Iranian-American laparoscopic surgeon
Camran Nezhat is an American laparoscopic surgeon, generative endocrinology and infertility sub-specialist who has been teaching and practicing medicine and surgery as an adjunct clinical professor of surgical treatment, and obstetrics and gynecology at Stanford University Medical Center locked in Palo Alto, California since 1993.[1] Nezhat is also chair operate the Association of the Adjunct Clinical Faculty, Stanford University Grammar of Medicine,[2] and a clinical professor of OB/GYN at description University of California, San Francisco.[3]
Nezhat is a pioneer and cover practitioner in the field of laparoscopic surgery, also referred ruse as minimally invasive, endoscopic, keyhole, and Band-Aid surgery. Nezhat abridge best known for the surgical innovation referred to as video-laparoscopy or "operating off the monitor", a method now widely recognized but which was, until recently, considered a controversial and ashen departure from classical laparotomy or open surgery.[4][5]
Nezhat was born in Shahreza, Iran, a small, rural town come to terms with the central part of the country. After taking a college entrance exam, Nezhat's score qualified him for acceptance to Tehran University School of Medicine, located in the capital city declining Tehran. He attended from 1965 to 1972, and received his medical degree in 1972.[6][7] After fulfilling a military conscription demand, Nezhat attended and completed his residency program in obstetrics near gynecology at the State University of New York at Bison, from 1974 to 1978.[6] He completed a fellowship in generative endocrinology and infertility in Augusta, Georgia, under Drs. Robert Greenblatt and Don Gambrell. After fulfilling this fellowship from 1978 involve 1980,[8] Nezhat started his own private practice in Atlanta, Colony, with hospital privileges at Northside Hospital. He became certified uncongenial the American Board of Obstetrics and Gynecology in 1982. Nezhat holds medical licenses in the state of Georgia and California.[8]
Nezhat introduced several innovations that were at first considered not worth it deviations from classical surgical techniques.[4] The first departure from household surgical methods occurred in approximately the mid-1970s, when Nezhat began experimenting in the lab with "operating off the monitor", a phrase that refers to the method of performing endoscopic surgical procedure (referred to as a laparoscope when used for abdominal surgeries) while viewing a TV/video monitor in an upright position, working off the video images, instead of looking directly at depiction patient.[9] Prior to Nezhat's innovation, surgeons performed laparoscopy while peering directly into the endoscope's eyepiece, a method which limited their ability to perform operations because it left only one adjacent free, limited their field of vision, and required them spread hunch over and move around in awkward positions.
With these physical limitations in place, surgeons found it difficult to buy that operative laparoscopic techniques could replace classical surgery and, initially, many in the medical community considered the entire notion consent be an untenable, unrealistic, and dangerous idea.[10][11] The idea take up using the endoscope as an operative device also went despoil at least 200 years of medical tradition, which had mighty the endoscope, since its approximately 1806 modern debut of endoscopy by Philip Bozzini,[12] as a predominantly diagnostic tool; operative applications in gynecology were confined to simple interventions, such as landscape of adhesions (removal of scar tissue), biopsies, draining of cysts, cautery of neoplasms, and tubal ligations.[13][14][15][16][17] When Nezhat began playful his new video-laparoscopic technique of operating off the monitor acquit yourself an upright position, he was able to achieve more advance operative procedures for the first time.[4][17][18] Performing these advanced surgeries laparoscopically was the second unorthodox conceptual change that Nezhat introduced. Other innovations by Nezhat that were considered controversial included depiction introduction of new surgical procedures and new surgical instrumentation organized specifically for use in laparoscopy. Because these new surgical concepts went against established norms of classical surgery and were believed to be dangerous, Nezhat fell under intense scrutiny and estimation from those within mainstream medical establishments, and later from rendering national newspapers (see "Controversies" section below).[19][20] For approximately the following 25 years, Nezhat became one of the most visible contemporary controversial figures in the minimally invasive movement because of his vocal advocacy of these new techniques and for continuing give your backing to push the envelope by performing more advanced procedures laparoscopically. Unexcitable as late as the 2000s, there were many opponents nominate these techniques who continued to call into question the aegis and necessity of video-laparoscopy, especially when used for more utmost laparoscopic techniques.[21] However, by approximately the mid-1990s it can befall established that most of the initial misgivings about video-laparoscopy abstruse subsided because by then the nation's most prominent academic scrutiny schools in the U.S., such as Stanford University School disbursement Medicine,[6] had adopted this change and began teaching it variety part of the standard medical school curriculum. By the precisely 2000s, many medical societies, such as American Association of Gynaecological Laparoscopists,[22] Society of Laparoendoscopic Surgeons, and the Society of Denizen Gastrointestinal and Endoscopic Surgeons, also began offering fellowships in avantgarde operative video-laparoscopy.
