Newsletter of the

Society of American

Gastrointestinal

Endoscopic Surgeons

(SAGES)

When SAGES wasfirst founded in1981 by Gerry

Marks and his “small bandof surgical renegades” theorganizat ion’s pr imaryf o c u s w a s o n f l e x i b l eendoscopy and its role forthe general surgeon. Sincethe late ’80s early ’90s we

have tended to focus on the excitingand rapidly changing area of laparo-scopic surgery, however we have notforgotten our bond with flexibleendoscopy which continues to bestrong, and vital to our patients. Weneed to refocus our attentions on flex-ible endoscopy.

At a recent meeting in Washington,D.C., several members of the leader-ship reaffirmed our concern about thepreservation of flexible endoscopy inthe practice of surgery. They brain-

Desmond Birkett, MD, FACS

SCOPESCOPE

I N S I D E

First SAGESManual ....................Page 3

GERD Course for Chicago ..............Page 4

Spring, 1997

stormed about solutions to the contin-uing problem of privileging in manyhospitals, new therapeutic techniquesand how to teach them, and flexibleendoscopy in residency education.These issues are important enough forme to address them in my firstPresident’s message.

Privileging Issues – Turf or Patient Protection?

For those of you who think the turfquestion was resolved long ago, thinkagain! The SAGES office receives 5-10calls per week with questions concern-ing difficulty in obtaining privileges.The “turf battle” with our GI col-leagues continues, but even morecomplicated are the issues of patientaccess and managed care policies. Insome states the major health careproviders bar surgeons from perform-

(continued on page 12)

President’s Message Flexible Endoscopy – SAGES Continuing Role

Desmond Birkett (left), IncomingPresident of SAGES, congratulatesGreg Stiegmann, who completed histerm of office at the March San Diegomeeting, with a presidential plaque.Dr. Birkett, in his introductory comments, discussed Dr. Stiegmann’sgreat contribution toward movingSAGES in a leadership role in resident education.

the sidelines skeptical of thefuture of this procedure. Thisis the ideal setting for a ran-domized and prospective trialand is also a unique situationin the world of GeneralSurgery. Historically, when anew technique has been intro-duced, once judged by sur-geons (and/or patients) asbeing advantageous, it hasbeen rapidly assimilated andbecame widely practiced bysurgeons who are not willingto wait for the results of a ran-domized trial to demonstratethe efficacy of the new proce-dure over the older, moreestablished operation. Theexplosive growth of laparo-scopic cholecystectomy is thep e r f e c t e x a m p l e o f t h i s

“method” of development. However, with LAC,the majority of surgeons remain unconvincedand are not, therefore, performing the operation.Meanwhile, the relatively small core of propo-nents who are convinced of the benefits of LACare performing LAC for cancer. A prospectiverandomized trial, if well performed and of ade-quate size, should answer the questions raisedabove and determine the appropriateness of LACfor colon cancer. For the first time in eons, theresults of a randomized trial may well determinethe fate of a new technique.

Two such randomized prospective trials arepresently under way in the United States. TheClinical Outcomes of Surgical Therapy (COST)trial is a multi-center trial sponsored by theNational Cancer Institute (NCI). Currently,there are over 40 participating centers in theUnited States. The following cooperative cancergroups are involved with the trial: North Central

RandomizedTrials—OurResponsibility

As we are all well aware,laparoscopic techniques

have forever changed the faceof General Surgery. Laparo-scopic cholecystectomy and

l a p a ro sc o p i c a n t i -reflux procedures havesupplanted the equiva-lent open operationsas the procedures ofchoice. Laparoscopica d r e n a l e c t o m y ,splenectomy, appen-dectomy, and hernior-rhaphy are also widely

practiced minimally invasiveprocedures. Laparoscopic tech-niques for colonic resection have also beendeveloped. However, because of the develop-ment of port site tumor recurrences, a greatcontroversy has arisen as to whether or not it isappropriate to use minimally invasive tech-niques to resect colon cancers for cure. In addi-tion to the port site tumor issue, manysurgeons remain unconvinced that an equiva-lent cancer resection can be performed laparo-scopically while observing accepted oncologicprinciples. Finally, because a small incision isneeded to remove the specimen and to facilitatethe anastomosis, critics point out that thepotential benefits of laparoscopic-assisted colec-tomy (LAC) are less than for other fully laparo-scopic procedures.

Presently, there is a relatively small core oflaparoscopic enthusiasts who are performinglaparoscopic-assisted colectomy for cancerwhile the majority of surgeons are standing on

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a crit ical look at endoscopic surgery

Scientific Editor for SCOPE:R. Larry Whelan, M.D.,

Assistant Professor of Surgery,Columbia Presbyterian Hospital

New York, New York

This section of SCOPE explores theclinical science of surgical endoscopyand attempt to address some contro-

versial questions in the SAGESnewsletter. Your thoughts and com-

ments, will be enthusiasticallyreceived. Letters to the editor will bepublished on a space-available basis.

