>> WHEN WE FIRST STARTED MINIMALLY INVASIVE SURGERY
AT CHOP, WE COULD PRETTY MUCH DO APPENDECTOMIES,
PYLOROMYOTOMIES FOR PYLORIC STENOSIS,
AND MAYBE A FEW OTHER MINOR THINGS.
>> WE NOW DO EVERYTHING THAT CAN BE DONE IN A PROPER
MANNER WITH A MINIMALLY INVASIVE APPROACH.
>> WE CAN TAKE OUT DEFECTIVE LOBES OF THE LUNG.
WE CAN REPAIR THE ESOPHAGUS.
WE CAN REMOVE DUPLICATION CYSTS.
WE CAN FIX REFLUX DISEASE.
IN FACT, CHOP OFFERS OVER 100 DIFFERENT PROCEDURE
CODES FOR MINIMALLY INVASIVE PROCEDURES ALONE.
>> IN THE OLD DAYS WE WOULD THINK ABOUT DOING
A PROCEDURE OPEN.
NOW WE ALWAYS THINK ABOUT,
"CAN WE DO THIS MINIMALLY INVASIVELY?"
>> HAVING A TEAM IS CRITICAL TO MAKING THIS WORK
THE RIGHT WAY.
>> TEAMWORK IS THE MOST IMPORTANT THING THAT
WE DO HERE.
>> THE REASON THAT WE CAN DO ALL THOSE DIFFERENT
PROCEDURES IN THE DAYTIME AND THE NIGHTTIME,
ON THE WEEKDAY OR ON A WEEKEND IS THAT ALL THE
NURSES ARE VERY, VERY WELL TRAINED IN THESE TECHNIQUES.
>> WITHOUT THE INSTRUMENTS AND WITHOUT THE THINGS THAT
WE PUT IN PLACE, THEY COULDN'T DO THEIR SURGERY.
SO BASICALLY, AS THE SPECIALTY NURSE,
I HAVE TO MAKE SURE THAT THE INSTRUMENTS WE HAVE ARE
FUNCTIONAL, AND THAT WE HAVE THE INSTRUMENTS THAT EACH
DIFFERENT DOCTOR NEEDS FOR EACH DIFFERENT SURGERY
THAT HE DOES.
>> SHE HAD TO LEARN HOW EVERY SINGLE ONE OF THOSE
THINGS WORKED AND THEN TEACH THAT TO ALL THE OTHER NURSES
IN THE OPERATING ROOMS.
>> SO THAT WE CAN HAVE THAT SORT OF QUALITY 24 HOURS
A DAY, 7 DAYS A WEEK.
>> MINIMALLY INVASIVE SURGERY IS A VERY
TECHNICAL ENDEAVOR.
YOU'RE DEPENDENT ON HIGH TECHNOLOGY TO DO
THE PROCEDURES.
>> YOU NEED AN INDUSTRY PARTNER HERE ON SITE TO HELP
YOU SOLVE THESE PROBLEMS IN REAL TIME.
>> AND THAT'S WHERE LEM COMES IN.
LEM IS LIKE A SECRET WEAPON.
LEM IS LIKE OUR ACE UP THE SLEEVE.
>> WHERE THE NURSE IS CONCERNED WITH THE PATIENT,
MY JOB IS TO BE CONCERNED WITH THAT ROOM.
IT'S A UNIQUE POSITION.
THERE'S NOT TOO MANY ON-SITE TECHNICIANS IN THE COUNTRY.
>> LIKE ANY COMPLEX ELECTRONICALLY DRIVEN
SYSTEM, YOU CAN HAVE BREAKDOWNS IN THAT SYSTEM.
YOU CAN HAVE GLITCHES THAT OCCUR,
AND THEY CAN DURING SURGERY OR BEFORE OR AFTER SURGERY.
>> ONCE THE ROOMS ARE UP AND RUNNING,
WE THEN MOVE ON TO THE INSTRUMENTS.
>> OUR INSTRUMENTS HAVE TINY LITTLE MOVING PIECES.
VERY, VERY FINE ACTION AT THE TIPS,
AND THEY'RE-- THEY'RE JUST DELICATE.
THEY DON'T LAST NEARLY AS LONG AS THE OPEN KIND
OF TOOLS DO.
AND, AS A CONSEQUENCE, WE'VE GOT TO REALLY PAY ATTENTION
TO MAKE SURE THAT THE TOOLS THAT WE'RE USING ARE STILL
IN GOOD WORKING ORDER.
>> YOU'RE CONSTANTLY CLEANING, OILING, MAINTAINING,
ADJUSTING, TIGHTENING ALL THESE INSTRUMENTS,
AND MAKING SURE THIS EQUIPMENT,
EVERY CASE, IS JUST LIKE NEW.
>> PORSCHE PERFECT FOR EVERY PROCEDURE,
FOR EVERY BABY, EVERY SINGLE TIME.
>> VERY OFTEN WE FIND THAT THE TOOLS WE USE DON'T WORK
EXACTLY THE WAY WE WANT IT TO.
SOME OF THE THINGS WERE DESIGNED PERFECTLY FOR
THE BABIES, BUT MOST OF THE THINGS WEREN'T DESIGNED
FOR CHILDREN.
AND WE'VE ADAPTED THEIR USE, BUT EVEN THOSE WILL
HAVE PROBLEMS.
>> YOU HAVE TO GET INDUSTRY TO PLAY ALONG BECAUSE THEY
HAVE THE HORSEPOWER TO MAKE THE THINGS THAT YOU NEED.
SO WE GENERATE THE IDEAS.
THEY GENERATE THE INSTRUMENTS.
>> AND WE CAN GIVE THEM VERY SPECIFIC
RECOMMENDATIONS.
YOUR TOOL WOULD HELP US IF IT DID THIS.
>> HAVING THAT INNOVATION DONE HERE TRANSLATES OUT
INTO THE FIELD IN ALL THE OTHER HOSPITALS.
>> KIDS WOULDN'T SURVIVE AS WELL,
OR DO AS WELL, IF WE DIDN'T HAVE THE TEAMS THAT WE HAVE
AND IF WE DIDN'T COMMUNICATE THE WAY WE DO.
>> THERE ARE NINE GENERAL SURGEONS ON THE STAFF HERE
AND ALL OF THEM USE MINIMALLY INVASIVE
TECHNIQUES IN THEIR PRACTICES.
MOREOVER, SOME OF THE UROLOGISTS ARE NOW USING
THESE METHODS, INCLUDING THE ROBOT.
SOME OF THE NEUROSURGEONS USE SOME OF THESE
TECHNIQUES, EVEN USING MINIMALLY INVASIVE SURGERY
IN THE HEAD.
THE EAR, NOSE AND THROAT DOCTORS HAVE ALWAYS USED
DIFFERENT SCOPES, BUT NOW THEY HAVE DIFFERENT TOOLS
THAT THEY USE.
AND, OF COURSE, THE ORTHOPEDIC DOCTORS ARE USING ARTHROSCOPY,
OR LOOKING INTO THE JOINT, THAT WAY.
SO, ESSENTIALLY, THIS HAS BECOME A VERY NORMAL PART
OF WHAT WE DO AT CHOP.