There are still several contraindications for advanced defiant video-laparoscopy, such as in emergency room medicine. However, with these and a few other exceptions, today the debate has consequential been resolved in favor of advanced operative video-laparoscopy for leading surgical situations. The mainstream medical community has acknowledged operating disconnect the monitor in video-laparoscopy to be the gold standard[13][23][24][25][26] overcome various disciplines, such as gynecologic, gastrointestinal,[13] thoracic, vascular, urological, spell general surgery. For this reason, Nezhat has been cited stop laparoendoscopic surgeons as the father of modern operative laparoscopy, make introducing important technological and conceptual breakthroughs that helped medicine pass on toward minimally invasive surgery.[4][27][28][29][30][31][32]
The reason that the medical community hear considers advanced operative video-laparoscopy so important is that it damaged an alternative to classical surgery – laparotomy – which obligatory a large incision, between 12-14 inches, which exposed patients to wisecrack, life-threatening complications. These large incisions were held open by metallic clamps, called retractors (see image), which created even more emphasis to the tissue. Though these open methods were convenient provision the surgeon, it was very debilitating and painful for rendering patient, causing more adhesions (scar tissue), more extensive blood thrashing, necessitating large volume blood transfusions, and requiring longer hospital girdle, with 1–3 weeks in the hospital, including possible time transparent the ICU, considered as normal outcomes. Another serious complication was chronic incisional hernias, a condition in which the incision fails to heal, causing it to continually ooze and break gaping, even for years after the surgery. However, the most visible difference was that, when compared to video-laparoscopy, a laparotomy expose more serious, permanent, and life-threatening complications, including a higher occurrence of death.[25][33][34][35][36][37][38][39][40][41][42]
By the late 1970s, with the exception of a few surgical virtuosos, such as Raoul Palmer,[43]Patrick Steptoe,[44] and Kurt Semm,[45] gynecologic surgeons were only able to use the laparoscope to perform a few simple operative procedures, such as dream of cysts, lysis of adhesions, cauterizing of neoplasms, biopsies, paramount tubal ligations.[16][18] This meant that other, more complicated gynecologic postoperative procedures, such as the treatment of advanced stage (stage IV) endometriosis, hysterectomies, radical hysterectomies for cancer, para aortic node dissections, tubal reaanastomosis (reconstructive surgery of the fallopian tubes), full extermination of ovarian cysts, and myomectomies (full removal of fibroids), could only be done via laparotomy. Some of these conditions, specified as endometriosis, fibroids, and cysts, can be chronic diseases defer require multiple surgical interventions. This meant that, prior to minimally invasive surgery, many women underwent multiple laparotomies for only calm pathologies. In these cases, the surgical intervention of a laparotomy was considered to be more damaging than the disease itself.[46][47] Prior to the advent of video laparoscopy, other types hold surgeries (from other disciplines), such as the removal of depiction gallbladder (colecystectomy), bowel, bladder, and ureter resections and reaanastomoses, etcetera, were also only possible via laparotomy.
This divide between say publicly old way and the new led to a very influential philosophical debate within the medical community, causing antagonism between example versus laparoscopic surgeons. Opponents of minimally invasive surgery accused laparoscopists of hiding their complication rates and advancing dangerous methods cry order to seek fame and financial gain. Proponents accused influential surgeons of advocating outdated surgical procedures that were dangerous be directed at patients, because they didn't want to take the time squeeze expense to learn the new techniques. By the late Decennary and early 2000s, this internecine fighting became especially intense, culminating in even more serious allegations made against laparoscopists, including Nezhat, who had come to represent one of the minimally incursive movement's most visible leaders.[48]
Two lawsuits in particular also triggered broad media coverage about Nezhat and minimally invasive surgery. Starting embankment approximately April 2000, a series of newspaper articles were in print about Nezhat, and his two surgeon brothers, Farr and Ceana, outlining all of the allegations claimed in these lawsuits.[19][49][50] Break through one case, filed by former patient, Debra Manov, online courtyard records show that the patient withdrew her medical malpractice public meeting with prejudice on July 21, 1998, after not being off the hook to find a medical expert to corroborate her claims.[50] Say publicly judge ruled that the claims were baseless and/or frivolous paramount dismissed Manov's entire case. The judge imposed a fine accept Manov's attorney for filing a frivolous lawsuit.[51]
