Over a year ago, Frederick L. Greene, MD, FACS, clinical professor of surgery, University of North Carolina School of Medicine, recounted a brief history of SAGES (The Society of American Gastrointestinal and Endoscopic Surgeons). For my first blog, and in honor of the 2014 meeting, I would like to recount some of that story.
In 1979, several surgeons and gastroenterologists, such as Gerald Marks, MD, George Berci, MD, and Ken Forde, MD, gathered in Philadelphia to discuss spearheading an organization centered around endoscopy. A year later, Dr. Greene recalled receiving a letter from Dr. Marks, inviting him to join the small group in their endoscopic endeavor. Dr. Greene, an associate professor of surgery at the University of South Carolina School of Medicine at the time, had been teaching courses on flexible endoscopy and was eager to join.
Later that year, around three-dozen surgeons met at The Peach Tree Plaza Hotel in Atlanta to outline their new organization, the Society of American Gastrointestinal Endoscopic Surgeons (SAGES). Dr. Marks was appointed the first president from 1981 to 1983.
SAGES began small but slowly over the next decade continued to build itself up. In 1983, SAGES held its first scientific session in Philadelphia, and in 1986, had its first meeting in Williamsburg, VA, focused on colorectal and flexible endoscopy. There were only 11 exhibitors.
By 1988, SAGES participated in the first World Congress of Endoscopic Surgery in Berlin and supported the launching of Surgical Endoscopy, the organization’s official journal. During this time, SAGES issued several sets of guidelines, including rules on resident training in endoscopy and granting surgeons privileges in flexible endoscopy.
“For the next few years, we were basically a flexible endoscopy society,” Dr. Greene recalled. “There was no discussion of laparoscopy yet.”
A turning point for SAGES occurred in 1989. At the meeting in Louisville, Kentucky, Jacques Perissat, MD, asked if he could play a video. The video showed him and his colleagues performing a laparoscopic cholecystectomy. Surgeons in attendance became excited by the new procedure.
After this, SAGES began to focus on minimally invasive surgery. In 1990, SAGES organized a multicenter randomized controlled trial, involving 2500 laparoscopic cholecystectomy cases, and issued guidelines for clinical applications of laparoscopic cholecystectomy that laid the groundwork for who should do the procedure and under what circumstances. SAGES also started a series of “Training-the-Trainers” courses to help spread the technique.
“SAGES became the leader in laparoscopy, embracing it the most out of all organizations,” Dr. Greene said. “There was no interest from academia and as an organization, we felt it was important to be involved. Some opponents criticized us for issuing the guidelines so quickly but we wanted to bring some order to this new movement.”
In 1990, SAGES hosted the 2nd World Congress of Surgical Endoscopy. Dr. Greene, who directed the program, noted the mounting interest in SAGES.“That was a big year,” Dr. Greene recalled. “About 450 surgeons turned up whereas the year before we had only 200.”
In 1991, laparoscopic techniques were continuing to gain popularity. The leaders of SAGES as well as company representatives from US Surgical and Ethicon were flown to China to introduce laparoscopic cholecystectomy. “The surgeons and nurses caught on quickly,” recalled Dr. Greene.
Reflecting on the early days of SAGES, George Berci, MD, senior director of Minimally Invasive Endoscopic Research at Cedars-Sinai Hospital, Los Angeles, noted, “We were instrumental in the laparoscopic evolution, and helped produce a worldwide snowball effect. I’m very proud that I was one of the guys who triggered it.”
In 1992, when Dr. Greene became president of SAGES, the organization started a series for laparoscopic courses for residents at Ethicon’s new training center in Cincinnati. In 1993, the society began framing guidelines for post-residency training, and in 1994, became a CME-granting organization to help surgeons who hadn’t had formal training in laparoscopic techniques.
Fast-forward to 2014. What started as several dozen pioneering surgeons interested in promoting endoscopic surgery became a global society focused on advances in minimally invasive surgery, which now boasts 6,000 members. The latest meeting in Salt Lake City, Utah, included over 75 exhibitors from industry and other companies (including General Surgery News), dozens of sessions on anything and everything MIS, including hands-on workshops in NOTES.
“Still today, SAGES continues to push the boundaries,” said Robert Hawes, MD, medical director of the Florida Hospital Institute for Minimally Invasive Therapy.
The original group that met in 1981 to lay the groundwork for the Society of American Gastrointestinal and Endoscopic Surgeons.
Photo courtesy of Frederick L. Greene, MD