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Global Arthroscopy Foundation Guest Physician
Visit Report: |
“Doctors are a conservative profession – they need to see it to believe it. Once people see that (arthroscopy) works, they can then convince their hospitals to invest in the equipment.” ~ Dr. Vytautas Tutkus, August 2003
Dr. Vytautas Tutkus, GAF Guest from Vilnius, Lithuania. “In Lithuania, there were about 30 surgeons who had done arthroscopic surgery, but none had ever done surgery on the shoulder,” Dr. Sweeney said. “Dr. Tutkus has done several shoulder surgeries since (he returned) and now he can teach others.” Dr. Tutkus is a surgeon from Vilnius, Lithuania affiliated with the Vilnius Center University Hospital, Department of Plastic and Reconstructive Surgery. Dr. Tutkus was the President of the Lithuanian Arthroscopic Association at the time of his visit and has practiced arthroscopy of the knee for nearly 10 years. He has more than 23 years of surgical experience, and identified a need to bring arthroscopy of the shoulder to his country. Shortly thereafter, he was introduced by a fellow surgeon to Dr. Sweeney, head of the Global Arthroscopy Foundation. He was ultimately brought to Chicago in the summer of 2003 to be trained at area hospitals and surgical training centers. Arthroscopy is still an emerging technology in Lithuania, and prior to Dr. Tutkus’ visit to Chicago, there were no doctors using arthroscopy to perform surgeries on the shoulder in this small Eastern European country. By learning from Dr. Sweeney and other Chicago area doctors volunteering their time to the GAF program, Dr. Tutkus has been able to bring the many benefits of arthroscopic surgery of the shoulder to patients in Lithuania. The Chicago-Lithuania connection grew over the several years prior to Dr. Tutkus’ visit, and continues today. Dr. James Baldwin first brought arthroscopy to Lithuania in 1990, and Dr. Tutkus was one of the first physicians to embrace this new form of surgery. Since then, Dr. Tutkus has taught arthroscopic knee surgery to other doctors in Lithuania and hopes to do the same with shoulder arthroscopy. During a trip to Latvia in 2001, Dr. Sweeney briefly visited Lithuania at the suggestion of Ms. Melody Hughes, the head of the “Hands Across the Atlantic Foundation.” On that trip, Dr. Sweeney met a plastic surgeon who helped him seek out a doctor interested in arthroscopic surgery. After the introduction was made, Dr. Sweeney and Dr. Tutkus discussed several options for furthering arthroscopic surgery in Lithuania. They remained in contact, ultimately leading to Dr. Tutkus’ visit to Chicago in August 2003 and the events that followed. Dr. Tutkus was trained as an orthopedic surgeon during the time that Lithuania existed as part of the Soviet Union. After practicing for several years, his surgical career became focused on micro-surgery, including surgical re-attachments. This focus on using the microscope to aid in surgical technique led to an interest in knee arthroscopy. Surgeons in Lithuania do not take the ability to travel to the United States for granted – particularly experienced doctors, most of whom learned their craft when the country was a Soviet republic. In those days, the Soviet medical community was closed off from other parts of the world and was part of a health system with very different values than the Western world. “When we were part of the Soviet Union,” Dr. Tutkus explained, “we talked about human rights, but didn’t really have them at all. Patients were not typically asked for permission to do any specific surgery. Now, we explain more and ask permission.” Today the political climate is different, but the barriers to training are now more financial than ideological. The cost to GAF to bring Dr. Tutkus to Chicago is roughly equal to one year’s salary for a surgeon in Lithuania. 
Dr. Tutkus, participating in a workshop at the Orthopedic Learning Center in Rosemont, Illinois. It has been documented that arthroscopic surgery achieves stunning results with far less risk of infection, far less time hospitalized, far less need for extensive physical therapy and virtually no period of reduced productivity. However, these facts had not permeated the surgical community in Lithuania prior to Dr. Tutkus’ visit. “Currently, many wait up to six months for any type of surgical treatment of the shoulder, and then are treated using open surgical techniques,” Dr. Tutkus said in 2003. He also observed that the advancement in arthroscopy of the shoulder is roughly 10 years behind arthroscopy of the knee in Lithuania. Learning from surgeons in the Chicago area helped Dr. Tutkus to improve not only his surgical skills, but also his ability to understand certain diagnoses. “Through arthroscopy, we have a better understanding of shoulder pain and a better surgical option for treating it,” he said. Specifically he cited that patients in Lithuania would benefit due to the fact that arthroscopy can provide more advanced diagnosis and treatment for shoulder conditions related to repairs of a dislocated shoulder, diagnosis and treatment for rotator cuff tears, ‘mini-opens,’ and diagnosis and treatment of shoulder pain sometimes attributed to spinal conditions. Dr. Tutkus observed that not enough physicians in Lithuania are trained in major joint surgeries. Many doctors are conservative, and reticent to do surgeries because they are not properly trained, which means that many people do not have modern techniques like arthroscopy as an option. At the same time, some doctors are interested in learning arthroscopy, but do not have the proper equipment to perform it. “Arthroscopy is a very modern surgery; programs like this ensure that the achievements in this field are transported to other countries so more patients can benefit from that knowledge,” Dr. Tutkus said. The GAF experience brought the doctor an important new comfort level with arthroscopy of the shoulder. “I am now ready to do this surgery at home,” Dr. Tutkus said. “I wasn’t prepared before, but now I am.” He also noted that he expected, and was given, both the knowledge from experienced surgeons and the opportunity to try the techniques himself, assisted by an expert. After his return to Lithuania, Dr. Tutkus began performing arthroscopy of the shoulder. He planned to present his experiences to the Lithuania Arthroscopic Society and teach others, as equipment was available. GAF continues to work with Dr. Tutkus to assist in obtaining equipment for the surgeons in Lithuania.