V i e w

Membership List to Be On-Line Before End of Year

SAGES membership list will e available on-line by the end of the year, making it easierto keep up with members address changes

and current information. While SAGES does notprovide referral services, the list will be avail-able to patients and others seeking to locateSAGES members in a specific area. Since all sur-geons offices are listed in AMA directories and

the phone book, we do not believe there is a pri-vacy issue t consider. However, if you have ane-mail address and you DO NOT WISH IT TOBE LISTED please contact the office by e-mail,fax, or letter. Please do not call. Written com-munications will provide a record of yourrequest. We expect to have the service availablebefore the end of the year. ●

R. Larry Whelan, MD

(continued on page 7)

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Winton Berci (left), Vice-President, Circon Corporation, presents the Circon Golden Laparoscope to the Young Researcher of 1997,Phillip Schauer of the University of Pittsburgh Medical Center,Pittsburgh, Pennsylvania.

In a project with SpringerVerlag, the publisher ofSAGES official journal,

SAGES will produce its first“nuts and bolts” manual enti-tled The SAGES Manual:Fundamentals of Laparoscopyand GI Endoscopy. some timein 1998. Designed for both residents and practicing sur-geons, the manual will pro-vide a how-to guide for bothflexible endoscopic and gener-al laparoscopic surgical proce-dures. Carol Scott-Conner,M.D., Ph.D., Professor andHead, Department of Surgery,Staff Physician, University ofIowa Hospitals and Clinicsand College of Medicine, IowaCity, Iowa, has been appoint-ed editor. Contributors will in-clude the world’s leadingexperts, in addition to a widearray of procedures and tech-niques and will include hun-dreds of diagrams and drawings.

T h e m a n u a l w i l l b erevised periodically and isexpected to be the pocketguide reference to mini-access surgery and endo-scopy. It will be a paper-

back volume with a modestprice tag . More detai ledinformation about the antic-ipated release date will beannounced by SAGES beforethe end of the year. ●

Two New Residents Courses in Advanced Laparoscopy Attending Surgeons May Participate as Part of Team

As part of its augmentedfocus on the integra-tion of advanced lap-

aroscopy into residencytraining, SAGES, with the sup-port of two corporate support-ers, developed two courses inadvanced Laparoscopic surgeryfor resident within a fourmonth span. To assure clinicaland training support after theint roductory courses , anattending surgeon from theresident’s institution may reg-ister under specific circum-stances. The first course inLaparoscopic Foregut Surgerytook place in May at the

University of Southern Cali-fornia Medical Center in LosAngeles and was supported byan educational grant fromEthicon Endo-Surgery. Underthe direction of Jeffrey Peters,MD, the two day intensive labcourse addressed esophagealmotor disorders, diagnosis ofand laparoscopic techniques totreat peptic ulcer disease, antire-flux surgery including laparo-s c o p i c f u n d o p l i c a t i o n ,esophagea l myotomy andtoupet, etc. 26 residents and 4attending staff participated.

The second course in Lap-aroscopic Colon Resection is

scheduled for September 5-6,1997 in Norwalk, Connecticutat the United States SurgicalTraining Institute. Under thedirection of Steve Eubanks, MDof Duke University MedicalCenter, the course will includelaparoscopic colon resection,laparoscopic abdominal per-ineal resection and lower anteri-or resection, laparoscopiccolostomy formation, etc. Thetwo day course consisting ofhalf day of lectures and one anda half day of hands-on trainingwill be sponsored by an educa-tional grant from USSurgicalCorporation. ●

SAGES First Surgery Manual to Be Published Next Year

4

President Greg Stiegmann (left) presents a certificate

of recognition to Jay Tims,

Dexide Corporation,congratulating

him for his year as President

of the SAGESCorporate Council.

GERD Course Slated for Chicago inOctober – Call Now to Reserve a Place

Full programs for SAGES first AdvancedUpper GI Lap course will be available andmailed by early July. In the meantime, if

SAGES members wish to reserve a place as acourse registrant, please contact the office byphone or fax.

Course Title: Laparoscopic Approach to GERD

Date: Sunday, October 12, 1997, immediately preceding ACS Clinical Congress.

