The Keyhole Opens the Door

The next set of events I have concluded were the most satisfying achievements of my 50 year career in medicine, and one of the reasons I am writing this chronicle. But also that my children and grandchildren can appreciate what contributions I made with my knowledge and inventiveness to further medical science.
For obvious reasons, Gynecological applications were not driving manufacturers to enthusiastically develop the technical equipment to expand Pelviscopy. So when I was at a tactical brain storming gathering at US Surgical Corp in 1989. the many applications that I foresaw were not appreciated by most of the other participants, especially the company’s CEO. When it became the common mode of taking out 98% of all gall bladders, the whole industry was literally falling over each other trying to out develop and market equipment.
One interesting thing happened with a major orthopedic manufacturer, I asked them since they made video equipment, would they be interested in helping me start a division to capture the market that was out there and be a major player in this new approach to surgery. They responded that they were comfortable in their present position. Over 15 years have transpired and they are now Johnny come lately, but now they finally have a minimally invasive division.
I realized that the key for this revolutionary surgery to catch on was not going to be driven by it’s unique applications that reduced pain, shortened hospital stay and speeded recovery. It was that the inroads other modalities had for treating gall bladder disease had made a deep hit on the general surgeons pocket book but lapcholes could now provide them with a surgical procedure that cured the condition permanently. And for that reason, there was a frenetic amount of interest to learn the procedure and a tidal wave of surgeons wanting in line. So courses were being taught by gynecologist, who were proficient in laparoscopy teaching the rudiments to the surgeons.
I was approached by one of the leading general surgeons on the Methodist staff and asked if I would teach him how to perform what was being called a “laparoscopic Cholecystectomy”. He had gone to a work shop in Georgia to learn the rudiments. And the course was recommending that a laser was needed to do the procedure. I was skilled in all the applicable surgical lasers
and questioned that need. He had recruited an ideal young thin male patient to do the first procedure on. This case was done in 1990 and it took us roughly 6 hours to perform. The lengthy operating time was mostly due to he having no proficiency in using the instruments or operating with me.
I later concluded that if he had practice on my trainer and learned the basics of working in concert, we probably would have done the case in about 2 hours; but after working together on 4 or 5 cases, we had reduced the operating time to under an hour. By the end of his first year he had personally performed 700+ cases usually a busy surgeon might so 20 open cases in a year! ( also bought a vacation house in Florida ).
Because he had the foresight to see the impact this was going to have on surgery he asked me to collaborate with him in setting up a course to teach the technique to interested doctors at our hospital and around the Midwest.
We set up a series of courses approved by out Medical Education Dept. for CME accreditation and proceeded to teach over 100 attendees.
Spanning the years 1990-1992, he and I acted as instructors for courses that were taught across the Eastern US to surgeons who were signing up in droves. These courses provided didactics and pigs as models to operate on because their gallbladders were similar to humans. The interesting thing about the course was an operating room was set up in the most unlikely places…… convention centers, hotel auditoriums even a school gym.
The pig lab was developed by a veterinarian who had contracted with pig farms across the country who raised animals to his specs and he had a 18 wheeler that was decked out with a corral and a prep area to anesthetize the animals. Once at a course site he would pull into the loading area and transport the pigs asleep in special containers to the area where the operating tables were set up. There could be other functions going on in the venue and no one knew that an animal lab (no odors or squeals) was being held. He was good and all this was under government approval and supervision.
One of the last courses we taught was for the NMA in 1992 when they met in Indianapolis. There we provided the only dedicated course to their surgical section at a significant reduction in cost since all the instructors donated their expertise as a favor to me for teaching them.
With all the surgeons now trained at Methodist, there was not enough equipment to do the surgery. The Director of OR Services ended up buying 7 sets at 50K to provide for the rapidly expanded income source where as 2 years before I couldn’t get any support.
There is one thing I taught every student or course participant; have a plan so you do not have to convert the case to a laparotomy (open case). We emphasized know the equipment and learn how to suture and use the bipolar forceps for bleeding. Now anyone in the country that uses these techniques I know was trained by some one that I trained. That is one of the indelible marks I left on the general surgeons that had some degree of connection with me.
I tried to show that the keyhole opened the door to a myriad of surgical procedures that now include the brain, heart, lung, colon, bladder, prostate spine it goes on and on. I hope that I passed Herr Dr Semm’s torch diligently. The one thing that he inspired in me was to peak my curiosity to challenged his concepts and seeking out what I didn’t understand about light. And when I solved the problem, I opened a whole new
minimally invasive method of doing surgery.