Harry Reich honoured by RCOG

London, 28 September 2012

Harry Reich MD FACOG FRCOG has been appointed a Fellow (ad eundem) of the Royal College of Obstetricians and Gynaecologists in honour of his pioneering work in the field of endoscopy.

Dr Reich is best known for pioneering Total Laparoscopic Hysterectomy (TLH) and the development of radical excisional laparoscopic techniques for the removal of extensive and deep endometriosis — pivotal moments in the development of gynaecological surgery.

Dr Harry Reich at the Royal College of Obstetricians and Gynaecologists

Dr Reich is a true pioneer.

He discovered as early as 1978 that it was possible to diagnose endometriosis via laparoscopy – as opposed to the much more invasive laparotomy – and in that year he excised endometriosis for the first time using laparoscopic techniques. Since 1983 he has performed open surgery in less than ten cases.

Yet, despite first presenting his work on the excision of endometriosis at both the ASRM’s and the AAGL’s annual meetings in 1987 — and performing the world’s first laparoscopic hysterectomy in 1988 — it took four years for his achievements to be accepted for publication in the scientific literature, because his techniques were considered “too experimental”[1].

Today, Dr Reich’s skill and courage to persevere benefits women worldwide. His commitment to develop – and teach – radical excisional laparoscopic techniques for the removal of extensive and deep endometriosis has spared thousands of women from having big, scarring, painful incisions.

These techniques are now recognised as a “gold standard method” and are imitated in most specialist endometriosis centres worldwide, making Dr Reich one of the most influential gynaecological surgeons of the late 20th century.

That first Total Laparoscopic Hysterectomy (TLH)

As mentioned earlier, Dr Reich is mostly well known for being the first person to undertake and describe the operation of Total Laparoscopic Hysterectomy (TLH), and according to Professor Ray Garry:

Professor Ray Garry

The successful demonstration of this procedure transformed overnight our perceptions of what was surgically possible without the need for large abdominal wall incisions. Laparoscopic cholecystectomy was developing around the same time as TLH and has been hailed as one of the greatest ever advances in general surgery. I would submit that TLH represents a similar pivotal moment in the development of gynaecological surgery.

Dr Reich is a charismatic surgical teacher and whether in an auditorium of a thousand people, in small group live surgery demonstrations or – best of all – in one to one surgery he is inspirational. He is also a brave and determined surgeon who has overcome hostility and fierce opposition to his concepts.

Like every advance TLH was not performed out of the blue. It represented the gradual accumulation of concepts, equipment and skills acquired over many years.

Haemostasis in laparoscopic pelvic surgery was a major barrier to the uptake of this type of surgery, and one of Harry Reich’s first developments was to demonstrate that correctly applied bipolar diathermy energy could prevent haemorrhage from ovarian and uterine vessels – a concept previously considered absurd until he presented his 1987 paper on laparoscopic oophorectomy and salpingo-oophorectomy in 24 women with benign tubo-ovarian disease [2].

Another technical obstacle to undertaking advanced laparoscopic surgery was difficulty with laparoscopic suturing. At first, only straight needles could be used and these were very difficult to work with. Dr Reich described a simple technique of introducing any size curved needle down a 5mm trocar channel and a method of easily performing extra-corporeal knotting, further prerequists to safely undertaking a TLH.

Laparoscopy in endometriosis – another first

Important as the development of TLH is, it is not necessarily Dr Reich’s greatest contribution to gynaecological surgery, according to Professor Garry:

Dr Reich was among the first to recognise and publish on the potential of laparoscopic surgery in the management of cul de sac obliteration. In 1991 he published a series of 100 patients with retrocervical deep fibrotic endometriosis treated by laparoscopic excision. The mean operating time for these procedures was 178 minutues giving rise to another quote indelibly associated with Harry “The Foreveroscopy”.

For me this approach provided me with a Saul on the Road to Damascus conversion moment. I had considered myself a bit of an expert on treating endometriosis for I had a couple of lasers and I knew that endometriosis was red and black spot lesions that could be vapourised out of existence with my guns. The hard material found alongside the endometriotic spots I knew to be just reactive fibrosis or BURNT-OUT disease. It was difficult to remove and could be safely left behind.

This changed the day I saw Dr Reich painstakingly removing all this ‘non-disease’ and placing it in 19 separate pathology pots. When challenged about the need to do this he told me to visit the path lab the next day and I was shown the specimens. Every one contained active glands and stroma and now I knew this was not burnt out endometriosis – this was what endometriosis is. This was a painful realisation for me and sent me on a long and very difficult road of trying to learn the skills to remove this dreadful disease.

Dr Reich had transformed my practice life and through me the lives of many of my patients. I was only one of many scores, maybe hundreds of gynaecologists so influenced. It is clear that in transforming the practices of so many doctors he has undoubtedly improved the lives of innumerable women in every corner of the world.

On behalf of women with endometriosis worldwide, Endometriosis.org wishes to echo the words of Professor Garry in recognising Dr Reich as someone who has undoubtedly improved the lives of thousands and thousands of women worldwide and to CONGRATULATE him on this well deserved recognition of his achievements.

Thank you for persevering, Dr Reich!

Acknowledgment

Thank you to Professor Ray Garry for his contribution in writing this tribute to Dr Reich

References
  1. Reich H. Laparoscopic hysterectomy. Surg Laparosc Endosc 1992;2(1):85-8.
  2. Reich H. Laparoscopic oophorectomy and salpingo-oophorectomy in the treatment of benign tubo-ovarian disease. Int J Fertil 1987;32(3):233-6.
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