Trip to Keil Germany

Going to Germany was an experience in itself, I was to fly from Indianapolis via TWA into Kennedy in NYC and connect with Lufthansa for 7:00PM departure to Frankfort. My TWA flight was late leaving Indy and on reaching Kennedy I had to get a limousine for $50 to go to the International terminal which was literally 100 yards across the road. As I rushed to the check in, the clerk said the boarding for my flight was closed. I panicked. Here I was on the hospital’s dime and had missed my flight and I had to be in Kiel the next day. I asked her what options did I have and she nicely said “I can put you on a flight that leaves in an hour to Hamburg from there you can get a train to Kiel”. That was a relief plus it gave me time to exchange some currency which I hadn’t had a chance to do. So I finally boarded and wondered what was ahead. I almost suffocated on the flight because the German passengers bought cigarettes duty free and tried to smoke them all on the flight.
Arriving the next morning, I cabbed to the train station which was huge and my not being able to read or speak any German manage to find the ticket window and purchased a ticket to Kiel. Instinctively, I listened for the train to be called and since I had no idea about what car to board I decided to get in the one closest to the engine, which was a smart move on my part; because the train as it went north dropped off cars from the rear that were switched to other destinations. Luckily I didn’t take the car towards the end of the train or I would have ended up I don’t know where.
The train trip was through some beautiful scenic country side and I knew I was safe to arrive at my destination since Kiel was the end of the line.
As soon as I checked into the hotel which was about 3PM, I crashed with the time zone change and slept until about 10PM. Since dining is done late in Europe I ate and decided to scout my surroundings for tomorrows adventure at the University Hospital. Arriving back at the hotel I found the hotel bar and immediately connected with the bartender and a keyboardist that played in the bar until the wee hours. Now that I knew I was situated, I felt relieved.
The course started the next morning and as I trudged up an inclined path to the Hospital, wondering what was in store for me. I hadn’t met anyone that was an attendee until I entered the auditorium.
We were greeted by Dr Jordan Phillips an internationally known laparoscopist who had established a society called the American Association of Gynecologic Laparoscopist and had coordinated this course and introduced with Dr Semm.
Herr Proffesor Semm began by describing how he envisioned being able to do operaterations via laparoscopy and what innovations he had developed to achieve that goal.Having a degree in engineering helped bring his technology to fruition.
The goal that he had was to be able to do most of the common gynecological operations through the laparoscope using multiple puncture sites in the abdomen to access the organs and develop a technique for cutting, clamping, suturig and removing pathology. He than proceeded to describe what he had invented or designed to achieve this.
First, was an automatic insufflator that pumped gas on demand to distend the abdomen for visualization. Second, were special trocars (spikes) to insert into the abdomen where tubes could be inserted to allow instruments for manipulating tissue as you would in an open case. The insufflator kept up with any gas that leaked around the gaskets in the cannulas (tubes), Third, he
developed a series of instruments (grasper,clamps,needles, scissors and needle holders). Fourth, he invented a unit that could coagulated tissue without burning any adjacent structures. Fifth, he created an irrigation suction system to keep the operative field clear of blood and debri. Six, he designed a morcellator that chewed up tissue for removal. And lastly,
he perfected a technique of suturing that gave the surgeon the reassurance of securing bleeding from large blood vessels. All of these inventions and techniques were compiled in a syllabus that was handed out for future reference. This was definitely needed since most of the lecturers spoke English but some things were lost in translation.
Listening to the introduction to the course and having practiced on their trainer model to become facile in manipulating tissue and tying knots, I felt more comfortable than I had been in Miami a year ago.
There were 24 attendees and we were divided into twelve groups of two and assigned to a trainer with one of his fellows. My fellow was from India and we struck it off right away. He had us go through a series of exercises to see what our dexterity was and satisfied with that put us through a series of steps that replicated surgical procedures (ie. taking out a cyst, removing a tumor, tying a blood vessel with both kinds of knots). The knot tying (intracorporeal and extracorporeal) was emphasized since Semm believed this was the key to completing the surgery without having to convert the case to a laparotomy (opening the abdomen).
After practicing our trainer exercises all morning, I asked my instuctor if I could show him a maneuver that I had come up with for tying that was simpler than what Semm did and proceeded to demonstrate it to him. He was impressed! So I ask him if he could show it to Dr Semm. His reply “NO, I could never show Herr Professor anything”. I asked if I could show it to Semm’s Associate Professor Tennenbaum and he again said “NO WAY”. That’s when I got the feeling that Semm was not likely to take suggestions or take fools lightly (me). So I kept my mouth shut on this point. But found later that my technique was easier and having shown some of the attendees they returned home with Robinson’s knot tying method.
With the basics over we were told that Semm had 6 cases scheduled the next day to demonstrate Pelviscopy on actual patients.
That night we had a reception to welcome us to Germany and to sample the food and customs where we were bussed to a medieval castle. This was really an interesting event and we were plied with food and toasted with drink far into the night, making the early wake up call a little hard to accept.
The next day was the part of the technology I had come to see. Looking at video tapes and working on trainers was great but I wanted to see what Semm could do in real time on real pathology in real patients.
We were split in to 6 groups of 4 so one group could come into the operating room while the others were able to observe on close circuit in an adjoining room.
This was where something happened that produced a seminal moment in my thoughts about Pelviscopy.
When our group was in the operating room we saw that Semm sat on a special stool and had arm rest (like an ether scree) to brace his elbows over the patient and the laparoscope was held by his assistant who looked into a side port to observe what Semm was doing. And periodically they would attach a crude camera to the scope and feed a signal to a TV monitor back to the conference room where the we could see what he was doing. All this was fascinating and quite impressive as Semm provided a running commentary of what he was doing. As I recall they took out a cyst, removed a fibroid tumor and separated some adhesions along with removing the appendix.
When the surgery was complete we had a “snack” that was really a feast at about 11 O’clock between the next 3 cases in which they served sparkling drinks, cold meats, cheeses, black breads, pastries, fruit and the like which they told us was an everyday operating room ritual in Germany. (I was ready to definitely adopt this and bring back to the US).
When done we adjourned to the conference room for a question and answer
session. Dr Semm took the podium and was peppered with detailed questions about this and that from the audience.




I had this thought and when he recognized me I asked “ Herr Professor, why don’t you watch the TV monitor to operate so everyone can see what is going on rather than look through the scope”. He replied, to my embarrassment, “Dumbkoff don’t you anything about light, every time you connect a link to the light source (source to cable to scope to lens vs camera) you lose 50% of the light” and went on to answer other questions. I slid down in my seat and said to myself, I need shut up and learn something about light!
The next days in Germany consisted of more cases and some side trips to see some sites and then my return home.
On the flight back I reviewed the material I had received about the procedures, the equipment and the copious notes I had taken all leaving me with the burning question……would doctors in the US accept this tedious method of doing surgery no matter how elegant. And as I fell asleep high above the Atlantic, I surmised NOT!