Thursday, January 03, 2008

Henry Courtenay Clarke ~ Father of Laparoscopy?

11/07/2007 05:38 pm Henry Courtenay Clarke (Canada)
The ISGE News
In January 2006,Editorial on Plagiarism was interesting. The Oxford Dictionary: plagiarize, to take and use (the thoughts, writings, inventions etc. of another person) as one’s own. Dr.Tulandi stressed the writings but the thoughts and inventions may be more significant. I published, presented and patented my method for loop ligation from 1972.Clarke, H.C., Laparoscopy: New Instruments for Suturing and Ligation: Fertil. Steril. 23, 274 (1972).In 1981 Herr Professor Baron Von Semm of Germany applied my method for appendectomy without mention of my work. He continued to published this method for oophorectomy, salpingectomy, and even for supracervical hysterectomy. He was sponsored by financially powerful surgical companies, and organizations such as the AAGL and the ISGE. The AAGL named him the father of laparoscopic surgery.Also honored as father of laparoscopic surgery by the AAGL was Professor Bruhat of France The Bruhat knot tier, the CICE knot tier or Clermond-Ferrand knot-tier are identical with the Clarke knot tier.(see above: Pomeroy tubal ligation). The Levine knot-tier, and the Reddick-Saye knot-tier are Clarke knot-tiers, marketed with disregard for the moral rights involved.The work of Clarke has been obscured and the credit due to him has been given to others. This is the vile result of plagiarism. Combined with racial bigotry, endemic in North America, the result to the plagiarized is disastrous. The patent lawyers may negotiate a 5% royalty, but the instrument company having gained the right to market the instrument awaits the expiration of the patent. You can sue the company but this is prohibitively expensive. How about a “contingency” plan with your lawyers, who maintain that you have a valid claim? In this way, they collect part of the settlement as their fee. They cannot accept this arrangement since the instrument company may counter sue a quarter of a million dollars or more and they decline this responsibility. Plagiarism continues. The Knot pusher 5 mm of the Richard Wolf Company (catalogue No. 8393.3451) is the Clarke ligator scissor forceps, which has been patented and published. (Clarke, H.C., An Improved Ligator in Operative Laparoscopy: Obstet Gynecol, 83, 299-301 (1994).Again this powerful company, and three others, market similar instruments in the United States ignoring the moral and legal rights of Clarke.But there may be a value to plagiarism. The plagiarists, with financial, academic and national support denied to the plagiarized, may fulfill their personal aspirations while promoting the borrowed concepts and inventions world wide to the benefit of poor patients who need them the most. Yours sincerely, H. Courtenay Clarke _______________________________________________________
THE CONCEPT OF SURGERY WITH MINIMAL TISSUE INJURY In Port of Spain, Trinidad, in the late 1950's, Clarke ran a small private hospital where he developed instruments and methods for surgery, mainly in gynecology, through small incisions.He had found that with smaller incisions his patients were able to be discharged from hospital in a shorter time. This was important, in his practice in a developing country, since these patients often had an income of twenty cents U.S. for eight hours work in the foreign owned oil and asphalt companies. Many could afford only the minimal costs of hospitalization even without a surgeon's fee. These instruments were applied for ovarian cystectomy, salpingectomy, myomectomy, hysterectomy, uterine suspension, and appendectomy. Clarke performed some hysterectomies with two inch Pfannensteil incisions. Following these operations his patients were able to return to work earlier and with less morbidity. Later in Buffalo, New York, the Clarke instruments and methods were useful in several laparotomy procedures. (Clarke HC. A Simple Surgical Ligator: Archives of Surgery 701: 914, 1973). In 1983, John Wickham, a British Urologist, recognized the advantages of this new concept in surgery and called it "Minimal Invasive Surgery". OPERATIVE LAPAROSCOPY IN BUFFALO NEW YORK In 1970, at the University of New York at Buffalo, Clarke studied laparoscopic diagnosis and electrocautery. Clarke modified his instruments for suturing and ligating in minimal invasive surgery and applied them for use in laparoscopy. In 1971 the Clarke instruments were being patented in the United States and marketed by the Ven Instrument Company of Buffalo, New York. Clarke had described various suturing techniques, simple ligation, loop ligation and advocated the use of electrocautery to supplement these procedures. Some of the members of the teaching staff, such as Professor Jack Lippes, had supported the work of Dr. Clarke and applied his instruments in surgery. It was now possible "to perform lysis of the thicker and more symptomatic adhesions, ligation, and excision of small pedunculated tumors or benign cysts after