The Road to success in Pelviscopy

The path I had to take to be able to successfully get Pelviscopy established at Methodist Hospital in Indianapolis was difficult and convoluted.
Once I reported my experiences in Germany to Benson, my boss, he asked what were my thoughts on incorporating it’s use in our institution. I told him frankly that I didn’t understand how to solve some of the limitation it presented to teaching American doctors; but I had a plan if I could somehow purchase the needed equipment and develop a teaching model it might be doable.
Because the initial investment for the basic equipment was around $40,000 dollars, I knew that going to the hospital for funding a major expenditure in their budget was slim to none. But fortunately Benson was Chairman of the Ob section and Director of the OB/Gyn residency program and had proposed that the OB/GYN clinic be incorporated calling it the OB care center (OBCC) and that the OBCC be run like a private practice removing the stigma to the patients of attending a “clinic”. In the past the clinic ran at a $200,000 loss to the hospital and he proposed that the hospital turn it over to the OBCC and allow it to keep all income and be self sustaining. The hospital readily agreed to relieving itself of it’s loss.The genius of the plan was that he had a corporation formed of the 26 attending OB/GYNs who agreed to allow the OBCC to bill for their physician service which were being lost due to some physicians keeping the insurance payments which they now allowed the OBCC to collect. This concept was unique and I don’t know of any other OB program in the country that used this paradigm. What it essentially did was to have a clinic that functioned like a private office with the residents participating in the business side of practice and the income after expenses were than available for equipment, resident education, stipends and conferences eliminating the usual red tape.
Because the hospital was not involved in appropriating the money any expenditures were voted on and approved by the OBCC board of directors. By this mechanism, I was able to secure funds for developing Pelviscopy.
Even though Benson was totally supportive, I still had to sell the concept to the board. And because there was a group in opposition the vote to support me and buy the equipment was 14 to 12 in my favor to buy the equipment. ……..at times facing adversity goes a long way in helping one achieve a goal.
Having the funds to purchase equipment was not even half the task of instituting Pelviscopy, I first had to convince a doubting staff of the perceived benefits of the technology.
I did a grand rounds on what Pelviscopy was as apposed to laparoscopy and what surgical benefits it provided and what I saw was it’s potential in the future.
One of the attendees to my lecture was the Director of the General Surgery residency program and he asked me later was there any surgery applications where this could be used. I told him that I had heard that some surgeons in France had successfully taken out a gall bladder through the scope. Because of his interest and support, I approached the IRB ( institutional research board ) to approve some animal studies to perfect the procedures. We still had no instruments and I had not done any surgery on a single patient. I got approval to set up an animal lab using pigs and my practice instruments and an old laparoscopy set borrowed from surgery.
Working with one of my gyn resident and one of the surgery residents started to practice doing some surgical procedures. Here we were able to refine our suturing and tissue manipulating skills.
To give you an idea of how Pelviscopy differed from laparoscopy, you have to understand what Semm contribution did to expand the
capabilities. To understand what he did was to transfer what is done in a laparotomy ( open abdomen ) to doing it all by laparoscopy. There is a saying by a famous surgeon who disparaged laparoscopy “ why look through a keyhole when you can open the door”. Sadly he did not envision what the future had in store.


To convert the mechanics of open surgery is to understand that you need light, you need to see (eyes), exposure (retraction), instruments to manipulate, grasp, cut and coagulate, suturing and lastly tissue removal. What is so unique about Semms’ genius was he developed a light source, auto insufflator ( to distend the abdomen), a scope to see, coagulation for hematstasis, special instruments to grasp, cut and tie etc, irrigation and a morcellator (bite pieces) to remove tissue virtually duplicating everything that was possible in an open operation. All this may sound difficult to learn and it was……. and now I was attempting to teach this to my colleagues
What I did next was to invite members of the Gyn faculty to the lab along with my residents and teach them the basics of handling instruments and the rudiments of suturing so when the equipment did arrived from Germany in about 6 months they would be ready for the next step…..operating on a patient. The other thing that I did was ask the Director of Surgery Services if I could form a team of 6 surgical nurses in the techical intricacies of Pelviscopy and the complex equipment and it would be familiar to them scrubbing on cases. They were later christened by me the “Pelviscopy Queens” and their number rose to 18 so that all three shifts in surgery were covered with a knowledgeable scrub staff.
But my biggest challenge lay ahead. I had already rejected the use of a direct view scope ( as done by Semm)and decided that a system in which a video camera and monitor was the only way surgeons in America would embrace this technology; but I first had to figure how to do it since Semm had shot me down about not understanding how light worked in relation to utilizing a camera.
I guess people paths cross in ways we don’t realize later in life and fortunately mine intersected with a nurse who I has grown up with in Evansville, who was now the head of operating room purchasing at Methodist Hospital. What happened will follow.