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The First Laparoscopic Standard BPD: A Lesson in Leadership

Francesco Saverio Papadia recalls that, after the 1999 Naples Symposium, in 2000, Scopinaro led the
effort to develop the laparoscopic technique for the standard BPD. He was the first surgeon in those
early cases, with the Genoa team, Giuseppe Marinari, Giovanni Camerini, and Papadia, working
alongside him. The initial attempts were difficult; during the first two or three procedures, despite
Scopinaro’s leadership, the team was forced to convert to open laparotomy because of technical
challenges.
At that time, Professor Scopinaro left for the annual meeting of the American Society for Bariatric
Surgery (ASBS). The three younger surgeons, however, operated on the remaining candidate patient
and succeeded in performing the first complete laparoscopic standard BPD in the world. In almost
any surgical department, a chief who finds that his assistants have performed a major, high-risk
innovation in his absence would be furious. Papadia and his colleagues were trepidant, anxious,
expecting a lavata di capo (severe reprimand). When they called Scopinaro to deliver the news, he
was not angry. Instead, he took the podium at the ASBS meeting and announced –not that he had
done it— but that his collaborators had performed the world’s first laparoscopic standard BPD, giving
full credit to Marinari, Camerini, and Papadia. He celebrated their success as if it were his own,
because in his mind it was the success of the team and the success of the field.
For Papadia, that moment was unforgettable. He had seen Scopinaro’s courage in the face of a
broken parachute and his calmness under surgical pressure, but this was something else: a grandeur
of spirit that put the glory of the team above his own ego: a true leader.

Beyond Obesity: Metabolic Surgery for Type 2 Diabetes

Even as the BPD was proving its power in severe obesity, Scopinaro and his team had noticed early
on (as early as 1986) something extraordinary. Patients with T2D who underwent BPD became
normoglycemic within days, long before any significant weight loss. Something was happening that
could not be explained by restriction or malabsorption alone.

Scopinaro’s group systematically studied this effect. They showed that BPD could achieve remission
of T2D in nearly 90% of patients, and that the effect persisted for decades. Moreover, they
demonstrated in a series of landmark papers from 2005–2014 that BPD could resolve diabetes even
in patients with a BMI < 35 kg/m² and even in those with a BMI of 25-30 kg/m², patients with
overweight, not obesity [3]. This was heretical at the time; T2D was supposed to be managed with
drugs, not surgery. Scopinaro’s work laid the foundation for the concept of MBS as a primary
treatment for T2D, later validated by randomized controlled trials, such as the Surgical Treatment and
Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial (Schauer et al, 2012). In
recognition of this contribution, Scopinaro received the ASBS Foundation’s Outstanding
Achievement Award in 2006 and he was invited to lecture at the world’s most prestigious institutions.

A Polyhedric Personality: The Man Behind the Surgeon

Nicola Scopinaro was not only a great surgeon but a man of extraordinary range. He spoke fluent
English and French. His classical education gave him a lifelong command of Italian literary culture;
he could recite Dante and the Latin classics from memory. He was a competitive parachutist, winning
six Italian championships and a world championship medal. In 1977, his parachutes malfunctioned,
and he fell at nearly 100 km/h. While falling, he did not scream or look up – the surest way to die, he
said. Instead, he thought about how to distribute the impact across his legs and pelvis to protect his
internal organs. He survived with 13 fractures, but no injury to his abdomen, heart, or lungs.

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