James Daniell, MD

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OBGYN.net Conference CoverageFrom ISGE - Montreal, Canada - April, 1999

Endometriosis with Bowel Involvement

 "Here       we are in Montreal at the ISGE after many years of laparoscopy, and 

       is extremely lucky to be able to capture for a moment - the father, or       maybe even the godfather, or the god of laparoscopy - Professor Semm,       who's my hero. When I was just beginning, just a small boy out of medical       school, I heard of Professor Semm - he's led and published many, many       innovative articles. So Professor Semm, here you are now in Montreal. It's       an honor to have you with us, and I want to personally thank you for the       influence you had on my career and give you a chance through the new       technology of the Internet to say a few words to the doctors and women of       the world who sign on to 

.       What are your thoughts on what you've seen over the last 50 years in       endoscopy?"
       
       

       "I started in 1963 with surgical periscopy, now called laparoscopy,       and everybody - the whole world - was against me."
       
       

 "Yes,       I know that. You were right and they were wrong."
       
       

       "Yes, I thank you a lot. I'm still living and general surgeons would       like to kill me at this time as an antique surgeon, as a charlatan -       because I changed "big incision - big surgeon." The surgeons       said to me, "Semm, come on. I am a surgeon, I must see something. I       open very broad." I said, "But you with your… come on, you can       forget it."
       
       

 "Yes,       this is right. I remember all the criticism that you received, and I       remember thinking - he's right and they're wrong. Now all the surgeons are       taking out the gallbladders, the appendix. You were the first to take out       the appendix through the laparoscope; the first to do subtotal       hysterectomy - over 200 firsts that you've done in your career."
       
       

       "I wrote two books with over 750 full frame slides, color slides, and       they were dispersed around the world in two years - 20,000 pieces. Now you       can't buy one."
       
       

       "That's right. Your publishing career has been unbelievable. I think       no one else in the field of gynecologic endoscopy has published as much       and produced as many wonderful video tapes and developed as many       innovative procedures and taught people all around the world. You've       traveled all around the world with suitcases full of equipment, and I know       that you have influenced more people in the field of laparoscopy than any       one else in the world. The younger gynecologists - and even though I'm       bald, I'm still younger than you - we appreciate what you've done.       Hopefully today, the general surgeons now can look back and say, "Semm       was right, we were wrong." So it's an honor to have you on 

       here today, and it's good that the women of the world and also the men of       the world - now benefit from your early, early pioneering work. So thank       you on behalf of the women of the world, Professor Semm."
       
       

       "Thank you very much for the kind words."

Changes in Laparoscopic Surgery

 "It's       my great honor to be here in Montreal to have the chance to interview for 

       one of the real pioneers in women's health care, one of my heroes and now       my good friend, Dr Jack Sciarra. He's always busy; you are returning to       the place of your greatest triumph, because Montreal was where you were       the President for the ISGE. That was a real zoo; this time you can walk       around real nicely. Give us your recent memory of how it was to run the       meeting here in Montreal when you had 10,000 people."
       
       

       "Montreal in 1994 was the FIGO World Congress, and at that time I had       the privilege of serving as president. We had no idea when we set the       meeting up - since we planned for 6,000 people - that we would have the       large turn out that we had. So it was a nice problem to have, but it       really made the meeting much more complex. My involvement, of course, as       president was more political than educational or scientific; my main job       at that meeting was to keep everybody else doing the things that they were       suppose to do. Fortunately, everyone did everything beautifully and it       turned out to be a wonderful meeting, but you're right, it was a much       larger show than this one."
       
       

 "We       know the ISGE is very, very lucky because we've been able to recruit you       to be our incoming president. Do you think that you'll have 10,000       physicians at the ISGE meeting in Chicago in 2001? That would really say       something for your skills to take it from 1/2 of 1,000 to 10,000."
       
       

 "But       Jim, that's not our goal. Obviously the ISGE, which is a       specialty-oriented organization, has totally different goals and       objectives than FIGO. So I think that what we would like to do in Chicago       is to have a quality meeting - a first class scientific meeting - that       would showcase the state of the art of gynecologic endoscopy at that time.       My guess is we'll probably have about 500 people; if we have more, then       that would be a great success but our target is around 500."
       
       

 "Many       of you who may not be familiar with Professor Sciarra's background should       know that he has three offices. This is true - you have three offices in       your department or in your domain in Chicago, and he stands up behind his       desk and goes from office to office. Tell us how you get everything done       through the day, it's amazing."
       
