nothing to disclose. Received March 10, 2014; Accepted March 18, 2014. From the Athens School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. Correspondence address: Demetrios Moris, MD, Athens School of Medicine, National and Kapodistrian University of Athens, Anastasiou Gennadiou 56, 11474 Athens, Greece. email: dimmoris@yahoo.com 1 ª 2014 by the American College of Surgeons ISSN 1072-7515/14/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jamcollsurg.2014.03.025