Surgery helps set Mayo Clinic apart from its peers

Jan. 26—ROCHESTER — What was billed as a very simple surgery for Jason Haws turned into a milepost in his life.

Not necessarily in a positive way.

On Sept. 9, 2022, Haws checked in at his local hospital in Green Bay, Wisconsin, to remove a mass near his rectum. When the surgery was done, his wife, Carrie, was told everything went well. The mass was removed. Jason had been moved to recovery. He'd go home later that day for a couple of weeks of recovery then get on with his life like normal.

"They told my wife everything went well," Jason said. "We didn't know until (later) that same day that a mistake was made in a surgery where they had cut through the rectum into the urethra."

That mistake — which led to Jason getting both a colostomy bag and a suprapubic catheter to deal with his waste — sent the Hawses down a path from Green Bay to Milwaukee's Froedtert Hospital to, eventually, the operating room of Dr. Kevin Behm, a colon and rectal surgeon with Mayo Clinic in Rochester.

"I just hope the surgery is as a success," Jason said two days before his scheduled Dec. 7, 2023, surgery at Mayo Clinic. "That's the only thing, you know, you can't control what happens after that."

Behm, who led a group of three surgical teams — a team from urology and a plastic surgery team, in addition to his own colorectal team — said the surgery lasted about 11 hours and went about as well as they could have hoped considering the unique case complications that Jason faced.

"Whenever we're doing surgeries this big, we have a very carefully thought-out and detailed plan of what we are hoping to accomplish," said Behm the day after the surgery. That plan is articulated to everyone on the team, a team that has been together for several years. "Thankfully for (Jason Haws), there were no unintended surprises. ... We accomplished all of it the way we wanted to. It went really well. And he's doing well on the wards right now. So as far as 24 hours goes, it's exactly where we wanted him to be."

Across all its properties, Mayo Clinic performed more than 141,000 surgeries in 2022. In Rochester alone — where the bulk of those surgeries happen — Mayo has 123 operating rooms in its Rochester campuses, and roughly 285 surgeons. Those numbers increase to 139 operating rooms and more than 300 surgeons if the Florida and Arizona campuses are included. Those surgeons work in 27 different surgical specialty areas.

All this makes Mayo Clinic a surgery leader, but it's not just numbers that put Mayo Clinic on top.

"I think a lot of the early magic of Mayo was not only their talent, and the team approach, which we love to talk about, but the way they structured things," said Dr. Michael Kendrick, chair of the Department of Surgery at Mayo Clinic.

Kendrick said having doctors specialize in surgery and clinical practices was all part of the Mayo brothers' determination to support the motto that is plastered all around the clinic's campuses: The needs of the patient come first.

As new buildings open — the Anna-Maria and Stephen Kellen Building, which opened in December — and new buildings are planned as part of Mayo's "Bold. Forward. Unbound." proposal, Mayo Clinic is in growth mode. All of that construction and expansion, he said, is simply there to support Mayo in its quest to better treat patients from the first time they walk through the door to when they've ended their recovery.

In nearly 27 years at Mayo Clinic, Kendrick said the big changes have come in the way surgeons do their business. Much of that is advancements in surgical technology — laparoscopic surgery and robotic surgery — but change also comes in the development of specialties.

Dr. Eric Dozois, program director for colon and rectal surgery at Mayo Clinic in Rochester, said the repetition and familiarity with certain surgeries that come with specialization pay benefits for the patients.

"An inexperienced surgeon doing the same surgery might take two to three times longer," Dozois said.

Dozois, who works in the same specialty at Mayo Clinic as did his father before him, said the changes he's seen have all been geared toward better outcomes for patients. Some of those changes have come in how certain ailments are treated. In his father's time, Dozois said, ulcer surgeries were common. Now, that ailment is mainly treated with medicines and lifestyle changes.

Like Kendrick, Dozois said the present and future are focused on specialization and technology.

"The biggest change is the surgeries we do — we have the same goals — but we're doing it in a less-invasive way, which improves recovery and improves the patients' quality of life," Dozois said.