       

 "I       think that's fair, but lots of people have more than one office. I happen       to serve as Chairman of the Department of Obstetrics and Gynecology at       Northwestern, and also as Head of Obstetrics and Gynecology at       Northwestern Memorial Hospital. These are two separate but interlocking       organizations and I divide my time - actually my academic time - between       them. Then we also have a faculty group practice, and I have an office       there where I also have the office of the International Journal of       Gynecology and Obstetrics. But they're all close and they're all within       walking distance. I think it makes it relatively easy to migrate back and       forth between them."
       
       

 "In       addition to the work you've done on behalf of the women in Chicago, you've       done tremendous work in third world countries. Would you fill in the       people who've logged on to look at this on your reason or goal that you       embrace; what you have done in third world countries, and fill everybody       in on what you've done in Africa particularly, and also all around the       world for women."
       
       

 "My       main interest when I was with FIGO, and that started in the mid-1980's,       was to enhance everyone's understanding of maternal mortality, to try to       move forward the safe motherhood initiative that had been introduced by       the World Health Organization. FIGO was a strong supporter of that; I       think it's a well-known fact now that every year there are over 500,000       women that die in childbirth around the world and 97-98% of those maternal       deaths are in developing countries. As we've tried to move this initiative       forward, we also individually became involved in different projects. The       area that I felt was most important, at least from my involvement, was in       the training of obstetricians and gynecologists in the third world. We       were fortunate in the late 1980's to have a sizable grant from the       Carnegie Corporation in New York to develop a training program using       indigenous resources in West Africa, and the country that we were working       in was Guyana. We had two teaching hospitals there in A-cron and Ka-moss-ee       (Kamakusa) where we developed a residency program based on the U.S. and       the U.K. model. The reason for this was that for many years prior to our       involvement - prior to the 1980's - the Guyanan physicians were sent       abroad by the government to have specialty training in obstetrics and       gynecology in the United States or in the United Kingdom or in other       countries, and the majority of them never came back to practice in Guyana.       So we put forth the concept, with the help of the American College and the       Royal College and a group of interested professionals led by a man who's       now deceased - Thomas Elkins - to develop a training program using the       local hospitals, but with imported talent for the teaching for the first       few years until such a time as individuals that were trained could then       stay on and train others. It was a ten-year program; it began in the       mid-80's and it's phasing out now - phasing out in terms of international       support - but the program has been eminently successful and showing as a       pilot project what could be done in a under served situation with a proper       plan and with the help from the developed world. So I spent a fair amount       of time during those ten years in West Africa being a part of this       program. I think that sort of sums it up."
       
       

 "You       had a lot of physicians spend a little time in Chicago, and some of those       you were instrumental in making or encouraging to go back to West Africa       and not stay in America, I understand."
       
       

       "Right, as part of this program we had Guyanan physicians who were       training in obstetrics and gynecology come for short periods of time to       either the United States or to the United Kingdom for what would be       considered specialty or subspecialty rotations. I was also fortunate in       having one of the native Guyanan physicians who'd come to Chicago for       training, want to go back to Guyana, and was also a part of this program       on the local scene. I think that was a great help also in making it a       success."
       
       

 "In       addition to the work you've done for the women of the world, I think from       my personal experience from reading the Journal of FIGO, you've really       turned that into a very obscure journal that really nobody read, to       something that, I think, is very important as making statements and       communicating good common sense information to people around the world.       Say a few words about your role with that journal, and your thoughts about       what that effect has had on communication between Ob-Gyn's around the       world."
       
       

 "The       International Journal has always been the official journal of FIGO, and it       was started over thirty years ago. I became the editor in the mid-80's and       at that time we tried to outline a mission for the journal, which was       actually twofold - to publish articles from developing countries,       particularly from those countries that did not have an ob-gyn journal of       their own; and secondly, to publish articles from developed countries that       would have relevance in the developing world. As part of this, we made an       agreement or understanding with the American College of Obstetricians and       Gynecologists to allow us to publish their educational bulletins and other       material from ACOG that would, in our opinion, facilitate and enhance the       practice in other countries. The third thing that we introduced, which I       think was helpful, was a literature review whereby every month we reviewed       a large number of internationally oriented journals and selected abstracts       that we thought would be of interest to people in the developing world.       Our journal is primarily a library-based journal with about 500 of our       subscriptions in libraries in over 100 countries. We hope that by having a       library focus, it will allow more than one reader to benefit from each       issue. The publisher estimates that with library subscriptions, each issue       reaches ten people rather than one person in a personal       subscription."
       
       

       "Right, in those countries those people can't afford a journal, and       it's probably very difficult distribution systems. It's interesting that       you, I think, are responsible for probably one of the most important       journals worldwide that gets out to the hands and to the minds of some       people that otherwise have had no access. But on the other hand, you also       publish, at least Ob-Gyn's heaviest journal, which is the six volume       gynecology obstetrics. Where are you going with that over the next decade?       There's so much new information just in endoscopy here at this meeting,       but other areas of medicine as well. How do you keep making that current?       Because you do, you have so far; I guess the secret is in what you'll tell       us here."
       
