World Class Doctors

Dr. Charles Koh and Dr. Grace Janik: Laparoscopic Trailblazers

(excerpte/images/upload/mkemag_big.jpgd from Milwaukee Magazine)

In the midst of a medical conference last fall in Atlanta, Dr. Charles Koh flew back to St. Mary's in Milwaukee to perform a hysterectomy. The Atlanta conference then watched Koh, 56, operate via closed-circuit television. But what set the procedure apart was something else: Koh never opened up the patient.

Koh and his colleague, Dr. Grace Janik, have been leaders in using smaller and smaller instruments to do more and more complicated gynecological surgery. Whether its repairing prolapsed uteruses, performing hysterectomies or treating endometriosis, Koh and Janik, 41, are among a small number of doctors nationally using laparoscopy. The technique involves passing a slender tube into a small incision in the body to view the area of surgery and the use of specialized instruments also inserted through small incisions.

By using laparoscopy, surgeons can avoid cutting open the abdomen to perform the same procedures, Koh explains. The change in technique reduces the risk of infection and the number of days patients must spend in the hospital.

Koh and Janik are part of the Milwaukee Institute of Minimally Invasive Surgery at St. Mary's Hospital, where Koh is Co-Director. Six years ago, they were the first to use microsurgery to reverse a tubal ligation in a woman who had been sterilized.

The work can be like walking a tightrope. Koh compares it to the delicate work of a jeweler, especially when the surgery is intended to cure infertility. "Once you do it badly, that's the end - there is no repair."

They are contrasting colleagues: Koh is courtly, his hair graying, and favors New Age music in the operating room; Janik is matter of fact and orders up the Rolling Stones when she operates. Both say they're willing to push the envelope a bit. For instance, they use the microsurgical procedure to perform hysterectomies even on larger uteruses other gynecological surgeons would prefer to take out the conventional way.

The minimally invasive surgery institute has been marketing its services on the Internet, where patients and their doctors have started to discover it. But managed care plans haven't yet been universally sold, Koh acknowledges, despite the procedure's track record for cutting hospital stars and complications.

We're trying to get that across even in Milwaukee," says Janik. The pair have collected a lot of data on the process. Once they did it mainly for academic purposes, but they have another goal now: to demonstrate cost-effectiveness.

"We've spent the last 10 years trying to be the best and the brightest, and then to show our peers," says Koh. "That's easy. Now we're trying to show the HMOs. That's less easy."




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