Place: Chicago (Palmer House Hilton)

Length of Course: Full day

Type of Course: Lecture and Hands-on-Lab

Corporate Council ElectsNew Officers and DirectorsSAGES Corporate Council approved the following slate of officersand directors at the General Membership meeting in San Diego:

OFFICERS President – Ellen Duke, BioEnterics Vice-President – Matthew McFarlane, Taut (2nd term) Treasurer – Riki Metzger, US Surgical (3 yr. term) Secretary – Patrice Downey, JARIT (last year of 3 yr. term)

DIRECTORSLarry Doll, BEI Medical Systems Lorne Elder, Welch Allyn Cindy Holloway, Valleylab Ed Standen, Ethicon Endo-Surgery* Bob Vrooman, Springer Verlag*

* New directors

Ellen Duke has long partici-pated as a member of theCorpora te Counc i l andhas previously held theoffice of Treasurer. She was ahigh profile participant ofthe joint SAGES/CorporateCouncil educational presen-tation to key policy makersin Washington in the sum-m e r o f 1 9 9 5 . M a t t h e wMcFarlane has also been along time member of theCouncil and is the first offi-cer to be re-elected to anoffice. Riki Metzger alsochairs the Exhibit AdvisoryCommittee which benefitsfrom her years of experienceas US Surg i ca l ’ s exh ib i tmanager. Patrice Downeyhas been a vital member ofthe Council since 1991 andc o m p l e t e s h e r t e r m a sSecretary this year.

Ed Standen, Ethicon’s newDirector of Professional Edu-cation has recently joinedthe Council and has alreadytaken an active role . BobVrooman i s a l so a morerecent participant of theCouncil and will continue tooccasionally publish the“ C o r p o r a t e C o r n e r ” i nSurgical Endoscopy. ●

Under the direction of Lee Swanstrom, MD,the hands-on GERD course has a limited regis-tration of 90.

The course will cover:• Fundamental skills• Patient selection• Pre Op testing• Basic techniques and problem solving• Complications• Advanced procedures

A complete registration form can be obtainedafter July 30 by contacting the office. ●

5

1997 SAGES Research Grant Award WinnersPrincipal Investigator: David Brams, MD

Project Title: Effect of HumidifyingInsufflated Gas onHypothermia due toPneumoperitoneum

Institution: Lahey Hitchcock MedicalCenter

Grant Support: Karl Storz Endoscopy Amount of Grant: $15,000

Principal Investigator: Mark Callery, MD Project Title: Kupffer Cell Activation and

LaparoscopicSurgery Institution: University of Massachusetts

Medical Center Grant Support: United States Surgical

Corporation Amount of Grant: $14,000

Principal Investigator: Ara Darzi, MD Project Title: The Effect of Laparoscopic

Surgery on IntraperitonealFibrinolytic Activity andAdhesion Formation

Institution: St. Mary’s Hospital Grant Support: United States Surgical

Corporation Amount of Grant: $14,000

Principal Investigator: Michel Gagner, MD Project Title: Blinded, Randomized,

Prospective Trial of ElectiveLaparoscopic Cholecystec-tomy with and withoutProphylactic Antibiotics

Institution: The Cleveland ClinicFoundation

Grant Support: United States SurgicalCorporation

Amount of Grant: $15,000

Principal Investigator: William Richards, MDProject Title: Prevalence of Gastroesophageal

Reflux in Patients who haveUndergone Heller Myotomy

Institution: Vanderbilt University Schoolof Medicine

Grant Support: United States SurgicalCorporation

Amount of Grant: $15,000

Principal Investigator: Jonathan Sackier, MDProject Title: Evaluation of Cerebral Spinal

Fluid Absorption duringAbdominal Insufflation

Institution: George WashingtonUniversity

Grant Support: Ethicon Endo-Surgery Amount of Grant: $15,000

Greg Stiegmann (left) presents SAGES’ firstDistinguished Service Award to SAGES’ Founder and first President Gerald R. Marks, M.D., F.A.C.S.,Edgar J. Deissler Professor of Surgery, Director ofComprehensive Rectal Cancer Center, Director of GISurgical Endoscopy, Allegheny University of the HealthSciences, Philadelphia, Pennsylvania. The plaque thatDr. Stiegmann presented read, “Founder, Pioneer,International Statesman in Endoscopic Surgery. You ledthe way. You fought the battles worth fighting. Youunderstood the role of endoscopy for surgeons. Youmade it easier for those who followed.”

Four patient education brochures will soon be available through the Educational Resources Committee and

through the generous support of an educational grant from U.S. Surgical.

The first samples will be sent to all members by the end of the summer. Members may order a supply at only $25 per hundred.

Look for the samples and order forms soon.

The four brochures are:

Laparoscopic Gallbladder Removal

Laparoscopic Colon Resection

Laparoscopic Hernia Repair

Laparoscopic Anti-Reflux Surgery

First Patient InformationBrochures Now Available

6

Valleylab Inc. recentlyannounced the intro-duction of its new

Tungsten LLETZ Loop Elec-trodes for precise tissueremoval in LLETZ and otherlocalized tissue-excision pro-cedures. The new VALLEY-L A B L L E T Z w i r e l o o pelectrodes, made from tung-sten, according to the compa-ny a r e d e s i g n e d to o f f e rgreater control and increaseddurability than stainless steelproducts . Tungsten wireresists breakage while provid-ing control against flexingand bending while in use.

