On the Leading Edge: The Milwaukee Institute for Minimally Invasive Surgery

with Charles Koh, M.D., Gynecologist and Laparoscopic Surgeon, Columbia St. Mary's

Posted: April 1, 2005

The growing field of minimally invasive surgery, where major surgery is performed through an instrument called a laparoscope, has become increasingly popular over the years and will eventually replace much of conventional open surgery, suggests Dr. Charles Koh.

A gynecologist and laparoscopic surgeon at Columbia St. Mary’s Hospital, Dr. Koh and his colleague Dr. Lyle Henry are co-founders and co-directors of the hospital’s Milwaukee Institute of Minimally Invasive Surgery (MIMIS).

“In the early 1970s, the laparoscope, a fiber optic instrument that’s been called a diagnostic window to the inside of the human body, was mainly used in gynecological diagnosis and sterilization procedures,” Dr. Koh explained.

Charles Koh, M.D., Gynecologist and Laparoscopic Surgeon, Columbia St. Mary’s

“In the mid-1980s, the introduction of lasers and other tools allowed gynecologists to perform more involved, but minimally invasive operations. And about five years later laparoscopic surgery expanded into gall bladder surgery.

“The field continued to grow and in 1992 we formed the MIMIS at Columbia St. Mary’s. We decided we needed to synergize the multi-specialty aspect of this type of surgery,” Dr. Koh said. Dr. Henry said MIMIS is the Midwest’s first multi-specialty minimally invasive surgical center.

According to the co-directors, their team of specially trained physicians and nurses is able to use the most recent technologies and surgical techniques to deliver state-of-the-art laparoscopic procedures. In addition to gynecology and general surgery, their specialties include urology, spine and thoracic surgery.

If a patient undergoing laparoscopic surgery needs a combination of those specialties, the team’s different specialists can provide this during one operation, said Dr. Henry.

In addition to the laparoscope, TV monitors and specially designed instruments are used. The surgeons are able to perform major operations through several tiny openings without the need for a large incision.

The laparoscope, a narrow tube, is inserted and the delicate instruments used for performing surgery are slid into place. In some cases carbon dioxide gas is used to expand the body cavity and provide space for the surgeon to operate.

For chest surgeries and some spine procedures the viewing is done through a thorascope instead of a laparoscope.

Over the years MIMIS established several important firsts in minimally invasive surgery. In 1992 they performed the world’s first laparoscopic microsurgical technique to reverse sterilization operations.

“We were also the first in the Midwest to perform surgery for advanced endometriosis with a multi-disciplinary team of general surgeons and urologists. Another world first was an innovative technique for performing total laparoscopic hysterectomy by the introduction of the KOH-RUMI system,” Dr. Koh said.

Following the national and international meetings at which the MIMIS doctors spoke, referrals nation-wide appeared, some from institutions such as Harvard and Chicago University, and from far-flung areas such as Hong Kong and England.

Members of the institute monitor their progress and report their results to the medical community. Outcome data compiled over the years indicate that patients of MIMIS physicians and nurses receive excellent care.

Dr. Koh said minimally invasive surgery now involves the chest, abdomen, spine and pelvis.

“There are definite advantages for patients who undergo this type of surgery. It results in less trauma to muscle tissue, less scarring and less postoperative pain,” he said.

Because no major muscle groups are cut, postoperative breathing, coughing and walking are easier. And reducing the need for pain medication means less unsteadiness, drowsiness and fatigue.

Significantly, overall recover time is faster and patients return to normal activities sooner, compared to traditional open surgery.

In recent years, the MIMIS has been instrumental in developing new minimally invasive techniques to correct sports hernias, osteoporosis-related spine fractures, degenerative disk diseases, and even colon cancer.

Several years ago, Dr. Henry performed a new minimally invasive technique for liver surgery. His surgery, among the first of its kind in Wisconsin, removed a large benign tumor from a 29-year-old patient’s liver.
A study conducted in 2003 indicated several advantages to laparoscopic liver surgery. These included decreased hospital stays, less blood loss, fewer surgical complications and reduced trauma to the abdominal wall. The study concluded that laparoscopy should become the standard approach for liver surgeries, except when tumors are extremely large.

Recently, MIMIS’s Dr. Grace Janik and Dr. Koh went to France to train in a new infertility diagnosis procedure known as fertiloscopy. Columbia St. Mary’s MIMIS is now the only Midwest location and just the third in the U.S. to offer this non-invasive procedure.

“MIMIS continually integrates new minimally invasive procedures and improves existing ones,” Dr. Koh said.
According to Dr. Henry, not all surgeries can be done laparoscopically. “But many can and should be offered if the choice is available.”

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