       

       "Right, that's a totally different production as you know. The       loose-leaf series was begun now over fifty years ago, and I became the       editor in the 1970's. At that time, we decided that the approach would be       along subspecialty lines so that the six volumes are actually divided       quite nicely among the various subspecialties that are disciplined, and       each of the volumes has one or more associate editors. The concept is       loose-leaf that we would replace about 10% of the series every year, and       of course, add new material as it becomes relevant to clinical practice,       which you know is not only endoscopy but it's every other area as well.       And so, what we do at the beginning of each editorial year is we go       through the whole series, myself and the associate editors, and decide on       material that has to updated or changed, and what void areas have to be       filled in that year. At that point, it becomes a solicitation process to       search out and find the best person to write the chapter or to revise the       chapter, encourage them to do it in a timely fashion, get the material in,       edit it, assemble it, and send it off to the publisher so that it can be       distributed in the spring of every year as a series of loose-leaf pages to       be inserted into the set. It's worked reasonably well up until the present       time, however, as you know the world is changing, and for the past two       years now we've had a CD-ROM version which has proved to be quite popular       particularly among our younger subscribers. Hopefully, we will continue       with the electronic format one way or another for those people that wish       to use the material in that fashion. The interesting thing that we've been       able to do with the electronic format is that we have 21 journals that we       have been able to abstract and include with our regular printed material       so that, for example, if you are reading a chapter on laparoscopic       sterilization and you want to see all of the references that have come out       in the Green Journal, the Gray Journal, and Lancet - the British journal       in the past five years, that material is also on CD-ROM. So it's a little       added feature that we've been able to move into the electronic version,       and we've been able to use some video clips, some 9-second video clips as       well, and a lot more color in the electronic version. So, it's been an       exciting change actually."
       
       

       "Certainly the people that are seeing this interview are going to be       the one's that are most knowledgeable and up-to-date because on 

       of course, you're getting the computer users in the world. There are many,       many people in the world that don't have access to the opportunity to come       to a meeting like this and hear the presentations or to even come to FIGO,       so through electronic information transfer it now becomes possible for you       to sit and people who don't know you have a chance to hear you talk. For       those who don't know that much about Dr. Sciarra, you should know that he       became chairman when he was just a child, 36-years-old. He was appointed       chairman in Minnesota, stayed there for six years and made an interesting       career move, he actually moved to Chicago to become chairman and director       of a hospital that wasn't even completed yet. Isn't that right? Being       built, right?"
       
       

 "He's       been there for 25 years, the President of the Central Association of Ob-Gyn       America - which is a very prestigious organization, President of FIGO -       which is the most prestigious world wide organization, and now is the       President-Elect of the International Society for Gynecologic Endoscopy.       He's had many great achievements and has been a quiet man. And I've never       seen you raise your voice or be irritable toward anybody and you lead by       example. I think you've been a great example to a whole generation of       physicians and not just in North America but also around the world. I       personally congratulate you on your career and for being a great role       model to many. I sound like Larry King now."
       
       

 "You       certainly do."
       
       

 "Of       all your accomplishments besides driving your Corvette very fast - what       are you most proud of what you've done?"
       
       

 "I       think the thing that I'm most proud of are the people that I've had       occasion to have with me in my department, not only at the student level       and the resident level but also my colleagues, many of whom have gone on       to meaningful academic positions at other institutions. I think that this       is a legacy that will continue to educate generations of future       obstetricians and gynecologists."
       
       

       "That's interesting because a very famous Nashville physician who       died recently, Dr. Thomas Frist, Jr., who founded the world's largest       hospital corporation - HCA said, "Good people beget good       people." I think what you've done in your career has been a good       example of that, so on behalf of those who trained in America, I say thank       you, and half of those people around the world who have met you thank you.       You're still a young man and a lot of miles to go; with your ability to       juggle so many balls, I'm sure you'll have a lot more things going.       Speaking on behalf of the people who have enticed you to become a leader       in the ISGE, we thank you for taking us into the next millennium, and we       look forward to being in Chicago with you. So thanks so much for taking       time out to meet with us, and thank you 

       for letting us do this interview with a leader in Ob-Gyn and in the world       today."
       
       

       "Thanks Jim, and we invite everyone to Chicago in the year 2001 - I       think it will be an excellent and exciting meeting."
       
       

       "Great, thank you very much."
       
