When Ralph V. Clayman, MD, FACS, and his team performed the first laparoscopic nephrectomy in 1990, they paved the way for a revolution in laparoscopic organ removal that transformed surgery.
Now, 36 years later, Dr. Clayman, a distinguished professor of urology and dean emeritus of the University of California, Irvine School of Medicine, will revisit this groundbreaking case as he delivers today’s Martin Memorial Lecture, “Curiosity and Innovation: The Promise of Wonder.”
Looking back through the lens of the modern operating room—one increasingly shaped by the promise and uncertainty of artificial intelligence (AI)—he will discuss how creativity, innovation, and collaboration made the procedure a success. The Martin Memorial Lecture will take place immediately after the Opening Ceremony, from 9:00 to 9:30 am in Hall B, Lower Level.
In the late 1980s, Dr. Clayman and fellow urologist Louis R. Kavoussi, MD, MBA, were working with Nathaniel J. Soper, MD, FACS, conducting experimental laparoscopic cholecystectomies in pigs.
“While Nat was looking at the liver, Lou Kavoussi and I were looking at the kidney,” Dr. Clayman explained. “That’s what gave us the idea that we could possibly take the kidney out laparoscopically.”
The inaugural laparoscopic nephrectomy was performed after Dr. Clayman treated an 85-year-old woman with a 3.5-centimeter tumor. On June 25, 1990, the team used a morcellator to break up the kidney, remove the fragments, and complete the procedure through a 12-millimeter incision. The patient went on to live to age 90.
Throughout his career, Dr. Clayman has sought more creative and effective ways to solve problems. He described the importance of, “Answering that seminal question, ‘Why are we doing something?’ Why are we still making big open incisions to take out kidneys in 1990 when there’s a laparoscope? It requires imagination and creativity.”
His lecture will explore the seven “brainsets” that Shelly Carson writes about in her book, Your Creative Brain: connect, reason, envision, absorb, transform, evaluate, and stream. Dr. Clayman will argue that reason, absorb, and evaluate are deliberate, while the rest are spontaneous.
“Nobody has all seven,” he said. “You need to find other people who have what you don’t have so you can work together.”
When it comes to AI, Dr. Clayman views it as a colleague, not competition, suggesting that its ability to “absorb” Information is the one brainset in which the technology surpasses humans.
“It cannot connect different disciplines,” he said. “It cannot envision the future. It cannot transform negative results into data to use for a positive exercise.”
For that reason, Dr. Clayman believes surgical teams still must lean on the human mind to develop innovative solutions to challenges in the OR.
For younger members of the audience, Dr. Clayman will offer several ways to foster creativity. He will advise young surgeons to be alert and ready for inspiration to strike when they least expect it.
“If you’ve got a problem, the answer’s going to come when you’re on a ski slope, when you’re taking a shower,” he said, noting that great ideas also arrive in the middle of the night. “Have a pad and pencil next to your bedside; you won’t remember it in the morning.”
He also will urge surgeons to view failure as an opportunity rather than becoming discouraged, and to recognize that “no” is the first step on a creative pathway. Whenever Dr. Clayman has encountered someone telling him “No,” he’s returned to that essential question: “Why?”
Now, he’s applying that same question to a century-old procedure: bladder augmentation. The conventional method for expanding a small bladder is to use a piece of bowel tissue. After performing a nephroureterectomy, Dr. Clayman examined titanium staples in the bladder and realized that they did not encrust, prompting experiments in titanium augmentation of pig bladders. The work has demonstrated potential to modernize bladder augmentation.
Whatever challenges and triumphs Dr. Clayman faces next, he’ll rely on the same pillars that have guided him throughout his career: partnering with colleagues who complement him, harnessing inspiration whenever it strikes, and continuing to ask “Why?”—or, more aptly, “Why not?”
For those unable to attend the lecture in person, the Martin Memorial Lecture will be available for on-demand viewing shortly after the live presentation.
Dr. Ralph Clayman is the author of That Will Never Do!, which will be available on Amazon in October.
