Beverly Love, MD

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  Hi, I’m Doctor Beverly Love from Montgomery, Alabama, and today we’ve  got with us Doctor Randall Loy from Orlando, Florida. I think that what you have developed  here is something I’ve always thought about with laparoscopy and also  hysteroscopy because one of the complaints I have in operating rooms is  that I have a difficulty getting my instruments and the other people,  the technicians, feel like I’m a perfectionist and I know that there are  certain ways that we can organize things to where it works more  efficiently, irrespective of who we work with in the operating room and I  see that you have this new device, it’s called an Endo Organizer.  What  the heck is an Endo Organizer?
 
 

 We have the same problem and we’re clinicians and how can we always get  the right instrument when we need it?  In surgery, as you know, seconds  matter and if they’re having to fish around on the back table for the  instrument, then you might have a bleeder there or you might need to do  something and those seconds are critical, so we came up with a way that  either the scrub or the surgeon can grab the right instrument at the  right time.  This device is just a toolbox, that’s really what it is.   It’s like the old Craftsman toolbox, it sits there, except instead of  screwdrivers and hammers, you’ve got your biopsy forceps, your  coagulation device or whatever.
 
 

  You mean to tell me you went into Sears and Roebucks one night and you  had this brilliant idea that you had to organize things like a toolbox?   I go into Sears at least every month or two and I haven’t had an idea  like this.  They wouldn’t, the lord wouldn’t let me get to think  something like that.  But I think you’re absolutely right and, you know,  and I know it sounds, it may make things sound so Christian, but that’s  exactly what you want to be, you want things to be more functional, you  want the procedure to be made easier in terms of how you get your  instrumentation and that’s one of the things that I’ve always had, but I  think you’ve solved it with this device and I just want to let you see  what Dr Loy’s prototype looked like for himself.  Now I think this is a  great, this is a great way of organizing things.  Now is it only useful  for gynecology or can other specialties use this device.
 
 

 You know, we have in our tests, we’ve allowed surgeons of different  sorts, including cardiovascular surgeons, general surgeons, urologists,  OB/GYNs, of course, to use this and everybody is really like that.  I  mean, across the board, the surgeons have liked it.  Now what the  general surgeons especially like is they do different kinds of  procedures, they may do a misanthundoplication one day, a lapcoly the  next day, they might do a hernia the next day, and this is just the  front plate of the box, of course, and they’re able then to have this  customized front plate different for every procedure.  So it could be Dr  Smith misan, Dr Smith lapcoly, Dr Smith hernia, and they have different  instruments in this thing and they’re ready to go.  Some of these  doctors even like the possibility of having their boxes up sterile with  their instruments in them and they go to their next patient and bang,  they’ve got their instruments ready to go and you brought up a point a  minute ago that we have used this kit for both laparoscopy and  hysteroscopy.  We often operate concurrently and so I have one for the  hysteroscopic instruments and then one for the laparoscopic instruments  working at the same time.
 
 

  You know that’s good because I think especially with hysteroscopy and  gynecology, it used to be we didn’t have that much instrumentation and  when you start talking about one set of instruments for the hysteroscope  and one set of instruments for the laparoscope, then I know it can be  confusing for different technicians and OR surgeons to say what device  they actually want and I know some of them get upset with me because I  say you don’t know the locations but I think this will solve one of the  headaches because people may have difficulty recognizing which one goes  with the hysteroscope, which one goes with the laparoscope, if you  happen to be doing concomitant procedures.
 
 

 You brought up two great points.  As we know, there’s a nationwide  nursing shortage and there are fewer and fewer scrub tech personnel,  fewer and fewer nurses who are expert in endoscopy.  So it’s not  uncommon to get someone who’s pulled from orthopedics and neurosurgery  who doesn’t know the instruments at all.  Number two is we often operate  in rooms where the lighting is low and where you can’t really see these  tips, because the handles are all alike, the tips are what are  different and so if you ask even a knowledgeable scrub tech, can you  give me grasping forceps, it’s difficult to find those and you might  often end up with scissors in those situations so we have less training  and we have low handle power lighting making for wrong instrument  selections.
 
 

  Now how would you position this in the set-up in the operating room?
 
 

 The way we’ve done it is put it right on the mayo stand, slightly  hanging over the mayo stand and that allows us then to have access to it  ourselves, we want to, now we typically would place this sort of  between the patient’s legs overhanging the pelvis.  Unless we’re doing  hysteroscopy, of course, then it goes to one side or the other.
 
 

  Now, if you have it like that, do you yourself as a surgeon grab the  device, the instrument, or do you allow the tech to get the device for  you?
 