Cirugia Laparoscopica y Toracoscopica was recently pub-lished by McGraw-Hill Interamericana and is now availablethrough their distributors in the United States, Spain, Portugal,and Latin America. The book is authored by Jorge Cervantes,M.D., F.A.C.S., Professor of Surgery.

Endoscopy of the Colon, Rectum, and Anus gives comprehensive coverage on all forms ofendoscopy for the lower gastrointestinal tract. It was published by Igaku-Shoin MedicalPublishers, Inc. The author is James M. Church, FACS, FRACS.

Molecular Genetics and Colorectal Neoplasia: A Primer for the Clinician makes themolecular genetics of colorectal cancer understandable to the physician caring for patientswith this disease. It was published by Igaku-Shoin Medical Publishers, Inc. The authors areJames M. Church, FACS, FRACS, Bryan R. G. Williams, PhD, and Graham Casey, PhD. ●

The Book Corner The Book Corner highlightsrecent books by SAGES mem-bers. If you have recentlyauthored or edited a book, submit the title, subject matter,publisher, publication date, andlocations where the book isavailable to the SAGES office.

CORPORATE COUNCIL TECHNICAL UPDATE

New Valleylab Lletz Loops Allow for Precise Tissue Excision

Reusable and single-useelectrodes with assorted loopsizes are available for a varietyof surgical needs. These wireloops are intended to mini-mize thermal damage andyield good histopathologyspecimens. Ball electrodes arealso available for fulgurationand desiccation.

According to Kay Clanton,VALLEYLAB Vice-Presidentof Marketing, “These elec-trodes were developed tomeet surgeons’ expectationss p e c i f i c a l l y f o r t i s s u eremoval in a wide range ofclinical applications.”

VALLEYLAB INC is a divi-sion of the Hospital ProductsGroup of Pfizer Inc. Valleylabtest data is available uponrequest. Contact Lauri Good-year at 303-581-6890.

U.S. Surgical Corp.In April, United States

Surgical Corporation releasedthe new MULTIFIRE ENDOGIA™ II Stapling System.This endoscopic stapler firesmultiple length staple lines ina single instrument.

The ENDO GIA™ II handleaccepts loading units thatdeliver 30mm, 45mm, and60mm staple lines. The ENDOGIA™ II Stapling System canbe fired 25 times in a singlecase, which is designed toreduce procedure costs.

S u r g i c a l a p p l i c a t i o n sinclude dividing and anasto-mosing stomach, small bowel,large bowel, and rectum, aswell as dividing the appendix.Vascular staplers are alsoavailable to divide mesentericand gastric vessels.

For more information, call800-321-0263 , extens ion51924, or contact your localAuto Suture representative. ●

7

Cancer Treatment Group(NCCTG), Southwest Oncol-ogy Group (SWOG), Cancerand Leukemia Group B(CALGB), Eastern CooperativeOncology Group (ECOG),R a d i o t h e r a p y O n c o l o g yG r o u p ( R T O G ) , a n d t h eNational Cancer Institute ofCanada (NCIC). Heidi Nelsonof the Mayo Clinic is the prin-ciple investigator for the trial.Patients without evidence ofmetas ta t i c d i sease wi thlesions in the right colon,hepatic flexure, splenic flex-ure, and left colon to the 15cm level are eligible for thestudy. The trial has been openfor patient accrual for the last1-1/2 years and, thus far, hasenrolled about 300 patients.The second randomized trialis a single-center study beingrun by Dr. Jef f Milson, aS A G E S m e m b e r , a t t h eCleveland Clinic.

There is no doubt that,with few exceptions, we, assurgeons, are strangers to theworld of randomized surgicaltrials. Most of us are reluc-tant to get involved in suchtrials. Involvement in a ran-domized trial requires astrong commitment on thepart of the surgeon. Enrollingpatients is also time consum-ing and can be a frustratingexperience. Adjusting yourthinking so as to accept therandomization, despite thefact that you may havestrong feelings about the use-fulness of the procedure inquestion, can be difficult.However, it is vitally impor-tant that we overcome thesereservations and becomeinvolved in randomized tri-als. The randomized trial isthe scientific way to answera clinical question. In thefuture, if the current politicaland economical climate per-

sists, we will probably haveto justify new procedureswith well performed studiesthat demonstrate a benefit.

The COST trial comparingopen and laparoscopic-assist-ed colectomy for cancer islooking for new investiga-tors. I urge SAGES memberswho are currently performingLACs to consider enteringthe trial. It is not that diffi-cult to enter, and being inthe trial is a satisfying expe-rience. I am proud to notethat half of the institutionalprinciple investigators in theCOST trial are SAGES mem-bers. Who better to perform alaparoscopic trial than themembers of the Society thatis committed to the properdevelopment of minimallyinvasive techniques! Interestedmembers may get informa-tion about the trial by con-tacting Dr. Heidi Nelson at507-284-3329. ●

View: from page 1

8

Learning Center ’97

Dr. Charles Filipi (center) demonstrates nissen wrap technique.

