Connie, Me and Pelviscopy

Because I believed that operating through the laparoscope could be vastly improved on if a camera could be used instead of the eye and the operative field projected on a TV monitor. I still had to figure on a system and out of the blue I remembered that the orthopedic surgeons used a similar system to operate in joints (arthroscopy). So with this idea, I went to my friend Connie and asked to borrow the video equipment orthopedics used. She said “done, no problem”. then while doing a simple case decided to try it out. I inserted the scope hooked up the camera and expected to shout “Eureka” but lo and behold the video screen had no image. To be sure everything was hooked up properly I removed the camera and looked through the scope with my eye and could see a vivid image. I couldn’t figure what was wrong, so it was back to the drawing board as to why it wasn’t working. I knew that light was the key and that I now understood that the delivery system was highly inefficient but I didn’t know where I was losing luminance in my system. Then I realized that I had been using an operative laparoscope which had three channels 1.light fibers 2. a lens 3. an operative channel. The operative channel was reducing the amount of light for delivery in the system and that’s why I couldn’t see. I also figured out that the abdomen was a light sink that absorbed virtually all the light where as in orthopedics joints they were lined with white tissue that reflected light…..so I needed to deliver more light. I remembered that we had a direct view 0 degree scope with just lens and light fibers and damn if I didn’t have an image because it delivered the needed light. I had essentially solved the problem but refining it would take some time at least I was going in the right direction. I had been working to develop this technology for over a year and in a way that was good because it made me cautious about operating on a patient. Another thing was that the instruments had still not been delivered. One reason being they were made in Germany and it was a cottage industry process in which craftsmen constructed the components in their own good time. And I found out later that they took off the whole month of August to vacation.
So I spent my time practicing the manual operative skills, instructing the residents and getting my Pelviscopy team of nurses ready for when we finally could operate. I am an impatient person with performing tasks but am the opposite when it comes to safety and I knew that if I messed up and had a bad outcome there were so many doubters it would set back the project. Communication with some of my course colleagues who had gone to Germany alluded that they were proceeding well in developing this at their institutions, but none had envisioned using the video system which I reasoned was the key to general acceptance of Pelviscopy in the United States.
While I was impatiently waiting for the equipment to arrive, I was honing my technique in the animal lab with a Gyn and General Surgery resident. Here we took out structures, sutured bowel tears and tied off blood vessels becoming so facile that we could do it literally blindfolded.
I don’t want to leave the impression that I was the only person to see the value of doing this surgery with a camera and a monitor. There were some surgeons in France and in the USA who were experimenting with its use.
No one had actually published any papers on it yet. Everything was word of mouth and anecdotal. So I decided to bring in someone to help support my contention of it’s value. An innovative Gynecologist, named Harry Reich, who was doing some similar things on the East Coast and he accepted my invitation to do a Grand Rounds. He was more advanced than I, and had actually done a partial hysterectomy through the scope. I wanted my colleagues to see that what I was trying to introduce wasn’t “smoke and mirrors”. He was a dynamic speaker and when he showed his video and they could actually see that he was able to secure a bleeder that was pumping blood and showed how he systematically clamped and coagulate it, the audience was spell bound and actually applauded the scene on the TV monitor. I felt that was a step toward winning some of them over and I soon was getting call from some asking could I give them a tutorial in the technique so they could be ready when the equipment arrived.
Because the term Pelviscopy sort of indicated a limited use to the pelvis, I started calling it minimally invasive surgery. As I mentioned the Director of the Surgery Residency was interested and the fact that a Cholecystectomy (take out the gall bladder) could be done was a compelling reason to adopt the method.
At last I got a call from Connie that the equipment had arrived and was being sent to biomed to be checked out for safety.
I was like a child awaiting Santa, my toys are in the house but I have to wait to play with them.
Once we had them up in Surgery and inventoried, Connie, the Pelviscopy nurses and I set up a room and I laid out how the instrument table and the cabinet should be arranged and we had a dry run of an operation.
The very first case was an ovarian cyst that was benign on ultrasound making spillage of any fluid an unlikely hazard. Prudence had paid off an everything went well but I found that Semm’s instrument ( the endocoagulator) was awkward and didn’t control bleeding easily.

So from the very beginning I proposed using the Kleppinger Bipolar forceps and they became our very practical and efficient way of hemastasis.
Now that I were operating on a regular basis most of the Gyn doctors wanted to learn the technique. So on top of my teaching duties with the residents, I was named Director of Gyn Surgery Education and set up weekly mini labs so they could learn the basics and then scrub in with me and later I would scrub on their cases.
In the background, some general surgeons were hearing about the possibility of doing cholecystectomies and asked if I could help them do one. Since they didn’t have any equipment and only knew what I had taught their resident they were forced to rely on my expertise.
Since Cholecystectomy is one of the most common operation surgeons do and the post op recovery is long and painful, the idea that this could be a procedure that was basically outpatient and back to work in days rather than weeks……I was in great demand. Not only did they need me to teach them a technique that was foreign to them, there was only one set of equipment in the hospital and it belonged to the OB care center. Even if the Director of Operating Room Services approved purchase of more sets at 50K/set it would take over a year for delivery! I was as it were in the “cat bird seat”.
I was now being courted by several surgical instrument companies who had started marketing trocars, cannulaes ,graspers, scissors and staplers to use their products and later be a consultant for their development of new products. My plate was full and I loved it but the true reward was yet to come.