My Story of Pelviscopy

In my life time and more specifically in the 50 years that I have been a physician some monumental events have affected the course of medicine worldwide; antibiotics, blood replacement, the cure for malaria, the Salk polio vaccine, cure for tuberculosis and more recently the DNA key to disease. The story I’m about to relate is my part in a technology that I believe shaped a new surgical approach in medicine to the magnitude of these events. The technical details of this story are necessary for me to relate so the reader can appreciate the magnitude of what followed.
This story starts in 1986 with a trip to Miami where Dr. Tom Benson the director of the OB/GYN residency at Methodist and I the associate director attended the first course held in the United States offered by Dr Kurt Semm from Kiel Germany. It involved teaching a technology he developed that was foreign to American gynecologists. We in the US had embraced laparoscopy for diagnostic purposes since the mid 1950’s. But because of certain limitations in equipment and with the only meaningful surgical procedure being tubal sterilizations, it was not seen as a truly operative procedure. And serious complications began to occur with alarming frequency that made a large number of gynecologists abandon it world wide ……electrocautery bowel injuries. These were produced because the electrocautery used monopolar current which cause burns if a structure was touched between the source and the object (i.e. tubes) due to a short circuit in electrical energy. These burns led to bowel perforation and in some cases death: making the procedure fall into disrepute and abandoned in the USA. In the 1970’s Dr. Richard Kleppinger invented a bipolar forcep that eliminated the danger of bowel injury due to their design. To understand the physics of this development is to understand how electrical current (energy) behaves. Monopolar current travels from the electrode (devise tip) through the body and exits to ground. Whereas, bipolar current is transmitted from one tip of a grasper to the other tip without any chance of shorting the circuit and causing an electrical burn.
The procedure Semm developed he coined the term Pelviscopy to differentiate it from the stigma that Laparoscopy had attached to it.
What Semm proposed was to be able to operate intraabdominally using a scope for visualization and insert multiple operating cannulas in the abdomen whereby instruments could be inserted to perform the tasks of grasping, coagulating, cutting and sewing that mimicked what was done in an open abdominal case (laparotomy). With that capability, he felt that he would not only eliminated the need for a large incision, recovery would be reduced as would post op pain.
His first task, which was his real contribution, was to design the equipment and instruments to achieve his operative goal.
The first thing he invented was an Automatic insufflator that would pump gas on demand to keep the abdomen inflated so multiple puncture sites for instruments could be used. The second thing was what he called an endocoagulator, an instrument that used heat to coagulate instead of electrical current. Thus, sealing off bleeding for hemastasis. Thirdly he constructed a series of instruments that could be inserted through the abdominal wall called cannulas (tubes) to grasp, cut and sew tissue. And lastly, and most importantly he developed a technique of ligating blood vessels ( intracorporeal and extracorporeal knotting) so diseased tissue could be removed. All these steps went to produce an elegant surgical innovation.
You don’t have to be a doctor to see that if this approach to surgery was feasible the impact it would have would be mind boggling. You could literally operate through a key hole and with some refined instruments remove diseased tissue the same way.
The course I attended in Miami was my introduction to this fascinating new approach to what was to be the surgery of the future.
I have always been fascinated by technology and when Benson, my boss, asked me if I saw any value in this in our hospital and residency, I said let me work on how hard it is for me to learn this and teach the basics and go from there as to it’s adaptation. But first I needed to have one of his practice units called a “pelvic trainer” and a few of the basic instruments so I could gain skill in doing the surgical maneuvers on an inanimate model.
He approved my request to purchase the needed equipment and I went to work honing my skill. I also had a group of lower level residents who were required to learn the skill in my lab to the point that we had a good feel for our ability to perform an operation but not on any patient yet.
About 6 months had gone by and I still wanted to feel more secure in doing this on a patient when I was invited to Germany to take a hands on course where I and 24 other doctors from around the world would get to see Semm actually perform Pelviscopy. Since Benson knew I was cautious and wanted to be as knowledgeable as possible he requested the hospital send me to the course.
Going to Germany was a learning experience that led me to developing Pelviscopy at Methodist Hospital and expanding it to the general surgeons, who reluctantly finally embraced it. Today that surgery is called minimally invasive surgery and spans practically every surgical specialty (ie. Hysterectomy, Cholecystectomy, colectomy, nephrectomy, pulmonary, heart, ortho, etc, etc). The story of the learning curve follows.