SAGES ’97 Sails into San Diego

At the gala hosted by U.S. Surgical, one of five fantastic musical groups entertains

at the cruise ship terminal where more than a thousand registrants relaxed

at the “Sailabration.”

Dr. Namir Katkhouda demonstrates some techniquesof minimal access upper GI surgery.A SAGES registrant tests his

skills while the ergonomics station records his movements.

Dr. Ramon Berguer(right) coordinated anergonomic measuringstation and survey as

part of the ‘97Learning Center.

Participants in the first OR Nurses Seminar andLuncheon. Left to right: Larry Whelan, MichaelMarohn, Trudy Kenyon, Jonathan Sackier, SueManicom, and Steve Eubanks.

9

Awards Ceremony

Carl Westcott is presented theprize for the Best Video at theSAGES meeting for his videoentitled “During EndosurgicalHeller Myotomy.”

Dr. Charles Nduka explains some of the fine points ofhis poster at the “Meet the Experts” Poster Session heldon Friday during the SAGES meeting in San Diego.

The second Pioneer in Endoscopy Award was presented toRobert Quint of the Circon Corporation for his “significantcontribution to the field of surgical endoscopy and his visionin enhancing science and technology for the care of ourpatients.” Left to right: Winton Berci, Vice-President, CirconCorporation; Dr. Frederick Greene, Chairman of the AwardsCommittee; Mr. Quint; Dr. Greg Stiegmann; Marc Effron,Group Product Manager, Endoscopy, Circon Corporation;and Richard Auhll, President, Circon Corporation.

Diego

Recipients of the 1997 Research Awards. Left to right: William Richards; Mark Callery;L. Yong accepting for Ara Darzi; AmyHalverson; Jonathan Sackier; Michel Gagner; B. Todd Heniford; Ed Standen, Director ofProfessional Education for EthiconEndoSurgery; and David Brams.

Dr. Frederick Greene(right) presents theaward for the BestResident Abstract toNinh T. Nguyen.

Go Wakabayashi was presented the second placeaward for Best Video atthe SAGES meeting.

Amy Halverson is presented with anaward for one of theBest ResidentAbstracts at theSAGES 1997 meeting.

★

Save This Date!SAGES Annual Meeting April 1-4, 1998

Seattle, WashingtonProgram Chairman: Daniel Deziel, MD, Associate Professor, General Surgery,

Service 1, Rush Presbyterian St. Luke's Medical Center, Chicago, IllinoisPostgraduate Course Director: Nathaniel Soper, MD, Professor of Surgery,

Washington University School of Medicine, Director, WashingtonUniversity Institute of Minimally Invasive Surgery, Staff Surgeon, Barnes-Jewish Hospital, St. Louis, MO

Wednesday, April 1, 1998 – Pre-conference hands-on course: MINI/OFFICE LAPAROSCOPY

Course Director: Steve Eubanks, MD

POSTGRADUATE COURSE: TIPS AND TECHNIQUES: THE DEVIL’S IN THE DETAILS

Two intensive half day sessions with the “how-to and when-to” maneuvers of the experts.

In 1998 SAGES will refine it’s practice of “the integrated meeting” by accent-ing the hands on skills needed for the postgraduate course topics in itslearning center. Exhibitors will also demonstrate equipment and techniquesfor the two major PG topics.

The didactic portion will take place at the Hotel. Registrants will then be trans-ported by shuttle to fully equipped animate laboratories in the Seattle area.

Mark Your Calendar! SAGES Symposium on Pancreatic Cancer

Slated for Wednesday Evening During ACSUnder the direction of William Traverso, M.D., SAGES will present a seminaron Pancreatic Caner - The Modern Approach. The program, which will beheld at approximately 5:30 PM on Wednesday, October 15th, is being present-ed in cooperation with SSAT (Society of Surgeons in the Alimentary Tract).

The course will include:

• State of the Art for Imaging• Endotherapy• The Role of Laparoscopy in Diagnosis and Treatment• Outcomes of Surgical Treatment for the Unresectable Patient • Outcomes of Surgical Resection• Unpublished results of chemoradiotherapy protocols, gemcitibine and

long acting sandostatin protocols

Space is limited register early!

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prove the comfort, safety, andefficiency of surgical opera-tions by better matching ourtools to the user’s characteris-tics—particularly in video-endoscopic techniques.

One of our primary focusesis to encourage interdisci-

plinary research of the anato-my, physiology, and psycholo-gy of surgeons at work. It isour hope that this effort,when paired with modernengineering design, will resultin surgical instrumentationand environments better suit-ed to the task and the user.Ultimately, better designswill enhance our ability toperform minimal access sur-gery and benefit our patientswhile minimizing costs.