aspiration, various types of uterine and ovarian suspensions, biopsy or excision of tumors with suturing and and peritonealization, and more effective tuboplasty". (Clarke HC. Laparoscopy: New Instruments for Suturing and Ligation: Fertility and Sterility. Steril. Vol. 23, No. 4, 274, 1972). In April 1972, with Professor Steven Piver, Chief of Gynecologic Oncology at the Roswell Park Cancer Institute, Clarke performed the first excisional biopsy of metastatic carcinoma of the ovary in a second-look exploration by laparoscopy. In 1980 the use of second-look laparoscopy was evaluated and found to be useful in patients treated for advanced ovarian adenocarcinoma ( Piver MS, Lele SB, Barlow JJ, Gamarra M. Obstet Gynecol 55(5):571, 1980). The Clarke methods and instruments had opened "a whole new era of laparoscopic surgery" (Leventhal JM. The place of culdoscopy and laparoscopy in diagnosis. In: Reid DE, Christian CD. Controversy in Obstetrics and Gynecology. Philadelphia: WB Saunders, 1974:622-3). DOCUMENTATION ON FILM In January 1972 Clarke was summoned to the operating room by Dr. Goperud of North Carolina, the Chief at the R. J. Meyer Memorial Hospital in Buffalo, New York. On the table was a markedly obese woman who was already anesthetized and prepared for surgery. Dr. Goperud asked that Dr. Clarke perform Pomeroy tubal ligation on the patient using his laparoscopic instruments. This was unusual since Dr. Goperud had shown no interest in Clarke's operative laparoscopy and had not given Clarke an opportunity to perform simple laparoscopy. Now, the scope had been prepared with an adapter to which a movie camera had been attached. Dr. Goperud was scrubbed to assist. With the scope supported by the assistant Clarke operated at arms length looking through the camera. With the Clarke ligator he applied a tie to a loop of tube and excised the loop. The tie was inadequate and blood spurted from the proximal and distal ends of the excision. Taking charge Clarke had the camera removed, and viewing through the scope applied ties to the bleeding vessels. The camera was re-applied and the operation was completed bilaterally. The Clarke method and instruments for operative laparoscopy had been documented on film. Dr. Clarke considered that the intention of Dr. Goperud was to discredit him and his new surgery by recording failure on film. In February 1972 the film was shown at a meeting of gynecologists of the Medical Faculty at Sisters Hospital where Clarke discussed operative procedures which had been performed by laparoscopy. A reporter recorded the event in the local newspaper (Spencer M. Gynecologist Devises New Surgical Method. The Buffalo Evening News, Buffalo New York, USA. February 23, 1972). The film was then locked away in the safe of Dr. Goperud with no access by Dr. Clarke. When Dr. Goperud resigned, Clarke obtained the film and video copies were made at the Buffalo Veterans Administration Hospital. Clarke presented his methods for operative laparoscopy documented on film, at the 28th Annual Meeting of the American Fertility Society (1972 ), the 19th Annual Scientific Meeting of the Canadian Fertility Society (1972), the 20th Annual Scientific Meeting of ACOG (1972), the 21th Annual Clinical Meeting of ACOG (1973), the 122nd Annual Convention of the AMA (1973), the 8th World Congress of Obs/Gyn(1973), etc DISCREDITATION IN THE UNITED STATES In May 1973, Clarke was invited to a formal presentation, recognizing his new surgery, at the Twenty-First Annual Clinical Meeting of American College of Obstetricians and Gynecologists, Bal Harbour, Florida, U.S.A. This was his second presentation before the College. On his way to the presentation as Clarke passed through a restaurant of the hotel where the Meeting was being held he was invited by three attendees to sit at their table. They inquired: "Are you going to present a paper on laparoscopy?" Clarke responded that he was. They then said " We have decided you are not to present this paper". Why Clarke inquired. They answered "If you did you will never be heard of again". Clarke proceeded to the adjoining auditorium where the presentation was being held. Dr. James L. Breen, the moderator appointed by the College, had written his congratulations to Dr. Clarke in a letter. But after the presentation, Dr. Breen showed slides of a girl in a green flowered bikini with several bandages on the abdomen as well as on the chest. "Ladies and Gentlemen" he said, " this is what Dr. Clarke is leading us into!" HISTORICAL OBSCURATION From 1975 to 1990 "historical obscuration" was applied to Clarke's work. In the United States and Canada his work and instruments for suturing and extracorporeal tying were obscured from public knowledge. This permitted his credit, academic and financial, to be given to others. In 1974 Leventhal claimed that the Clarke instruments and methods "opened a whole new era of operative laparoscopy", (Controversy in Obstetrics and Gynecology ll., Reid DE, Christian CD, W.B. Saunders Company, Philadelphia, 622-623, 1974). In 