An interview with MITIE’s Dr. Brian Dunkin

This is the third, and final, part of our three-part series on MITIE, the Houston Methodist Institute for Technology, Innovation and Education. To recap, MITIE is one of the largest and most comprehensive surgical education and research facilities in the world. Our first blog was a photo tour of MITIE. In our last blog, we talked about how MITIE provides physicians with a comprehensive training facility to learn new surgical techniques.

To finish our time together, I sat down with Dr. Brian Dunkin, the medical director of MITIE, to ask him why MITIE and the work done there is so important. When Dr. Dunkin isn’t at MITIE, he is an endoscopic surgeon, which means he performs surgery through small incisions or natural body openings to make surgery safer and recovery faster.

Me: Why is MITIE so important and why are you so passionate about MITIE that you’d move your family and practice to Texas to build it?

Dr. Dunkin: Passion is the right word to describe MITIE for me. In medicine, we have a pressing need to support the ongoing training of practicing health care professionals. With how quickly things are changing and constant advancements in technology, it’s become a real crisis. You could be in practice after your training for a relatively short period of time and you’re not up to date anymore and you have nowhere to go.

Dr. Brian Dunkin headshot
Dr. Brian Dunkin is MITIE’s medical director and an endoscopic surgeon.

I’ve developed training programs at several institutions, but nowhere did I see the opportunity to develop an educational facility of the scope and scale available at Houston Methodist. That’s what convinced me to move to Texas and become a part of this. I don’t think anyone else on the planet, and certainly in the U.S., could have done what we did with MITIE. No one else had the resources, the space, the commitment from hospital leadership, the people – it took a lot of things coming together for MITIE to be what it is. For example, I recently had the opportunity to give my mentor, a worldwide leader in surgical education, a tour of MITIE, and he was completely blown away by the facility, the scope of programs available, and the timeline in which we accomplished this. Even with our initial success, we still have a lot of things we want to do in MITIE, so we aren’t done yet.

Also, some practicing surgeons don’t understand the importance of or the value of educating other clinicians. I’ve been taught that you teach others what you know. I’ve found that in the process of educating others, you learn, too.

Me: You have a lot of ongoing projects, but what are some of the bigger projects you are working on right now?

Dr. Dunkin: The educational project I’m most excited right now is the MITIE Lapco program, which teaches laparoscopic colon surgery. Learners spend four days in MITIE doing hands-on training with experts from around the world. In most courses, that’s where the learning stops, leaving an educational hole where the surgeon goes back to his or her home institution and is alone in the operating room when trying to start doing this new procedure. I’ve always thought technology was the way to fill this gap.

We added telementoring, or the practice of using a videoconferencing system in the operating room to allow an expert surgeon to virtually mentor another surgeon, to the MITIE Lapco program. Learners have an expert with them virtually for their first 10 cases at their home hospitals. We believe that telementoring will help the learning surgeons perform better, safer surgeries and will help increase the U.S. adoption rate of laparoscopic colon surgery.

Microsurgery training at MITIE
Microsurgery is commonly used to reattach severed nerves and blood vessels. Microscopes are needed for these procedures to ensure that the cells in the nerve ending or blood vessel are lined up properly.

Telementoring is doable and every bit as powerful as in-person mentoring. I have hospital CEOs asking for us to offer telementoring for more courses because they’ve seen the outcomes. They know their surgeons will be able to do these advanced procedures safely and effectively and will have happier patients. I think five years from now, we’ll look back on this conversation and laugh because telementoring will be so common.

Me: What’s your favorite MITIE class or research project so far?

Dr. Dunkin: I think the clear favorite is MITIE Lapco. It wasn’t just the course we put on for the learners, but it was the thoughtfulness, time and effort we put in to designing the program from developing the curriculum and organizing telementoring opportunities after the course. And the feedback we got from learners during the course was unlike anything we’d heard before. Almost everyone in our first MITIE Lapco course had been to a previous course on laparoscopic colon surgery at another institution, and they were just blown away with the difference in their confidence level in performing this surgery at the end of our course compared to the others.

Me: What are some upcoming MITIE classes or research projects that you’re most excited about?

Dr. Dunkin: I’m most excited about the next stage of growth for MITIE because we’re right at the threshold of it.

The first stage was designing and building a physical structure. The next stage was building an infrastructure that could support volume and a variety of programs. In the seven years that we’ve been open we’ve had more than 28,000 learners here.

Now, we are at the point where I want to create more programs like MITIE Lapco that address the full spectrum of surgical education. I can’t tell you how many people have told me that no other place is doing what MITIE is doing. What’s really great is that where we want to go with MITIE fits with Houston Methodist’s goal of leading medicine rather than just practicing it. There are a lot of great courses and research projects in MITIE’s future, but it’s the whole MITIE package that I’m most excited about.

The more I see MITIE evolve, the more confident I am that we are going to change the medical world by creating better educational tools and providing them to colleagues from around the world.

BYOL: Bring your own ligaments

t’s funny how things change as you age. For instance, we all reach a point where we don’t have to have the newest or best of everything – we just need something that works. You might feel that way about your car or your phone, but what about your ACL and PCL?

A new total knee replacement features a shape that protects that island of bone & saves the ligaments Click To Tweet

The ACL, or anterior cruciate ligament, and PCL, or posterior cruciate ligament, are located in your knee and are essential to natural knee movement and function. That’s why you hear about so many athletes getting a torn ACL repaired – you need those ligaments to function properly.

“These ligaments provide stability for the joint and increase the patient’s ability to perform complex movements, such as dancing, gardening or golfing,” explained Dr. Bill Bryan, a Houston Methodist orthopedic surgeon.