As part of the 1997 SAGESprogram the task force stagedan ergonomics demonstrationstation at the learning centerwhich generated significantinterest from surgeons andmanufacturers alike. We alsodistributed a questionnaire forregistrants that polls surgeonsfor problems and inefficien-cies they have experiencedwith Laparoscopic surgery.The information gatheredfrom these activities will bepresented to the membershipand used to encourage manu-f ac tu re r s to adopt moreergonomic designs in futuresurgical tools.

The next step in theergonomics task force pro-g r am wi l l be a meet ingbetween committee membersand the SAGES corporatec o u n c i l a t t h e A C S i nChicago. We will present asummary paper on functionalergonomics problems in twospecific areas: Laparoscopicinstrument design, and Lap-a roscop ic v i sua l i za t iondevices. The program goal isto generate a lively and pro-ductive discussion about howto apply ergonomics princi-ples existent in industry toimprove the design of surgicalinstruments in these two

Formed six months ago,the task force’s goal is toencourage the objective

and scientific application ofergonomics to the design ofsurgical instruments, equip-ment, and the operating roomwork space. We want to im-

The SAGES Ergonomics Task Force: Bridging the Gap Between Surgeons and Manufacturers

(continued on p. 11)

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Legislative Update than all at once, as currentlyproposed.

A letter from SAGES toHHS Secretary Donna Shalalawill accompany our Tele-medicine guidelines and offerour expertise as the depart-ment of HHS begins to delveinto Telemedicine. One HHSdemonstration project willallow for Medicare paymentfor health services deliveredvia Telemedicine.

Consumer ProtectionCommission

Ms. Shalala will also headthe new Clinton appointedAdvisory Commission onConsumer Protection andQuality in the Health Careindustry whose first missionwill be to develop a consumerbill of rights. The 32 membergroup is comprised of a vari-ety of representatives includ-ing health plans and employeeorganizations.

SAGES Grass Roots Action

Under the direction ofJonathan Sackier, SAGES willattempt to mount a grassroots education program con-cerning one ore more basiclegislative issues. The ad hoctask force will meet over thesummer. If you are interestedin working with such a group

important areas. We envisionfuture programs involvingother surgical societies, theHuman Factors Society, andother experts in the field,focusing on how to developthe tools that best match theneeds and characteristics ofthe surgical team.

I encourage SAGES mem-

bers and corporate councilmembers to bring their ideasand concerns to the ergonomicstask force. SAGES remainscommitted to being a leader intechnology issues and main-taining a strong partnershipwith industry.– Ramon Berguer, MD

Chairman, Ergonomics Task Force ●

Ergonomics: from page 12

CPT & RUCAdvisors Appointed

SAGES takes an even moreactive role in shaping codingissues with the assignment ofadvisors to the AMA CPT andRUC Advisory committees.Charles (Chuck) Haynie hasassumed the responsibility ofserving as the CPT advisorand Aaron Fink as the RUCadvisor. These positions arequite demanding with pro-jects requiring time, attentionand special expertise. Dr. Finkis currently working on the“Phase III” correct coding ini-tiative involving over 200digestive codes. If you haveinterest in coding issues andwould like to be “on call” toassist Drs. Haynie and Finkplease contact Colleen Elkins,Manager of Legislative Affairsin the SAGES office. In addi-tion, Dr. Haynie will workwith the ACS to presentSAGES views to HCFA on theproposed development ofambulatory patient groups.

Committee ActionsSAGES continues to ally

itself with both the ACS andthe AMA on the impendingchange in the Medicare con-version factor. Unified effortsare being pursued in hopes ofimplementing the changeover a three year period rather

on a local or state level, pleasecontact Colleen Elkins at theSAGES office.

AMA Membership SAGES gained a seat on the

AMA house of delegates(HOD) after several years ofworking towards this goal.Membership on the HOD isavailable only to those organi-zations having more than 50%of their members as membersof the American MedicalAssociation. We want toassure our secure place at thetable. Please don’t let yourAMA membership lapse. Ifyou need information abouthow to join the AMA, Pleasecall 1-800-262-3211.

HMOs New Disclosure Rules

Based on a case alleging thatthe patient died because hedid not receive a referral fromhis primary care physician toa cardiologist, a US court ofappeals has held that HMOsare required to disclose anyfinancial incentive that dis-courages doctors from makingreferrals to specialists. In arelated case, the largest HMOin Texas agreed to divulge tosubscribers that the doctors’compensation can be reducedif they utilize too manyhealth care services. ●

New Membership Lists and By-Laws Available

In an effort to cultivate a leaner, morestreamlined administration, SAGES willprint and mail a new membership bookletwith by-laws every two years. However,those member who do use the list regu-larly may request it from the SAGESoffice via phone, mail, fax, or e-mail. ●

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President’s Message: continued from page 1ing flexible endoscopy. Wehave worked to correct orimprove these situations, butour success has been an uphillcampaign. We continue thisbattle with good reason. Thesame reasons we were found-ed in 1981.• It is often better for the

patient to have the eventualoperation performed by theperson who performed thediagnostic endoscopy. Thenthere is no ‘translator’ ofthe findings which has atendency to not always rep-resent the exact situation.Whenever it is possible forthe patient to see one physi-cian instead of two, theflow of care is smoother.