Dr. Tutkus, with a colleague at Evanston Hospital, Evanston, Illinois. Training surgeons is a critical step in bringing the benefits of arthroscopy to patients, and one of the core missions of the Global Arthroscopy Foundation. Each pebble in the pond allows waves to spread and reach areas much wider than originally touched. “I want them to teach their fellow surgeons in their country,” Dr. Sweeney said of this approach. The doctors who participate in the program in Chicago are chosen for their ability and desire to then subsequently train doctors in their home country. Dr. Tutkus was one of the first guest doctors to participate in the Chicago experience, and he shared a belief in the GAF mission that by training one doctor, that doctor can then ‘make waves’ throughout his or her home country by training others. Training is quite directly related to reducing time patients spend in the operating room and, subsequently, length of recovery time. When a surgeon is skilled in arthroscopy, it is a much faster surgery than open surgery – thus the long waiting times for surgeries can also be reduced. “I look forward to providing this service – and new treatment option – to the Lithuanian people,” Dr. Tutkus said. “They will recover faster, and feel much better. Using arthroscopy, there is no need to cut and heal muscles, so there is much less pain. You can start moving the next day.” The GAF program is tailored to the experience, goals and learning needs of each doctor, but is designed to include direct experience as well as laboratory time. “The way the training was organized was very beneficial,” Dr. Tutkus said. “I had a chance to see how many different operating positions can all be correct, and how they work differently for different doctors. First, I was able to attend a lecture-style course (provided through the Arthroscopy Association of North America). Then I had hands-on experience with a cadaver. After that stage, we then observed several doctors performing the surgeries in several different hospitals. Also, I was able to observe the lab at Evanston Hospital used by the residents using plastic models of the shoulder, and was introduced to other training techniques, including the knot table. Then we returned to the cadaver work, to apply the lessons learned during the week. I will be able to take many of these techniques and apply them in my training of other doctors at home.” Dr. Tutkus continued: “When you have valuable instructors, you will understand the value of their instruction – most importantly, when you remember their ideas in your practice. When you aren’t used to a certain method, it is easy to think only one view is normal, when there are many shapes that are normal, and only experience teaches you that. By observing different doctors, you are able to see many ways to perform the surgery correctly – then you can decide what works for you.” Experiential learning is particularly important to the field, specifically practicing using the camera and scope. “The hand becomes your eye,” Dr. Tutkus mused. “You touch and you see. Just looking on the screen when others are operating is not enough – you have to do it yourself.”
Dr. Tutkus, working with a virtual reality surgical simulator at Evanston Hospital, Evanston Illinois. Easing the cost of bringing arthroscopy to a new country is also an important part of the work of GAF. Even though arthroscopy of the knee was in practice in Lithuania, arthroscopy of the shoulder required new – and expensive – equipment and supplies. Lack of access to these necessary tools is many times the most difficult barrier to training surgeons a new technique. “Sometimes you have knowledge of a surgery, but no equipment,” Dr. Tutkus said. “Other times, you have the equipment and no properly trained surgeons. By participating in this program, I will be able to begin performing arthroscopy of the shoulder myself, and also provide training to other surgeons in Lithuania.” Dr. Tutkus returned to Lithuania with surgical instruments, which will be used in surgery and surgical training. “I and many of my colleagues work on donated equipment,” Dr. Tutkus said. “Our (governmental) system doesn’t allow for a lot of equipment purchases; some years it covers salaries and not much else. For every arthroscopic surgery I perform, I save the government two months of that patient’s salary. And yet it is difficult to convince them to invest in the equipment.”
As a follow-up to the training provided in Chicago, one of the GAF training doctors and also a GAF Founder, Dr. Gregory Palutsis, spent two weeks in Lithuania with Dr. Tutkus during the spring of 2005. He provided invaluable training on-site at the hospital in Vilnius, performing surgeries, observing other doctors and giving lectures on arthroscopy. He helped “establish a great relationship between surgeons in Chicago and Lithuania.” The GAF investment in Dr. Tutkus already has brought arthroscopy
of the shoulder to dozens of Lithuanian people, many of whom would
have experienced longer recovery times from riskier surgeries. This
is the realization of what he was most excited about, upon leaving
Chicago: the benefits that would soon be available to the Lithuanian
patients – and the training he would be able to bring to other doctors.
“I have been very happy with Dr. Sweeney, because in sharing what
he knows, it is doubled, and it will grow,” Dr. Tutkus said at the
time. “When you have all that you need, and you share the extra,
it is so valuable. It is wonderful when people decide to give something,
and what they give can then help other people.” |