Camran Nezhat

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Camran Nezhat MD , MD, FACOG, FACS is a laparoscopic surgeon, reproductive endocrinologist and subspesial infertility who has taught and practiced medicine and surgery as an adjunct clinical, and obstetrics and gynecology professor at Stanford University Medical Center in Palo Alto, California since 1993. Nezhat is also Chairman of the Clinical Faculty Association, Stanford University School of Medicine, and Clinical Professor of OB/GYN at the University of California, San Francisco.

Dr. Nezhat is a leading pioneer and practitioner in the field of laparoscopic surgery, also referred to as minimally invasive surgery, endoscopy, keyhole, and Band-Aid. Nezhat is renowned for its surgical innovation known as video-laparoscopy or "surgery from monitors," a method now widely accepted but which, to date, is considered a controversial and questionable departure from classical laparotomy or open surgery.

Video Camran Nezhat

Surgical technique

Nezhat introduced several innovations that were originally regarded as an unacceptable deviation from classical surgical techniques. The first departure from traditional surgical methods occurred around the mid-1970s, when Nezhat began experimenting in the laboratory by "operating the monitor," a phrase that refers to the method of performing endoscopic surgery (referred to as laparoscopes when used for abdominal surgery) when viewing a TV/video monitor in an upright position, operates a video image, rather than looking directly at the patient. Prior to Nezhat's innovation, surgeons perform laparoscopes while looking directly into the endoscopic lens, a method that limits their ability to perform surgery by allowing only one free hand, restricting their field of vision, and requiring them to bend and move awkwardly. position.

With this physical limitation in place, surgeons find it hard to believe that operative laparoscopic techniques can replace classical surgery and, initially, many in the medical community consider all ideas to be untenable, unrealistic, and dangerous. The idea of ​​using endoscopy as an instrument of operation also contradicts the at least 200 years of medical tradition, which has formed endoscopes, since about 1806 the debut of modern endoscopes by Philip Bozzini, as the ultimate diagnostic tool; the application of surgery in gynecology is limited to simple interventions, such as lysis adhesion (removal of scarring), biopsy, cyst drying, neoplasmal cautery, and tubal ligations. When Nezhat began using his new video-laparoscopic technique to operate the monitor in an upright position, he was able to achieve more sophisticated operating procedures for the first time. Performing this continued operation laparoscopically is the second orthodox conceptual change introduced by Nezhat. Other innovations by Nezhat that are considered controversial include the introduction of new surgical procedures and new surgical instrumentation designed specifically for use in laparoscopy. Since these new surgical concepts are contrary to established and perceived classical surgical norms, Nezhat falls under intense scrutiny and criticism from people within the major medical firms, and then from national newspapers (see section " Controversy "below). For the next 25 years Nezhat became one of the most visible and controversial figures in the minimally invasive movement because of his vocal advocacy of this new technique and continued to push the envelope by performing more sophisticated laparoscopic procedures. Even until the 2000s, there were many opponents of these techniques that continue to question the safety and need for video-laparoscopy, especially when used for more advanced laparoscopic techniques. However, around the mid-1990s it was learned that most of the early doubts about video-laparoscopy had subsided because at that time the most prominent academic medical schools in the United States, such as Stanford University's Medical Faculty, had adopted this change. and began to teach it as part of the standard medical school curriculum. In the early 2000s, many medical societies, such as the American Association of Gynecologic Laparoscopists, the Society of Laparoendoscopic Surgeons, and SAGES, also began offering scholarships in advanced video-laparoscopic surgery.

There are still some contraindications to advanced video-laparoscopic surgery, such as in the emergency room. However, with this and several other exceptions, today the debate has now been resolved in favor of sophisticated laparoscopic video-surgery for most surgical situations. The mainstream medical community has acknowledged the operation of laparoscopic monitor-in-video monitors into gold standards in various disciplines, such as gynecology, gastrointestinal, thoracic, vascular, urological, and general surgery. For this reason, Nezhat has been cited by laparoscopic surgeons as the father of modern laparoscopic surgery, to introduce important technological and conceptual breakthroughs that help the drug move toward minimally invasive surgery.

The reason that the medical community now considers advanced laparoscopic video-surgery is essential is that it provides an alternative to classical surgery - laparotomy - which requires a large incision, between 12-14 inches, which exposes the patient to serious, life-threatening complications. This large incision is held open by a metal clamp, called the retractor (see figure), which creates more trauma to the tissues. Although this open method is suitable for the surgeon, this method is very debilitating and painful for the patient, causing more adhesion (scarring), wider blood loss, requiring large volume blood transfusions, and requiring longer hospital stay, with 1 -3 weeks. in the hospital, including possible time in the ICU, is considered a normal outcome. Another serious complication is a chronic incisional hernia, a condition in which the incision fails to heal, causing it to continuously break out and rupture, even years after surgery. However, the most important difference is that, when compared to laparoscopy, laparotomy causes more serious, permanent, and life-threatening complications, including higher incidence of death.

