UNC Surgery Pioneer Publishes Third Edition Of Laparoscopy Text

July 01, 1998

By ALLISON ADAMS
Carolina Population Center

CHAPEL HILL -- In laparoscopic surgery, the physician makes a small incision and inserts a video camera and special instruments to see and to operate inside the body. As the procedure has increased in effectiveness, so has its popularity spread for many types of surgery. Patients benefit by less invasive operations, faster recovery and lower costs.

"It is hard to imagine that laparoscopy was once a controversial technique when introduced into the United States in the late 1960s," said Dr. Jaroslav F. Hulka of the University of North Carolina at Chapel Hill.

Hulka, one of the first U.S. physicians to use laparoscopy for elective sterilization, has taught a generation of physicians to perform it safely. Now professor emeritus of obstetrics and gynecology and of maternal and child health at the UNC-CH schools of medicine and public health, he serves as a fellow at the Carolina Population Center.

His newest contribution to medical science is the third edition of his "Textbook of Laparoscopy," just published by W.B. Saunders Co. Dr. Harry Reich, director of advanced laparoscopic surgery at Columbia Presbyterian Medical Center and a Columbia University faculty member, is co-editor. Reich was the first to use laparoscopy for hysterectomies and was widely criticized at the time. Today, a third of hysterectomies are done that way.

Their book, written with support from the population center, includes chapters by surgeons and illustrations by artist John Parker. Hulka's interest in fertility management attracted him to the center in 1966. That was about when Patrick Steptoe, a British physician, wrote the first book in English on the new sterilization technique. Hulka soon bought a laparoscope and began experimenting.

"There were no courses to learn how to use it," the UNC-CH physician said. "There were only about six such devices in the United States, and no one had ever used one here. It was viewed as a novelty and thought that perhaps one or two in the United States would be sufficient, but instead the field exploded."

He struggled to get the technique down.

"It was kind of scary," he said. "I had never done it before -- almost no one had. You open the body, and it's a sea of red. You have to be young to do that."

Hulka's eyes sparkled as he recounted his experience teaching basic and advanced laparoscopy throughout the world. A map over his desk at the population center is dotted with red pushpins to show where he has taught and operated. He was one of first to bring TV cameras into China's operating rooms and plugged his own video camera into TV monitors so residents could watch him operate.

"Eighty percent of teaching is inspiration -- motivating students to learn," said Hulka, who has played in an orchestra since age 13. He views each lecture as a performance, not expecting students to learn how to play the piece, just to leave "whistling the tune." If they catch the essence, he believes he might "inspire enough interest to make them want to go back to learn the whole piece."

In the early 1970s, laparoscopy revolutionized U.S. gynecology, first in treating ectopic pregnancies and then in sterilization and diagnosing infertility. Tubal sterilization quickly changed from an inpatient procedure requiring several days to an outpatient one requiring only hours. Today it is the leading method for maintaining family size in the United States.

"It has become an integral part of fertility management," he said. "I can do outpatient surgery on a woman in the morning under general anesthesia, and she can go home that day, which was absolutely revolutionary."

Hulka published the first edition of the book in 1985. His goal was to show how to do the procedures safely because the fundamentals had never been captured in a text.

"I thought the book would have a long run," he recalled. "As it turns out, it gave just a hint of what could be done with laparoscopy. Since then, the field has exploded with the expanding use by both general surgeons and gynecologists."

In three years, the first edition was out of date. Hulka had expected to go on to a new project, but instead published a second edition in 1994. By 1996, 85 percent of gall bladder operations were done by laparoscopy, and similar changes are occurring in general surgery. Today the procedure, which dates to the 19th century, has its own World Wide Web site -- http://www.laparoscopy.com.

The new edition reflects the still-growing number of procedures and how patients have fared. The physician is pleased that acceptance is widespread today.

"It was quite a ride," Hulka said. "This is a happy coming of age."
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Note: Hulka can be reached at (919) 966-2157.
Population Center Contact: Allison Adams 919-962-7235(w), 489-1521(h), aadams@unc.edu
News Services Contact: David Williamson, 962-8596
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University of North Carolina at Chapel Hill

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