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Urological "Giant" Bookends Residents', Fellow's Final Days

June 27, 2022
by Cheri Lewis

“There’s no one more supportive of his team and trainees.”

Seventeen years after completing his clinical and research fellowships, Isaac Y. Kim, MD, PhD, MBA, chair and professor of urology, formally recognized his mentor, Ralph V. Clayman, MD, with this accolade and an invitation to Yale.

Clayman was Yale Urology’s 2022 Bernard Lytton visiting professor, recently bringing to campus his years of knowledge, contagious passion, and slides of the grim reaper [part of a provocative lecture on percutaneous nephrolithotomy (PCNL) – a minimally invasive way to remove large kidney or ureteral stones that might be replaced with a non-incisional approach in the future].

Clayman is considered a leader in the field of minimally invasive urology. In 1990, he and his surgical team performed the world’s first laparoscopic removal of a kidney. He holds 23 patents and has published more than 475 peer-reviewed manuscripts. Currently, he is a Distinguished Professor in the Department of Urology at the University of California, Irvine, and co-directs the Curiosity and Innovation endourology research laboratory, as well as UC Irvine’s fellowship program.

Residents Wrangle

It wouldn’t be a Department of Urology Visiting Professor’s Day without a few passionately presented resident debates. Each one included rebuttals, an audience vote, and a wrap-up with, “What would our esteemed guest [Clayman] do?”

First up, To Biopsy or Not to Biopsy [a small renal mass]? Amir Khan, MD, arguing for biopsies and more knowledge, beat out Benjamin Press, MD, who made a case against biopsies as he said studies show they don’t typically change case management.

Next, Soum Lokeshwar, MD, MBA, narrowly lost to Tashzna Jones, MD, as the two duked it out on whether it is best to order a 24-hour urine collection when giving kidney stone prevention guidance. Lokeshwar argued for, while Jones debated against, saying “less is more” and advice like, “drinking more water” would be just as beneficial, if not more so, for the patient.

Finally, Katelyn Johnson, MD, and Justin Nguyen, MD, sparred over single port versus multi-port robotic surgery. Nguyen pulled out the win for multi-port advocates, citing single port’s steep learning curve and higher cost.

Industry Advancement?

This final debate spilled over into a real-time discussion among Clayman and Yale Urology faculty. Clayman said he would like to see robotic surgery continue, because it benefits many patients, but noted there is still much work to be done to make it better. For example, he welcomes the entry of new manufacturers into the realm of robotic surgery, which should help push innovation while driving down costs. Also, today’s robots only mimic the hand motions of the surgeon and thus provide computer assistance but are not truly robotic. He explained that “true robotic surgery will be when the robot knows every inch of a person’s anatomy … and can, with the push of a button, proceed to create a surgical anastomosis very rapidly, placing each suture at precisely the same distance from the edge of the tissue and from its neighboring suture while exerting exactly the same amount of tension on the running line of sutures. This may well provide for an anastomosis far superior to what is currently being done today.”

Yale Associate Professor of Urology Patrick Kenney, MD, agreed. “New technology and innovation are not the same things.” He stressed patient outcome improvements should be critical to determining whether something is truly an advance or simply an expensive “shiny new toy.” Michael Leapman, MD, assistant professor of urology, added, “There is often a perception that if medicine doesn’t accept each wave of new technology, innovation will stop. I don’t think that’s necessarily true. And in fact, there is an opportunity to push back and shape the message that the focus needs to be on clinically meaningful innovations.”

Celebration and True Innovation

Before Clayman wrapped up his two-day Yale visit, the department bade its three graduating chief residents and fellow a celebratory, chandelier-strewn goodbye. Kim kicked off the evening with a nod to his team of colleagues. “[Our fellow and residents’] technical skills are second to none. It’s quite evident the sacrifice and commitment that has been poured into our trainees by our faculty members.”

The graduates also acknowledged the special dynamics that made up their Yale experience.

“It has been really wonderful. For me, it was a leap into the unknown [as all his interviews/early meetings were done virtually], but I was certainly rewarded with a warm and welcoming experience,” said Michael Siev, MD, the department’s endourology fellow.

“The people I’ve met here have become family. I will miss them all dearly. They have hugely contributed to who I am today,” noted Jamil Syed, MD, urology resident.

“This has been such a wonderful journey,” exclaimed Marianne Casilla-Lennon, MD, who will stay on with the department as an assistant professor. “I’ve been so supported by my resident colleagues and I’m extremely excited to work as a faculty member [starting in September].”

“I’ve truly been honored and blessed these last 5 years at Yale. I’ve not only developed my skills as a clinician, physician, and future urologist, but I’ve been surrounded by some great role models and mentors here,” said Jay Amin, MD, urology resident.

And who mentors you, said Clayman, is key to how creative you will be in your medical career. In the final event, a special grand rounds presentation led by Clayman, he shared his definition for “true innovation” and the recipe he needed along the way to make his mark. His latest passion of developing a “force sensor” may be monumental in ending the all-too-common splitting of the ureter when placing an ureteral access sheath. It could open up a whole new field of study surrounding the concept of how much surgical force can be safely applied to a catheter or an endoscope.

“A career in medicine is extremely rewarding and is fed by an insatiable desire to relieve human pain and suffering,” said Clayman. “This ‘crisis’ is what pushes physicians to seek innovation.”

Submitted by Cheri Lewis on June 27, 2022