In the late 1970s, with the exception of several surgical virtuos, such as Raoul Palmer, Patrick Steptoe, and Kurt Semm, gynecological surgeons were only able to use laparoscopes to perform some simple surgical procedures, such as cyst aspiration, lysis. adhesion, cautery of neoplasms, biopsies, and tubal ligations. This means that other more complicated gynecological surgery procedures, such as advanced endometriosis treatment (stage IV), hysterectomy, radical hysterectomy for cancer, aortic node dissection, tubal reaanastomosis (reconstructive surgery of the fallopian tube), full ovarian cyst removal, and myomectomy ( full removal of fibroids), can only be done through laparotomy. Some of these conditions, such as endometriosis, fibroids, and cysts, can be chronic diseases that require multiple surgical interventions. This means that, before minimally invasive surgery, many women undergo double laparotomy only for mild pathology. In this case, laparotomy surgical intervention is considered more damaging than the disease itself. Before the advent of laparoscopic video, other types of surgery (from other disciplines), such as the removal of the gallbladder (colecystectomy), intestines, bladder, and ureter resection and reaanastomosis, etc., are also possible only through laparotomy.

Maps Camran Nezhat

Controversy

This division between old and new ways leads to a very strong philosophical debate within the medical community, causing antagonism between classical surgeons versus laparoscopy. Opposite minimally invasive opponents accuse laparoscopists of hiding the extent of their complications and advancing dangerous methods to seek fame and financial gain. Advocates accuse classical surgeons of advocating outdated surgical procedures that are harmful to patients, because they do not want to spend time and money on learning new techniques. In the late 1990s and early 2000s, this internecine battle became very intense, culminating in the more serious allegations committed against laparoscopy, including Nezhat, who came to represent one of the most minimally invasive movements of the movement.

Two lawsuits in particular also triggered national media coverage of Nezhat and minimally invasive surgery. Beginning around April 2000, a series of newspaper articles were published about Nezhat, and two of his surgeon brothers, Farr and Ceana, outlined all the allegations claimed in this lawsuit. In one case, filed by a former patient, Debra Manov, an online court note showed that the patient withdrew his medical malpractice claim with prejudice on July 21, 1998, after not being able to find a medical expert to corroborate his claim. The judge ruled that the claim was unfounded and/or frivolous and dismissed the whole case of Manov. The judge imposed a fine on Manov's lawyer for filing a reckless suit.

Another former patient, Mary (Stacey) Mullen, and her lawyer, Jim Neal, claimed that Nezhat's operation caused permanent damage to her intestines. Mullen and Neal (and then Mullen's new lawyer, Byrne) also accuse Nezhat of batteries and engage in violation of RICO (Influenced and Corrupt Organization Ranger). The judge found this and several other claims unfounded and reckless. Jim Neal was disqualified from the Mullen case by a Georgian judge in 1995 for "unethical behavior..." After a federal judge ruled out Neal's attempt to use the alleged blackmail of Nezhat, Neal was accused of insulting the court.

The final result is unknown to some parts of Mullen's lawsuit, as some court records are sealed. However, what courtesy of recording an online event is that Mullen withdrew his lawsuit on May 24, 2002. Later news reports out describing the case as "resolved," indicating that an out-of-court settlement has been reached.

For both of these cases, plaintiff's lawyer, Jim Neal, hired two doctors affiliated with Stanford, Dr. Thomas Margolis and Dr. Nicola Spirtos, as his medical expert. Spirtos and Margolis, two gynecologic surgeons who were partners at the Palo Alto clinic called the Women's Cancer Center (now closed), also accused Nezhat of various offenses, including conducting dangerous experimental surgery with laparoscopes. They suggested that Stanford fail to fully investigate Nezhat because of his high status - he was referred by the press as a celebrity surgeon - reportedly translating to millions of dollars for their profits. In Nezhat's defense, officials at Stanford say they investigate any claims and find them unfounded, and describe Spirtos and Margolis as "jealous competitors". In this case, Stanford officials and Nezhat supporters say Spirtos' personal clinical practice is one floor away from Nezhat. Spirtos also lost elections at Stanford to Nezhat, to the position of deputy head of the department of obstetrics and gynecology.

Nezhat supporters say the operation is not experimental. Dr Robert R. Franklin, a clinical professor in the department of obstetrics and gynecology at Houston Baylor College of Medicine, says that In my opinion, surgery performed on Mary (Stacey) Mullen is a necessary procedure and will not require a special consent form for experimental operations.

