The idea that I had formulated in 1986 to advance Pelviscopy had reached fruition with the embracing of minimally invasive surgery in the 1990’s, primarily Cholecystectomy. But it did not come easily or without rejection, impediments and jealousy. I distinctly remember one member of our staff saying “since you didn’t learn how to do laparoscopy in your training who are you to teach us something so advanced”. To which I replied “I’m basically a surgeon, I can technically operate anywhere in the abdomen but I choose not to, so what about you!” There is an axiom that is often quoted in medicine about doing procedures that goes “See one, do one, teach one.” I had a hell of a surgical foundation in my residency, much better that most gynecologists and was complimented often by general surgeons as to my abilities. Indeed there was no gynecologist on our staff who could come close to out operating me. With this confidence I was ready to face any and all adversity.
My base of support was really Benson, who knew if I was given a task it
was done when I was involved.
I knew that the OB/GYN section was reluctant to embrace anything new or different from when I joined the staff in 1963 and things had not changed They were still having heated debates in section meetings about the most mundane procedural things, sometimes a 7 PM meeting would drag on until midnight with inane arguing.
I had received IRC approval to do animal studies to deal with the technical aspects of performing surgery but there was no administrative support from medical education for financial seed money
So when, I went to the Director of OR Services Dr. Edwards, I had only Benson’s support. But when it turned out that lapcholes were going to be a winfall the equipment couldn’t obtained fast enough once the general surgeons were all wanting to do the procedure.
It was as if my idea wasn’t worth supporting until another discipline (surgery) validated it. Dr. Edwards was now imploring me to use my contacts in the industry to obtain sets of instruments and equipment from any source available.
Since I was the expert in developing and teaching the technology, I had personal contacts with which company or supplier had what was needed and was advising Connie where to purchase the equipment, which was now scarce nationwide.
Once the first lapchole. was performed by Dr. Rich Graffis and I in 1990, we collaborated to put on a symposium with a practicum animal lab for surgeons in our surrounding communities. We had so many applications, we could only accommodate 16 attendees. This was so well received that it mushroomed into what we later called mini-fellowships in which we trained surgeons in a special course we designed. I taught the didactics of laparoscopy and Grafffis allowed them to scrub in with us on 10-15 cases a week. The $1,500 fee that was charged for these courses was turned over to the general surgery education fund. A total of 70+ surgeons were trained at Methodist by us over the ensuing year. We both were than asked to teach courses that were being given periodically nationwide due to the demand for instructors.
In 1992 the NMA ( the black medical society) held it’s annual meeting in Indianapolis, and I offered to provide a training symposium for the Surgical Section. The course was specifically designed to teach Black surgeons how to perform Lapcholes for all that wanted learn at a reasonable cost at a convenient location. I don’t know how many of the attendees expanded their training, but I have never had any acknowledgement of my contribution to their surgical skill by the NMA or it’s Surgery section. I think one has to remember that white surgeons had embraced lapcholes as the acceptable way of removing the gallbladder and the open method was basically not indicated. Financially any Black surgeon who could not do lapcholes was losing patients.
One of the things I stressed in courses and teaching my residents was safety and knowing the equipment so a procedure would not have to result in a laparotomy (open abdomen) because of technical problems. This was one of the reasons I insisted on having a dedicated team of nurses who were able to trouble shoot problems.
I remember after giving a presentation to the surgery section at Methodist only one of it’s members, Dr. Cedric Johnson, came up to me and thanked me on their behalf for sharing my knowledge unselfishly with them. It at least showed me that some one recognized my contribution, appreciated it and expressed it.
During this period a tragedy occurred that brought an interesting series of events that connected 2 countries Japan and the US. In the late 1980’s Subaru Motors built a factory in Lafayette, IN. One of it’s executives was brought to a local hospital and died of a heart attack probably due inability to communicate. The Subaru Corp had close ties to Purdue Univ. and Dr Lloyd the president of Methodist and Dr Beering the president of Purdue Univ. were close associates and set up an exchange so that bilingual physicians from Japan could come to the US to act as interpreters for their employee’s medical conditions and as a bonus could avail themselves to American graduate medical education at Methodist. One of the physicians happened to be a young OB/GYN who Lloyd told what I was doing with Pelviscopy and asked me to tutor him.
His name was Toshio and he would come every Tuesday for me to teach and to observe my cases in surgery. We became very friendly and I attempted to learn some Japanese words and phrases. The doctor’s dining room had a great luncheon menu and I would treat him every time he came. One of the selections they always served was a huge standing round of beef roast, which he ordered every time. I told him he could have as much as he wanted and he would make 2-3 trips to the carving board. So I asked him what was his favorite American food. He said steak and that he and his wife would go to Kroger and buy a dozen porterhouses at a time a bargain compared to the 30-40 dollar/ pound price in Japan, all the while scarfing down roast beef. So to practice my Japanese, I asked him what was the word for roast beef. He said “roooast ah beef”. I said,” no what is the Japanese word” for example I said octopus is “toku su”. I repeated my question and he replied “roooast ah beef”. I was getting exasperated and said “ bull shit Toshio” What is it in the Japanese?
“Roooast ah beef Robi san, that’s it”…… then I realized there was no translation. We laughed and really bonded and I would tease him about not having a translation for his favorite food.
When he left he thanked me profusely and some months later the president of Subaru Motors made a special trip to the US and personally visited Dr Lloyd and brought him a gift of thanks and I was given a kimona as a token. The act of respect and thanks that was given to us still impresses me to this day especially since it was not as forthcoming from some of my colleagues.
Though rejection finally led to some degree of recognition during any reward came from being commended for my teaching. The residents awarded me the honor of best teacher of the year in 1989-90 and the senior class at Indiana University presented me with the Distinguished Professor of the Year Award that year. This was the only time anyone at Methodist had be so honored. I was also elected to the American College of Surgery unanimously by the local chapter in the same time frame.
My goal was always to advance laparoscopy (i e. pelviscopy) to new heights and I feel I achieved that and more by the expanded applications of the technology that are now common place.
Sunday, September 30, 2007
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.
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.
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.
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.
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.
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.
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