What's New July 15, Dr. Stuart Wolf

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Darren Murphy
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1 The University of Michigan Department of Urology 3875 Taubman Center, 1500 E. Medical Center Drive, SPC 5330, Ann Arbor, Michigan Academic Office: (734) FAX: (734) What's New July 15, 2016 Dr. Stuart Wolf Urology Department Faculty and Staff 1 Item, 10 Minutes Today, we hear from Dr. Stuart Wolf, who is penning his final contribution to What s New before making the move to the University of Texas. The timing of his final contribution is uncanny, as Dr. Wolf notes, as he started here at the University of Michigan 20 years ago, to the day! Today s edition contains a wealth of great insights into the past two decades, as well as thoughts about the future, so without further ado, let s hear from Dr. Wolf. -Eric Anderson Dr. Stuart Wolf It certainly is bittersweet to write this final personal What s New contribution. In a few short weeks I will complete my transition to the University of Texas. How did I get here? Undergraduate at Northwestern in Evanston, IL; Medical School at Northwestern in Chicago; Residency at University of California at San Francisco; Fellowship at Washington University in St. Louis. Then I started my first real job at the University of Michigan in Ann Arbor. on July 15, IT WAS TWENTY YEARS AGO TODAY (with apologies to Lennon & McCartney) Wow. What else was going on in 1996 (aside from the birth of my 4 th child, the first of three to be born in Ann Arbor)?

In the US Presidential Election 1996 Bill Clinton defeated Bob Dole and Ross Perot, and Clinton appoints Madeleine Albright as first female US secretary of state.

2 In the US Presidential Election 1996 Bill Clinton defeated Bob Dole and Ross Perot, and Clinton appoints Madeleine Albright as first female US secretary of state. Now Hillary Clinton is angling to be the first female US President. The Dow Jones Industrial Average closed the year at 6448 points. This week the Dow hit a record high of 18,372 points. Major League Soccer had its first season in the US. Prince Charles and Princess Diana were divorced. From January to December the number of Internet host computers grew from 1 million to 10 million. Dolly the sheep became the first mammal to be successfully cloned. IBM's Deep Blue defeated Chess Champion Gary Kasparov for the first time. The Chicago Bulls won the first of their 2 nd set of Three-peat NBA Championships. In the ensuing 20 years the department has grown A LOT. Below is the faculty picture from 1996, a few months before I started. Which of the faculty can you name? (Hint, of the 15 pictured, only 5 are still at UM). Gary Faerber and I were the only 2 members of the Division of Minimally Invasive Urology as it was called back then. I was appointed Head of the Division in Yipee.

3 My clinical innovations early on were primarily related to laparoscopy. Although hard to believe now, with straight-sticks laparoscopy being the old school way of doing minimallyinvasive abdominal surgery as compared to the modern technique of robot-assisted laparoscopy, at that time laparoscopy was cutting edge and it was very exciting to be part of its development. This was not the learning curve; it was the invention curve! At the end of 1996 I read an advertisement for a course at Cleveland Clinic for general surgeons, about a new technique called hand-assisted laparoscopy. I went to the course and found that only one urologic case had been done with that technique, a nephrectomy by Steve Nakada (who preceded me by one year in fellowship). I called Steve and told him that he had better hurry up and publish the care report because I was going to do one soon (Nakada et al, Use of the pneumo sleeve as an adjunct in laparoscopic nephrectomy, Urology 49:612, 1997). My first hand-assisted laparoscopy case (also a nephrectomy) was in February Shortly thereafter we reported the first comparative series of standard and hand-assisted laparoscopic nephrectomies (Wolf et al, Hand assisted laparoscopic nephrectomy: comparison to standard laparoscopic nephrectomy, J Urology, 160:22, 1998, which is still my 8 th most-cited paper) and performed the first handassisted laparoscopic donor nephrectomy (April 1998) and partial nephrectomy (November 1998). We did the first laparoscopic prostatectomy in Michigan in April 2000, and first used the Da Vinci robot (for a prostatectomy) here at UM in Jim Montie (Chair at the time) agreed to my choice of focusing on clinical rather than research endeavors, and after I closed my basic science lab in 2002 (Yes, I had VA Merit Review funding back in the day) we hired Will Roberts in 2004 to take over the research efforts of the Division. Smartest thing that I ever did! Subsequent hires included John Hollingsworth and Khurshid Ghani. Over the years we added more faculty who could do laparoscopy and robotics (many of whom had trained with us), primarily in the Oncology Division, such that eventually it made sense to change the name of our Division from Minimally Invasive Urology to Endourology and Stone Disease. I have kept a personal case log ever since I was a resident. Many papers have come from this log but clinical sciences have advanced and being able to write up my series of whatever doesn t cut it like it used to. I thought it might be interesting to share some highlights. In reviewing twenty years of personal operative experience: 9,609 cases (NOT including stent removals in Livonia OR, which we did for many years). So, I didn t get to 10,000 cases but I DID exceed Gladwell s 10,000 hours actually 15,054 hours if calculations are based on the average of 94 minutes-percase that I have had over the last 7 years.

4 o 3,441 ureteroscopic cases o 2,717 laparoscopic or robotic cases o 1,906 cystoscopic cases o 739 percutaneous cases o 496 SWL cases o 310 open cases In the 2 graphs below it is evident that ureteroscopy keeps growing and growing. Laparoscopy and robotics do too, but my share of those cases peaked about 10 years ago. My busiest year was 2010, with 1039 hours of surgery Lap/rob Perc URS Cysto SWL Open Type of Surgery by academic year (July 1 June 30), JS Wolf Jr operative log

5 Lap/Rob 1500 URS 1000 Perc Cysto 500 SWL Open Academic year (July 1 June 30) by type of surgery, JS Wolf Jr operative log All this clinical work has been very rewarding, but my most meaningful endeavor here at UM has been the training in which I have participated. I have been involved in the education of about 100 residents and fellows at UM over twenty years. This has been the source of my greatest satisfaction (OK, and my greatest frustration too but mostly satisfaction). It has been a wonderful ride and there is nothing I would have changed. I will miss you all. Take care. Go Blue and Hook em Horns. Look me if you are ever in Austin. stuart.wolf@austin.utexas.edu

Trends Toward Laparoscopy for Prostate Cancer

Trends Toward Laparoscopy for Prostate Cancer Transcript Details This is a transcript of an educational program accessible on the ReachMD network. Details about the program and additional media formats for the program are accessible by visiting: https://reachmd.com/programs/clinicians-roundtable/trends-toward-laparoscopy-for-prostatecancer/3467/