       

Conversation with John Sciarra, MD on ISGE, FIGO, maternal mortality and his life and work

 "We're       here at the ISGE and we people who do advanced endoscopy - like Dr. Duncan       Turner, here - think that everybody is in the same club. That is, that we       see a lot of advanced techniques and we read a lot of papers about what       are really very difficult procedures, and sometimes we forget that a lot       of the people in the world don't have the experience, the training, or       time and effort to do endoscopy. People like Dr. Duncan Turner, for       example. 

       asked us to talk about something controversial, and I've been privy to       some infighting. There's always politics in medicine and the people who       don't or cannot do endoscopic surgery to a high level or degree are often       very critical of those of us who do. Dr. Turner has agreed to make a few       comments and maybe relate a little of his story, a little vignette, about       what's happened to him recently because of all this controversy over       endoscopy. Dr. Turner, I've talked too much - you take this."
       
       

       "Thanks, Jim. Let's just say that the criticism usually comes from       people who don't do the procedures. We certainly can be constructively       critical to each other about techniques, but when we talk about the mode       of access, primarily of doing surgery endoscopically, this is a different       modality. We weren't trained to do it in our residencies and we've had to       be trained - to take time out of our practices, and train - so that we can       give to our patients what we believe is the best possible treatment.       Unfortunately, and we see this talked about a lot at meetings like this,       even though most hysterectomies, for instance, can be done endoscopically,       they're not. Most of the time, I would say that 80% to 90% of       hysterectomies could be done endoscopically, but only 10% to 20% are and       there are a number of reasons for this. One of the reasons is that most       surgeons, as I say, haven't been trained to do it this way and have not       taken the time to do so. Another reason is that the operation often takes       longer than the traditional way - or at least it does until you've done a       large number of cases - and so there's little financial incentive for the       physician to spend that extra time learning it. But when you see how well       these patients do post-operatively, and when you see how quickly they       recover, how little pain medication they need afterward, you can become a       believer very quickly."
       
       

 "Let       me just mention, in addition, that the history never seems to change. When       I was a resident in 1967, people were severely critical of the first guy       to do laparoscopy in Dallas, Texas. I remember all the talk about how they       would take him off the staff. It wasn't until he was doing 15 or 20       outpatient tubal ligations every day that they started coming not to him,       but to the residents, to say, 'teach us this new operation so we can       learn, too.' And then 15 years ago, when the lap cholecystectomies started       in Nashville, Tennessee, we were involved working with general surgeons       doing laparoscopy. The chairman of our surgery department said, 'I'll       retire before I'll do a gall bladder through the laparoscope, but I'll       have those two young surgeons disbarred!' That guy is now doing lap       cholecystectomies, and so is the rest of the world. I understand you've       received a little flack in California, and all I can tell you is time will       tell. If you don't have mistakes, you're not doing anything - all of us       learn from our mistakes, and others can learn from our mistakes. We're not       perfect, we're human, and I commend you on persisting and doing difficult       procedures and talking about it and publishing in a scientific way. We're       glad to have you on the board of the ISGE. Any other comments?"
       
       

 "I'd       like to encourage patients to be informed and be their own advocates when       looking for this type of solution to their problems. I really think that       with the laparoscopic cholecystectomy - the gallbladder surgery - it is       patient-driven, and the surgeons could not continue to practice that type       of surgery without learning the new techniques. So I've looked to the       patients to help us to be able to do more, to go looking themselves for       physicians who will do those surgeries in, if not the standard of care,       state of the art ways."
       
       

 "Those       of you who take the time to learn and to do research, that's why you're on       

       - to get unbiased, intelligent information. Look your doctor in the eye       and ask him... if it was his daughter, what type of operation would he       pick for her? Sometimes it's a very interesting answer, I think. Have you       ever had that experience, yourself?"
       
       

 "Yes,       absolutely. That's the bottom line when the patient's asking for real       advice - what would you do for your wife, or your daughter, or for       yourself if you're a female physician - and that has to be the most       accurate answer."
       
       

       "Educated patients mean good outcomes and more intelligent selection       of the pathway of hysterectomy. If you're a candidate for a hysterectomy       by a minimally evasive technique, you'll have a better outcome if you're       in the hands and of the care of a competent physician such as Dr. Turner,       so keep working at it. Let's hope the women of the world will be able to       benefit from MIS in broader ways than they have so far."
       
       

 "That's       my goal too."
       
       

 "Well,       thank you for taking the time to let us interview you for 

       here in Montreal."
       
       

Author | James Daniell, MD

Articles

Endometriosis with Bowel Involvement

Changes in Laparoscopic Surgery

Conversation with John Sciarra, MD on ISGE, FIGO, maternal mortality and his life and work

Controversies of Endoscopic Surgery