 

 It can be either way, it depends upon the tech.  As you know, there are  some techs who are pretty territorial and others who don’t mind if you  grab the next.  Both ways.  You want to show the box at all?
 
 

  And you can point out some of the instruments that we have on the front.
 
 

 I mean the box back here.  Should I get up and grab it?
 
 

  No, no, no.  I think that if we show right here the little template with your name on it with the different instruments.
 
 

 All right.  This, as you see, is customized to my name, the Olympus  logo.  I have set this up according to my typical usage.  Here we have  biopsy forceps, the second forceps, straight forceps here, another pair  of grasping forceps, these are atriomatic, and then we have another pair  of Olympus-type forceps, and scissors, Metzenbaum scissors, and I  usually put the coagulation device in there, like Klezinger forceps in  that last one.  You could also put the Sonosurge instruments in there if  you wanted to.  The beautiful part, I think, about this is that it’s  all refillable, you can flash this thing, you get it back next case, you  can do three or four laparoscopies in a row.
 
 

  Now does this device only work with Olympus instrumentation?
 
 

 No, it does not.  We have made this so that it is counterbalanced and  there is also partial covering of the shelves inside of the actual box  and so no matter how long the instruments or the counterweight on the  tip of the instrument, it fits into this nicely.  So any instrument  works.
 
 

  Now when will this device become available to gynecologists like myself?
 
 

 I’m hoping in the first quarter of 2003 this will be available generally.
 
 

  You know, I guess it’s good that this Endo Organizer was your invention  because if I produced it, I’d have to give it a name like the Love Box  and that might have all kinds of funny connotations and people may not  figure out what it was for.  Now, would you have several of these  toolboxes in the operating room if you were the surgeon on a case?  I  guess you could, you told me about hysteroscopic surgery so you could  had several boxes.
 
 

 You could.  The way I optimally envision this is to have one of the mayo  stand and then one or two more on the back table so that if you need  the instrument, let’s say you’re not using these seven instruments, but  you ask for something like another grasp or another scissor, then the  nurse or scrub tech goes right back to another second or third box and  pulls the instrument immediately.  They won’t have to re-focus the  lighting and so forth.
 
 

  Now what kind of comments have you got from other surgeons,  gynecologists that have been using the box in your tests, your field  tests?
 
 

 We have, by the way, we’ve sent this out to the top gynecologists in the  country, and without mentioning too many names, you get in trouble, but  . . . 
 
 

 But we’ve sent this out to eleven very well-known names and many of  these are department chairmen or division heads and just got their  comments, say what do you think, use it, see it, touch it, feel it and  to a person, they have had resoundingly good comments.  I mean, they  want to have it, they want it for their own surgeries, how soon can we  get it, sort of like your comments.
 
 

  Well, I think this is good and I think it would also cut down on the  time element, make your procedures much more efficient.  It’ll also cut  down on the frustration factor and I think one of the things that’s  always bothered me about doing procedures in that laparoscopy is that  there’s a certain level of frustration because that cuts down on your  own productivity, it makes you take longer to do your procedure and if  we can have devices such as yours, and I mean this is part of what I  call the KISS principle:  keep it simple, stupid.  In other words,  you’re keeping it simple so that anybody that wants to participate can  use a device like this and you can have different technicians come in  the room and they don’t have to feel like I’ve never worked with you  before, therefore I can’t help you or I don’t have an interest in what  you’re doing because I usually work with neurosurgery or orthopedics and  so on, I don’t know any of OBGYN instruments.  They don’t have to know  the instruments.  If they know how to read, and I’m assuming they know  how to read.
 
 But certainly, most people who work in an operating room know how to  read and would know the name of this instrument.  This really is an  advancement that will make it easier for us as gynecologists to do the  procedures and I certainly would applaud you coming up with this idea.  I  just hate that it wasn’t my idea and I hope you come up with some more  ideas along those lines  because as long as we can come up with devices  like this, we can keep the operating rooms  running much more smoothly  and we can save time and we can work more efficiently and that cuts down  on cost even though I know there’s a cost associated with this, but  it’s not going to be anything that’s monumental, it’s going to be  something that would be well worthwhile spending in operating rooms  because I know nowadays, it’s hard to get new things in the OR and if  we’ve already got something like that but, as far as I know, there are  no toolboxes in the operating room for laparoscopy or for hysteroscopy  or for endo, endoscopic procedures, so certainly this is an advancement  and we think this device, this toolbox that you have, this Endo  Organizer is going to move forward and we see it as something that’s  going to be in everybody’s OR at some point in time real soon.
 
 

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Author | Beverly Love, MD

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