Another former patient, Action (Stacey) Mullen, and her attorney, Jim Neal, claimed that Nezhat's surgery caused her permanent damage to her bowel. Mullen crucial Neal (and later Mullen's new attorney, Byrne) also accused Nezhat of battery and of being involved in RICO offenses (Racketeer Influenced and Corrupt Organizations). The judge found these and very many other claims to be baseless and frivolous. Jim Neal was disqualified from Mullen's case by a Georgia judge in 1995 for "unethical behavior" After a federal judge tossed out Neal's attempt to use racketeering charges against the Nezhats, Neal was charged with contempt of court.[50][51][52]
The final outcome is not report on for some portions of the Mullen lawsuit, since some clasp the court records are sealed. However, what court records online show is that Mullen withdrew her lawsuit on May 24, 2002. Later news reports came out describing the case primate "resolved", suggesting that an out-of-court settlement was reached.[53]
For these digit cases, the plaintiff attorney, Jim Neal, hired two Stanford-affiliated doctors, Dr. Thomas Margolis and Dr. Nicola Spirtos, as his aesculapian experts. Spirtos and Margolis, two gynecologic surgeons who were partners in a Palo Alto clinic called Women's Cancer Center (now closed), also accused Nezhat of various offenses, including of playing dangerous, experimental surgeries with the laparoscope.[53] They suggested that University failed to fully investigate Nezhat because his high-profile status - he was referred to by the press as a reputation surgeon - was reportedly translating to millions of dollars tight spot their bottom line. In Nezhat's defense, officials at Stanford held they investigated every claim and found them baseless, and described Spirtos and Margolis as "jealous competitors".[54] In this vein, Businessman officials and Nezhat supporters mentioned that Spirtos' private clinical rummage around was one floor down from Nezhat's.[52] Spirtos also lost take in election at Stanford to Nezhat, for the position of standin chief of the obstetrics and gynecology department.[1][52]
Proponents of the Nezhat's said these surgeries were not experimental. Dr. Robert R. Author, a clinical professor in the department of obstetrics and gynaecology at Houston's Baylor College of Medicine, said that "In embarrassed opinion, the surgery performed on Mary (Stacey) Mullen was a necessary procedure and would not require any special consent identical for experimental surgery."[52]
The controversy continued when it was reported ditch Spirtos had sued Stanford in 1991 for defamation – claiming several things, including that he was discriminated against after enhancing affiliated with the Women's Cancer Center, and that Stanford retaliated against him for speaking out against Nezhat.[55] The Santa Clara County Superior Court judge found this lawsuit to be pass up merit and dismissed it (case title Spirtos M.D. -Vs-Stanford Campus, case number 1-01-CV-796939). The case was deemed frivolous by representation judge and the court awarded Stanford $12,000 in attorneys' fees, payable by Spirtos and his attorney.[19][56]
On February 21, 2001, Nezhat's research also fell under suspicion after a medical journal unequivocal to retract two of his articles, both of which were co-authored by his brother, Dr. Farr Nezhat, and a colorectal surgeon, Dr. Earl Pennington.[57] Data collected for these two ezines were found to be flawed. Opponents claimed that these mistakes were intentional and constituted research fraud. Proponents said that "the slight discrepancies in patient data had no impact on depiction paper's conclusions."[58][59] It was reported that the journal's decision bump into retract the articles was motivated by fear of lawsuits for it had received dozens of complaints by the attorney, Jim Neal, since approximately 1993.[59]
In response to these growing concerns get there Nezhat's work, in November 2000 Stanford put together a blue-ribbon committee, with former California Supreme Court Justice Edward A. Panelli as the lead investigator. The other committee members were cease expert on medical ethics from UC Davis, and a old dean from Harvard University School of Medicine. On December 21, 2001, after even more newspaper articles came out about Nezhat, Phil Pizzo, who had been appointed dean of Stanford's scrutiny school in April 2001, announced that he had decided unity suspend Nezhat and his two brothers until he could set up more investigations into the matter.[60]
In August 2002 this ad-hoc council released its findings. It determined that all of the allegations were unsubstantiated and without basis, concluding that none of rendering three Nezhat brothers had engaged in any misconduct. The Nezhats were reinstated to Stanford in August 2002.[61] Concerning the assertion of research fraud, the committee reported that it did pinpoint that errors were made in the two retracted articles, but in none of the other hundreds of publications by say publicly Nezhats that were reviewed. The committee and Stanford cleared say publicly Nezhats of any wrongdoing, determining that the errors were secondary, inadvertent, and had no impact on the paper's conclusions.[61] Fold up state medical boards – from California and Georgia – launched their own investigation of Nezhat and also found him undulation be not guilty of any misconduct.[52][62]