The controversy continued when it was reported that Spirtos had sued Stanford in 1991 for defamation - claiming several things, including that he was discriminated against after becoming affiliated with the Women's Cancer Center, and that Stanford retaliated against him for speaking out against Nezhat. Santa Clara County Superior Court Judge found this lawsuit unfounded and fired him (case of Spirtos M.D. -Vs-Stanford University, case number 1-01-CV-796939). The case is underestimated by the judge and the court gives $ 12,000 to Stanford attorney fees, paid by Spirtos and his lawyers.

On February 21, 2001, Nezhat's research was also suspected after a medical journal decided to withdraw two of his articles, both of which were co-written by his brother, Dr. Farr Nezhat, and a colorectal surgeon. Earl Pennington. The data collected for these two articles is flawed. Opponents claim that this error is deliberate and is a research fraud. Proponents say that "little difference in patient data has no impact on paper conclusions." It was reported that the journal's decision to retract the article was motivated by a fear of lawsuits for having received dozens of complaints by lawyer Jim Neal since around 1993.

In response to growing concerns about the work of Nezhat, in November 2000, Stanford assembled a blue ribbon committee, with former California Supreme Court Justice Edward A. Panelli as the principal investigator. Another committee member is a medical ethicist from UC Davis, and a retired dean of Harvard University School of Medicine. On December 21, 2001, after more newspaper articles came out about Nezhat, Phil Pizzo, who had been appointed dean of Stanford medical school in April 2001, announced that he had decided to suspend Nezhat and his two brothers until he could do more many investigations on this issue.

In August 2002 the ad-hoc committee released its findings. It establishes that all these allegations are unfounded and groundless, concluding that none of Nezhat's three brothers are involved in any wrongdoing. Nezhat was reinstated to Stanford in August 2002. On the suspicion of research fraud, the committee reported that they found that mistakes were made in two retracted articles, but none of the hundreds of other publications by Nezhat were reviewed. The committee and Stanford cleaned the Nezhats out of any error, determined that the error was small, unintentional, and had no impact on the paper's conclusions. Two state medical agencies - from California and Georgia - launched their own investigations into Nezhat and also found him innocent of any wrongdoing.

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Early life and education

Nezhat was born in Shahreza, Iran, a small rural town in the central part of the country. After taking the college entrance exam, Nezhat's score made him eligible for admission to the Faculty of Medicine of Tehran University, located in the capital city of Tehran. He attended 1965-1972, and received his medical degree in 1972. After fulfilling the mandatory requirements, Nezhat attended and completed his residency program in midwifery and gynecology at the State University of New York at Buffalo, from 1974-1978. He completed the fellowship in reproductive and infertility endocrinology in Augusta, Georgia, under Drs. Robert Greenblatt and Don Gambrell. Having fulfilled this alliance from 1978-1980, Nezhat started his own private practice in Atlanta, Georgia, with hospital privileges at Northside Hospital. He became certified by the American Board of Obstetrics & amp; Gynecology in 1982. Nezhat holds a medical license in the states of Georgia and California.

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References

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Further reading

1. AAGL 2009 Honors Chair
2. Time Magazine, April 28, 1986. "Drugs: The Career Woman's Disease?" Claudia Wallis, Cristina Garcia/San Francisco and Suzanne Wymelenberg/Boston
3. Newsweek. October 13, 1986 pg 95 "Conquering Endometriosis" Clark, Matt, Carroll, Ginny
4. Cowley G (February 1990). "Hanging a knife, a new surgical technique promises to save patients time, money and blood." Newsweek . 115 (7): 58-9. PMIDÃ, 10120634. < span>
5. Business Week. September 27, 2004; pp. 121-122 "Women's operation: Less of a trial" Cropper, Carol Marie
6. MarketWatch February 7, 2005 "Robot as dissident dissenter" Gerencher, Christian
7. The San Francisco Examiner May 26, 2005 "Fertility surgeries capture success 10 years later" Wein, Josh
8. Mountain View Voice Volume 14 No 7 February 10, 2006 "A baby by all means" Sadoughi, Marjan
9. Conceive Magazine Spring 2006 Vol 3 Issue 1 "Dayna Story: From endometriosis to happy ending" Sherwood, Sarah
10. The Wall Street Journal December 13, 2005 Part D1 "What do you need to know before starting IVF" Westphal, Sylvia Pagan
11. OBGYN.net- Advisory Board: Camran Nezhat, M.D.
12. Stanford News
13. Nezhat Medical Center: Released (pdf)
14. Emory Caselaw: 11ca
15. ... The judge concluded that "the claim in the case has no factual basis..."
16. Inaccurate press coverage raises concerns at the Medical Center

Source of the article : Wikipedia