Top Doctors 2014

Training the Next Generation of Minimally-Invasive Surgeons

Remote control technology lets doctors perform less invasive surgeries than ever—and to train doctors all over the world from their offices.

By Catherine Matusow September 1, 2014 Published in the September 2014 issue of Houstonia Magazine

Dr. Brian Dunkin, medical director of the Houston Methodist Institute for Technology

During the early years of his career, Dr. Brian Dunkin found himself flying around the country, mentoring other surgeons as they performed their first laparoscopic abdominal surgeries, a Dunkin specialty. But he’s stopped doing that—flying, that is. He’s still mentoring as much as ever, in his capacity as medical director of the Houston Methodist Institute for Technology, Innovation and Education. He just…tele-mentors now.

In fact, Dunkin is a pioneer in this particular branch of medical pedagogy. He moved to Houston to build MITIE from the ground up back in 2007, then got a grant from the Department of Defense and went to work. “We developed this platform where a surgeon put on a little backpack with computer and headset, camera, and microphone, so I could see what they saw,” he says. “I could talk to them and they could hear me.” Throw in an Internet connection, and just like that—doctors could oversee each other’s work remotely. (This was before the era of Google Glass and iPads, which Dunkin and the team at MITIE now regularly employ.)

Which is not to say that all mentoring is done from afar. Each year, Methodist’s $40 million MITIE facility hosts thousands of health care professionals from around the world. They come to hone their clinical skills, acquire new ones, and generally stay up-to-date with technological advances in medicine, itself a constant challenge. “What you learn at the beginning of your training becomes obsolete,” says Dunkin. “We have a more rapid pace of change in medicine now.”

Laparoscopic abdominal surgery, which requires only small incisions, thereby “minimizing the insult to your body,” as Dunkin puts it, is a relatively new procedure. The first operation of this kind—a gallbladder removal—was performed in the late ’80s, and in the years since the procedure has changed radically. Advances in technique have led to more efficient surgeries, reduced hospital stays and recovery times, and less pain and risk for patients. 

“It lets you get back to full activity, your life, your job,” Dunkin says. “You watch somebody have a laparoscopic gallbladder removal versus open surgery, and you go, oh my God, it’s not just different in terms of recovering from pain, their life is different because they’ve recovered so much more quickly.” 

But mastering the range of laparoscopic surgical techniques used today isn’t easy, and so thousands of surgeons travel to MITIE each year to see how they and other advanced surgeries in multiple specialties are performed. “One of the things about minimally invasive surgery is it’s technology-dependent,” says Dunkin. “I need cameras, I need special instruments, that kind of thing. So people need to learn how to use that technology. That’s what we do a lot of here.” After surgeons train at MITIE and return to their hospitals, tele-mentoring helps them implement what they’ve learned. 

But there’s a lot more than that going on at MITIE these days. They’re also employing breathing, blinking, talking robots to simulate patient procedures; working on 3D robotically-guided X-ray imaging for safer, more accurate surgeries; and researching new ways of measuring surgeons’ technical expertise. In every case, the aim is the same: finding a way to do it better, and sharing knowledge gained. 

When he conducts training sessions at MITIE, Dunkin says that invariably someone will ask him why he’s training the competition. He tells them he doesn’t see it that way. “My job is to help them adopt things safely and efficiently into their practice so that they can take better care of their patients. I’ll hopefully get a little credit along the way, but there’s no way you can be exclusive about that. That just doesn’t make sense, and it’s not the right thing to do.”

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