Not only have those advances helped patients, Dozois said robotic surgery, for example, puts less wear and tear on the surgeons themselves. The spinal issues that many surgeons used to suffer — standing for hours on end — are becoming a thing of the past as surgeons now sit at a console to perform surgeries robotically. And the better ergonomics of robotic surgery help reduce pain in the wrists and hands.

Looking forward, Dozois said an integration of 3D imaging and 3D printing to aid robotic surgery, and the use of artificial intelligence in surgery are areas where further improvements will take place. That said, "We don't want to jump too quickly into technology," but instead evaluate new methodologies and ensure their safety before implementing them in the operating room.

Behm said surgeries are, more and more, going the robotic route. Today, he said, roughly 50-60% of the surgeries he performs are done robotically.

The benefits to the patients are many.

For example, rather than one large cut into a patient for a traditional surgery — for Haws' surgery, that would be an incision from the pubic bone "to probably halfway up" his torso — compared to a robotic surgery, which uses a handful of small incisions less than an inch apiece.

"We've known for a long time that there's significantly lower complication rates," Behm said. "Recovery is basically cut in half. And then some of the long-term issues with things like hernias, the rates of those go way down."

The use of laparoscopic surgery, which also features a less invasive mode, is part of the data that shows how any surgery with a smaller invasive footprint is better for the patient. Robotic surgery, he added, allows surgeons to do more complex work than traditional open surgery.

In addition to the benefits to the patient, Behm said that even though robotic surgeries might take a little longer to perform, they exert less wear and tear on the surgeon and his or her hands.

Not all advancements start in the operating room. At the surgical 3D modeling lab, Tori Sears, a senior engineer in the lab, and her colleagues create patient-specific anatomic models that help both with diagnosis and give surgeons and clinicians an opportunity to see what they are facing with an upcoming treatment option.

Mayo Clinic's first use of 3D printing came in 2006 for a pair of conjoined twins who shared a common bile duct.

Dr. Jonathan Morris actually began using 3D printing in 1999 while working for the National Institutes of Health. He brought his knowledge of this new tool to Mayo Clinic in 2002, and worked with Dr. Jane Matsumoto to help separate the twins by creating a model of them showing how their chests were connected. From there, spine surgeons asked for anatomical models. Then the tool was used to help radiologists develop plans for attacking particular tumors in individual patients.

Having the printing lab in the same building as the operating rooms means being able to provide a unique diagnostic tool immediately for doctors. The 3D printing lab also makes surgical guides — Morris said it was like creating a guide jig in woodworking — that is specific to that patient. For example, say a patient needs a bone graft, a guide can help surgeons take the exact size they need from the donor bone and provide a guide to the surgeon to cut the place where the graft will be implanted.

As more and more doctors have embraced 3D printing as a tool, the 3D modeling lab has grown. What started as a 300-square-foot facility has grown to a lab of more than 8,000 square feet.

Sears said the lab uses 23 printers but had 36 during the COVID-19 pandemic because the lab was manufacturing COVID testing swabs.

Dozois said with specialization comes a team effort on many complex surgeries.

A specialist in cancer surgeries of the pelvic area, Dozois said he'll often work with urological surgeons and plastic surgeons to help restore a patient's normal bodily function, much like the cooperating teams that worked with Behm on Jason Haws. This can mean having a team with four or five surgeons on a particular case, some coming and going during a lengthy surgery to accomplish their own tasks as part of an overall treatment plan.

By Mayo Clinic being a leader in surgery both in quality and in sheer numbers, it allows Dozois and other surgeons to focus in a small niche of surgery where they can become experts and bring better results for their patients. Dozois said his practice is focused, like the "tip of a pyramid."

"We have a high volume of patients who come to us with these problems, so I keep busy with that very narrow practice," he said.

Each surgery is planned and executed by a team that includes many players beyond the surgeon — a certified surgical assistant, a certified surgical technologist, surgical nurse, an anesthesiologist, anesthesia nurses assistant and, in most cases, a surgical fellow or two.

Mayo Clinic brings in surgical fellows from both the United States and from overseas, he said. It's something the Mayo brothers — William and Charles — believed in deeply, the idea of learning from others and sending knowledge back to other places around the world to improve health care there.

"There's a potential in every surgery for learning and growth and development," Dozois said. "If they're present, they get to take part in that environment."