When you are old enough for a knee replacement, your ACL and PCL are certainly a bit worn out, but they still work, which is good enough for you. So why do surgeons remove the ACL and PCL when you have a knee replacement? Until now, they’ve not had an option.

A traditional total knee replacement requires removing the “island” of bone to which the ACL and PCL are attached. A new total knee replacement implant features a shape that protects that island of bone and saves the ligaments.

Dr. Bryan was one of 10 surgeons from across the country and the only surgeon in Houston to be selected as an early evaluator of the XP knee, made by Biomet, which features the new ligament-saving design.

“Most of my knee replacements patients are completely happy with their new knee, but some complain that they are not able to physically do everything they previously could,” Dr. Bryan said. “By saving the ligaments, this knee implant provides an improved range of motion and increases joint stability and natural movement for knee replacement patients,” Dr. Bryan said.

Dr. Bryan believes that another benefit of saving the ACL and PCL for knee replacement patients is that the ligaments will take some of the strain off the metal and plastic components of the knee replacement and help it to last longer. Most artificial knees last approximately 10 years before needing to be replaced.

“For many years, orthopedic surgeons have recognized the need for total knee replacements that save the ligaments,” Dr. Bryan said. “Now that technology and design have caught up with us, patients can now get a total knee replacement that works and feels a lot like a normal knee.”

5 signs you may need a knee replacement

More than 600,000 knee replacements are performed each year in the United States, and an aging population will continue to drive that number up. If knee pain is affecting your daily life, it might be time to ask your physician about a knee replacement.

Before you take another pain reliever, consider these five signs from Dr. Stephen Incavo, an orthopedic surgeon at Houston Methodist, that suggest it’s time for a knee replacement.

Sign #1: Decrease in activity level or quality of life

Knee pain should not affect your daily routine or prevent you from enjoying your favorite activities. If you experience in a decrease in activity level or quality of life, talk to your doctor.

Sign #2: Pain and/or stiffness at night

If you dread the evening because your knees begin to stiffen up or become painful, you might be a good candidate for a knee replacement.

“Some patients will only have knee pain or stiffness at night, so they think they don’t need a knee replacement. It isn’t normal to be unable to sleep at night due to knee pain.”

More than 600,000 knee replacements are performed each year in the United States Click To Tweet

Sign #3: Non-surgical options no longer help

In some cases, your physician may recommend trying non-surgical options, such as physical therapy or anti-inflammatory medicine, to provide pain relief. If the non-surgical treatment doesn’t help or stops helping, don’t hesitate to go back for a visit.

“Don’t wait too long after non-surgical options stop helping to come back in. The goal is to get you back to a happy, pain-free life, but you have to tell your doctor when something isn’t working for you.”

Sign #4: Future prognosis is not good

For many, your knee pain slowly erodes activity level or quality of life. But if the condition of your knee will continue to worsen, why wait? 

“So many patients with arthritis know they will eventually need a knee replacement, but think they aren’t ready for it yet. But think about your current situation. Ask yourself if you want to enjoy your present years or wait until you’re older and potentially lose all mobility.”

Sign #5: The first replacement has not helped

Unfortunately, not all knee replacements function properly and may require a revision surgery to correct the problem. 

Reviewed by Dr. Stephen Incavo

Bladder surgery doesn’t stop student from graduating

Saturday, May 31, 2014, was a big day for Harrison Bowe and for everyone around him, but one couldn’t tell it from the 19-year-old’s laid back demeanor. Sitting in his patient room in Houston Methodist Hospital, Bowe didn’t show any outward signs of excitement that he would soon become the very first graduate from the Class of 2014 at Bellaire High School.  “It’s gonna be a great day,” he coolly observed.

Bowe was still recovering from a serious complication from a rare birth defect, and from bladder surgery that surely saved his life. He was born without a functioning bladder, so from the first weeks of his life, Bowe underwent a series of operations to construct one out of his own intestines. He’s managed his condition throughout his life, working his way toward graduation from high school.

Harrison and his family celebrate his high school graduation at Houston Methodist Hospital.
Harrison and his family celebrate his high school graduation at Houston Methodist Hospital.

But in early May, his bladder ruptured unexpectedly and Bowe quickly developed a dangerous infection and acute renal failure. At Houston Methodist Hospital, Dr. Lee Morris performed an emergency bladder surgery.  “Harrison came through it very well,” Morris observed. “Once he gets rid of any lingering infection, he should be right back on track.”

So Saturday was graduation day, but since Harrison was still recuperating, officials from Bellaire High School and the Houston Independent School District brought the graduation to him.  The graduate wore a cap and gown and was wheeled to a conference room at Houston Methodist Hospital, where friends and family gathered for the one-man graduation ceremony.

Nurses caring for Harrison decorated his patient room and door with congratulations, and everyone signed a poster on a bulletin board on the nursing unit. Mike McDonough, Bellaire principal, walked in with a red cap and gown for the ceremony.

McDonough praised Harrison’s determination in making sure he was going to graduate even while he was still in intensive care.  “He was still hooked up to a ventilator, but Harrison was still trying to figure out how he could graduate,” McDonough said.

Quoting from Baz Luhrmann’s song “Everybody’s Free (To Wear Sunscreen),”  the principal reeled off some profound advice: “Enjoy  your body, use it every way you can/Don’t be afraid of it or what other people think of it/It’s the greatest instrument you’ll ever own.”

Then, with diploma in hand, Harrison thanked his supporters and caregivers and tossed his graduation cap into the air.