• Surgeons should be wellprepared to perform thera-peutic endoscopic proce-dures as well as diagnosticendoscopy, particularly astheir knowledge of diseaseand how it relates to surgi-cal anatomy, the surgical

alternatives, and ability tohandle the complications ofGI endoscopy make them anatural choice for the per-formance of therapeuticprocedures . Combiningdiagnosis with therapy iscost effective and better forthe patient.

The leadership continues toagonize over the question of“numbers.” Our guidelinesnow contain minimal num-bers, these are less than thenumbers required by ASGE.Currently our numbers arebeing examined with a viewto revision. What do numbersmean? How do they guaranteethat you know what you arelooking for, whether you canrecognize it, and whether youknow how to treat it. We havealways believed and contin-u e d t o p r o c l a i m t h a tendoscopy is all about cogni-tive skills and the ability totreat GI disease. We maintainthat surgeons require fewernumbers because they con-

stantly work in the anatomy,they see disease lesions and asa result easily recognizethem. We therefore feel thatit takes fewer training ses-sions to become competent.

New TherapeuticTechniques and How toTeach Them

We have two challenges forpracticing surgeons:

• Surgeons who learned endo-scopy during training butuse it infrequently. For thissurgeon we have biennialrefresher seminars or work-shops to help hone skillsand learn state of the arttechniques. While we donot have a preceptorshipregistry, the SAGES stafffrequently help with refer-rals to learning centerswhich provide clinicalexperience.

• S u r g e o n s w h o l e a r n e dendoscopy and have integrat-

Does Your Hospital Utilize SAGES Guidelines?

In an effort to assurebroade r u n d e r s t a n d -i n g a n d a c c e p t a n c e

o f S A G E S guidelines ongranting of privileges, we needyour help. It will take aboutfive minutes. Please calleither the Chairman of theDepartment of Surgery or thechairman of the committeeon privileges in your hospitaland ask the following ques-t i o n s . F a x t h e form toSAGES no later than July 30.Your five minutes of inquirywill give us the informationwe need to fu r ther safe-guard pat ient sa fety andsurgeon access. Thanks.

Please return this form via fax (310-314-2585) to Sallie Matthews ●

Is your hospital aware of and/or utilizing any of the followingSAGES Guidelines?

GUIDELINES AWARE OF USESFlexible Endoscopy Privileging Guidelines: ❏YES ❏NO ❏YES ❏NO

Laparoscopic Privileging Guidelines: ❏YES ❏NO ❏YES ❏NO

Framework for (in determiningPost Residency privileges)

Surgical Education & Training: ❏YES ❏NO ❏YES ❏NO

Standards of Practice Guidelines: ❏YES ❏NO ❏YES ❏NO

If yes, which Standards of Practice Guidelines are you aware of?____________________________________________________________________________________________________________________

Comments: __________________________________________________________________________________________________________________________________________________________________

(continued on page 13)

13

ed it into their practices, butneed training in emergingtherapeutic techniques.While the above outline sem-inars are helpful for thesesurgeons, and our annualmeeting features new tech-niques, we are now preparingmore intensive trainingcourses. Under the directionof Jeffrey Ponsky, an ad hoctask force is preparing recom-mendations to address thistraining need in a way thatwill be meaningful. Shortcourses which serve only 30-50 surgeons are not necessar-ily the most effective way toteach. We are also workingon high tech methods tobroadcast new techniques toour members.

Flexible Endoscopy inResidency Education

SAGES has of fered twointensive weekend courses peryear in flexible endoscopy.Through the generous supporton Ethicon Endo-Surgery,

these have served as an impor-tant adjunct to residents whoare supposed to be learningflexible endoscopy as part oftheir residency training. Thebest venue is for direct train-ing at the resident’s own insti-tution with an experiencedmentor. It is uncertain howm u c h p r o g r e s s w e h a v eachieved since SAGES wassuccessful in encouraging theRRC to include endoscopytraining in residency. Theissue of the GI suite in controlof gastroenterologists stillexists. Many 4th and 5th yearresidents tell us that theycan’t “get their hands on ascope.” That is political issuethat we contend with daily.But another, more pressingproblem is that all of us,together, have not been con-vincing enough in impartingto our young colleagues thevalue of flexible endoscopy tothe general surgeon. We needto convince them of the poten-tial effectiveness of performingendoscopy for their patients.

