John Morrison, M.D., a general surgeon with the Fayette Medical Center in Fayette, Alabama, is a rural Alabama practitioner who has developed an international telesurgery audience because of his extensive experience and exceptionally low complication rate in the emerging surgical application of laparoscopy.

Laparoscopy is a minimally invasive procedure through which surgical procedures are performed by inserting a miniature camera and surgical instruments through tiny punctures. Currently, more than 100 surgical procedures can be performed laparoscopically, some in the time that would be required just to open the patient up to gain access to the surgical site using traditional techniques.

The medical supply company, Ethicon, a subsidiary of Johnson and Johnson, elected to install electronic broadcasting equipment at the Fayette Medical Center so that surgeons from all over the United States could benefit from Dr. Morrison’s skills in laparoscopy by viewing and asking questions in live time as surgical procedures are being performed. Besides the Fayette Medical Center, Ethicon has placed other telesurgery broadcast sites at hospitals in New York, Los Angeles, Cincinnati, Baltimore, and Miami.

According to Ethicon account representative, Brooks Johnson, Ethicon is not the only company providing telesurgery service, but it is one of only a few and there are only approximately 25 telesurgery sites like the Fayette Medical Center in the United States. Most of these are in major medical centers. Johnson notes that fewer than 10 of these can actually transmit.

According to Dr. Morrison, the patient benefits from laparoscopy surgery are great. He notes that postoperative problems are minimal, and when looking at the whole picture, it’s cheaper (for hospitals) although initially it’s more expensive. Unfortunately, this technique is not being taught in medical schools since this would add a year to residency programs.

However, this is an emerging field and Dr. Morrison feels that surgeons need training in it. His background in general surgery provides that he perform numerous different types of procedures with many of these being performed laparoscopically. His first laparoscopic operation was performed in 1991. During a normal month, Dr. Morrison will perform 120 to 130 procedures. This diverse experience combined with the fact that he is challenged by the more difficult cases makes Dr. Morrison a natural choice to provide such educational opportunities for other surgeons.

The first use of the telesurgery broadcast equipment at the Fayette Medical Center was in March 2000 when Dr. Morrison performed an acid reflux procedure which was viewed by more than 20 surgeons in Miami. The telesurgery equipment consists primarily of two cameras with one being focused externally and the other being on the laparoscope and a television monitor. The observing surgeons see exactly what Dr. Morrison sees on his monitor as he conducts the surgery. Observers can ask questions in live time as the surgery proceeds.                                               

Dr. Morrison and the Fayette Medical Center were selected for a telesurgery broadcast to approximately 150 observers attending the 30^th Annual Meeting of the American Association of Gynecological Laporoscopists in San Francisco. For this special broadcast, Morrison selected a difficult surgical case. The patient was a female who had thick scar tissue inside the abdomen from a precious C-section and a second surgery to remove a benign tumor. The scar tissue had adhered the intestines to the uterus. The surgery required Dr. Morrison to cut away the scar tissue and remove the uterus without making an open incision. The procedure was moderated in San Francisco by Dr. Paul Vietz, a Baltimore gynecologist. Dr. Morrison received a standing ovation from the San Francisco audience of surgeons when the procedure was completed.

Interest in this particular surgical procedure (the CISH procedure) had apparently been generated from the November 2001 issue of the international Journal for the American Association of Gynecological Laparoscopist which devoted nine pages to publishing a study by Dr. Morrison on the outcomes of 437 patients on whom he had performed the procedure over an eight-year period.

Dr. Morrison was asked to make a presentation of the expanded nine-year study on over 500 CISH patients at the prestigious International Congress of Gynelogical Endoscopy and Innovative Surgery in Berlin, Germany. This is the largest single surgeon experience in the world on the CISH procedure.

With assistance from Dr. Volker Jacobs, a colleague from Germany, Dr. Morrison has produced nine papers, made 33 oral presentations, had 53 poster presentations at national and international meetings, contributed to six books and won seven different awards for their research done at the Fayette Medical Center. Dr. Morrison received one of the most coveted international awards presented in the field of gynecopogy, the Kurt Semm Award for Excellence in Pelviscopy at the 1998 International Congress of Gynecologic Endoscopy which was held in Atlanta.

Dr. Morrison has recently been appointed to serve in an advisory capacity on the Technology Committee for the Society of Laparoscopic/Endoscopic Surgeons (SDS), an international society with a membership of surgeons representing 43 countries.

This committee evaluates new advances in surgical technology, telemedicine, and telesurgery and presents the society an annual report on updates in these fields. The committee is also considering developing a program for evaluating and teaching laparoscopic skills to surgeons using virtual reality plus standard laparoscopic teaching techniques.

"Surgical residents are now taught to perform laparoscopic gallbladder removal and perhaps appendectomies, but most advanced training in laparoscopic surgery must be done post-graduate and is a personal choice of the surgeon. Virtual reality training does have a roll to play when learning the fundamentals of certain laparoscopic procedures; however, there is no feedback. The surgeon receives no ‘feel’ of the instruments and tissue that exists when performing an actual surgery," said Dr. Morrison.

Morrison further expressed his desire to see the committee develop post-graduate courses which would certify surgeons according to their skill levels in laparoscopic surgical techniques. These courses could be offered in different venues of non-invasive surgery such as suturing and instrument usage.

The committee will also study robotics in surgery or computer enhanced surgery. "Robotics appear to be a good tool for very fine, delicate work such as certain neurological and cardiovascular surgeries," said Dr. Morrison. Although robotics may be able to play a part in these special procedures, he did not believe that robotics would take the place of surgeons anytime in the near future. Although it is feasible for robotics to be built to enhance numerous surgeries, it would be cost prohibitive for most hospitals to invest in that technology. "I’m much cheaper than a $1.4-$1.8 million dollar robot," he said.

Technology is advancing rapidly in the medical field. Many of these advances such as the strides being made in laparoscopic surgery produce much better results for the patient. According to Dr. Morrison, patients who have a surgical procedure done laproscopically will experience much less pain, recover in a shorter length of time and miss substantially fewer days from work or normal routines. Therefore, patients may soon be demanding that surgeons be skilled in laparoscopic techniques.

The responsibility falls upon Dr. Morrison and other committee members to keep surgeons abreast of the changing environment in the surgical arena and to offer their opinion on both the merits and pitfalls of available new technology and advancing research.

Information for this article came from material published in The Times-Record of Fayette, Alabama and provided by Jackie Waldon, Director of Public/Community Relations with the Fayette Medical Center. Special thanks also goes to Harold Reed, Hospital Administrator at the Fayette Medical Center.