1980, Semm and Mettler, supported by WISAP and Stortz, instrument companies of Germany, published similar instruments and methods claiming that "these advances have opened up a new era of gynecologic surgery based on operative laparoscopy" ( Semm K, Mettler L. Technical progress in pelvic surgery via operative laparoscopy: Am J Obstet Gynecol 138: 121, 1980). Clarke objected to this in a letter to the Editor (Am J Obstet Gynecol 141: 111, 1981). In a book on the History of Laparoscopy out of Frankfurt, Germany, it is claimed that after a visit of Semm to the United States, where Clarke had already published, demonstrated and patented his extracorporeal knot-pusher for knot tying including loop-ligature, Semm produced a similar, but disposable, extracorporeal knot-pusher for a pre-tied loop-ligature as the plane reached Frankfurt/Main Airport, in Germany. ( Litynski GS. The Magician of Kiel. In: Highlights in the History of Laparoscopy. Frankfurt/Main: Bernert Verlag, 134-5, 1996). There is no mention of Clarke's work in this book. In the 1980's, Semm was recognized by the AAGL as the father of operative laparoscopy. Similar public recognition was given by the AAGL to Bruhat of France in 1998, and to Levine of the USA in 1999. Bruhat wrote to Clarke that there were "many fathers of operative laparoscopy". Levine wrote claiming ignorance of the earlier work of Clarke, and that the honor of being the father of operative laparoscopy had been placed on him and was not of his choosing. In January 2000, the Canadian news journal Maclean's wrote "Minimally invasive or "keyhole" surgery, in which surgeons cut, re-tract and extract by manipulating extendible tools through tiny holes in the skin, has been around since 1987 when French gynecologists stunned the medical world with their techniques". (Shepherd R. Medicine in 2020: Robotic Surgery and Biosensors: Maclean's. page 50, January 10, 2000). Clarke's work had been obscured. This has permitted the sales of expensive, often unnecessary, technology which at times infringed on his patent rights. Dr. Levine, a member of the Board of the AAGL, has claimed "When I first influenced Ethicon to manufacture the loop-ligature in the United States it had nothing to do with either Semm or WISAP....I am extremely proud of the fact". WISAP with Stortzs of Germany (the Roeder loop ligature) and Ethicon (the Endoloop ligature) have marketed their pre-tied loop-ligature in North America. This was a disposable modification of the Clarke knot-pusher designed to exact a fee at each knot tying (Clarke HC. A New Clinch Knot. Letter to the Editor. Obstet Gynecol; 78: 156, 1991). Although Clarke was on the Faculty of several International Congresses where he taught his suturing and tying methods he was effectively prevented from promoting or advancing operative laparoscopy in Canada where surgery was performed mainly with the pre-tied loop ligature and the clip-gun of the United States Surgical Company. LASER, the pre-tied loop ligature, the clip gun and "CASH" hysterectomy replaced the skills of suturing and tying. This has resulted in expensive methods and a glamour surgery unsuitable for the people of the third world who need it the most. RESTORATION OF SUTURING AND LIGATING In 1990 Reich performed the first total laparoscopic hysterectomy by suturing and tying. He introduced radical laparoscopic hysterectomy with lymphnode dissection and demonstrated superior results with this method. He has found the clip-applicator dangerous and has exposed this with particular reference to poor homeostasis and injury of ureters. Reich has also developed a technique for introducing a large curved needle into the abdominal cavity by utilizing a 5mm trocar (Reich H, Clarke HC, Sekel L. A simple method for ligating with straight and curved needles in operative laparoscopy. Obstet Gynecol 79:143,1992). Suturing and ligating has proven to be a safe, reliable and cost-effective method in laparoscopy. Today in India laparoscopic surgery is mainly by suturing and tying. Now, while in some third world countries laparoscopy is still called "Laser surgery", others are now realizing the high cost of the often useless technologies that they have been served. ___________________________________________________
07/05/2007 02:14 pm Henry Courtenay Clarke (Canada)
In 1972 I invented, published, patented and taught instruments and methods for laparoscopic surgery. These were manufacturedand marketed with the names of other surgeons. More recentlyI have invented, patented and published “Clarke, H.C., An Improved Ligator in Operative Laparoscopy: Obstet Gynecol, 83, 299-301 (1994).” Four powerful companies are marketing this instrument in the United States. If I negotiate, the small royalty payment gives them the right to make the instrument which can be restricted until my patent is no longervalid. No reliable lawyer will take legal action from fear of a large Counter suit, although the lawyers agree that my claim is valid.

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