SAGES is in the process ofrevising our residency curricu-lum guidelines. We continueto press for an endoscopicinstructor or director in everygeneral surgical residency pro-gram. We are working withthe APDS (Association ofProgram Directors in Surgery)to assure that surgeons intraining are obtaining ade-quate training in flexibleendoscopy.

I urge all of you to pressyour residents to incorporateflexible endoscopy into theirfuture surgical practice.

SAGES wi l l publ i sh inJanuary’s issue of SurgicalEndoscopy a tip list for resi-d e n t s o n t h e “ T e n B e s tReasons to Incorporate Flex-ible Endoscopy into SurgicalPractice.” It wouldn’t be a badidea for our members to readit to remind ourselves why weshould all do it…for the bene-fit of our patients.

– Desmond Birkett, MD, FACS,President ●

Continued from page 12

14

New President Announces Committee Chairpersons

1997 Committees

ASSETS MANAGEMENT Chair: Ted Schrock

AWARDS Chair: Frederick Greene

BYLAWS Chair: Irwin Simon

CONTINUING EDUCATION

Chair: Lee Swanstrom Co-Chair: Nat Soper

CREDENTIALS Chair: Gary Vitale Co-Chair: Steve Wexner

DEVELOPMENTChair: George Berci Co-Chair: Jeff Ponsky

EDUCATIONALRESOURCES

Chair: Doug Olsen Co-Chair: David Edelman

ETHICSChair: Lee Sillin Co-Chair: Thom Lobe

FINANCE Chair: Steve Unger, Treas.

LEGISLATIVE REVIEW Chair: John Coller Co-Chair: Aaron Fink

MEMBERSHIPChair: Jonathan Sackier Co-Chair: Sherry Wren

NOMINATING (per Bylaws)Chair: Greg Stiegmann

PROGRAM Long-TermChair: Jeffrey Peters

1998 Program Director: Daniel Deziel

1998 PG Course Director: Nathaniel Soper

PUBLIC INFORMATION Chair: Eli Lerner

RESEARCH Chair: Steve Stain Co-Chair: Bill Laycock

RESIDENT EDUCATION Chair: Bruce Schirmer Co-Chair: Steve Eubanks

STANDARDS OF PRACTICEChair: Keith Apelgren Co-Chair: Dan Smith

STATE CHAIRPERSONSChair: Bob Fitzgibbons Co-Chair: Sherry Wren

TECHNOLOGY Chair: Steve SchwaitzbergCo-Chair: Scott Graham

SCOPE EDITOR Larry Whelan

SAGES educational resources committeeannounces the availability of printed tipson how to make a good video. Developed

President Desmond Birkett has announced 1997-98 Committee Chair appointments.

The following SAGES members will serve.

Video Production Guidelines Availableby Zoltan Szabo, Ph.D., the outline is availableby calling, faxing, or sending an E-mail requestto the SAGES office. ●

15

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SAGES Board of Governors:President:

Desmond H. Birkett, M.D.President-Elect:

John Hunter, M.D.Vice President:

Barry A. Salky, M.D.Secretary:

Jeffrey H. Peters, M.D.Treasurer:

Stephen W. Unger, M.D.Members of the Board:

Maurice E. Arregui, M.D.John A. Coller, M.D.

John Morgan Cosgrove, M.D.Karen E. Deveney, M.D.Daniel J. Deziel, M.D.

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Col. Richard M. Satava, M.D.Bruce D. Schirmer, M.D.

Carol E. Scott-Conner, M.D.Irwin B. Simon, M.D.

Nathaniel J. Soper, M.D.Steven C. Stain, M.D.

Greg V. Stiegmann, M.D.Lee L. Swanstrom, M.D.

L. William Traverso, M.D.Gary C. Vitale, M.D.

R. Larry Whelan, M.D.

S C O P E

EDITOR IN CHIEF:Keith Apelgren, M.D.

CO-EDITOR:Mohan Airan, M.D.EXECUTIVE EDITOR:

Barbara Saltzman Berci

SAGES2716 Ocean Park BoulevardSuite 3000Santa Monica, CA 90405Tel: 310/314-2404Fax: 310/314-2585E-mail: SAGESMail@aol.com

Several past presidents gettogether to congratulateOutgoing President GregStiegmann on a superb yearfor growth and progress. Left to right: George Berci;Tom Dent; Bruce MacFadyen,Jr.; Gerald Marks; Dr.Stiegmann; IncomingPresident Desmond Birkett;Frederick Greene; JohnColler; and Richard Satava.

Two prominent members of SAGES model the newSAGES striped laparo tiefor Dr. Sayeed Ikramuddin.Left to right, the prominenttie models are Dr. WilliamScott Melvin and Dr.Michael Marohn, USAF.