More notable developments from the Department of Surgery of the University of Montreal

I read with interest the paper entitled “The Department of Surgery of the Université de Montréal, 70th anniversary,” and found omissions of key developments during those 70 years.¹

The first in situ vascular grafts were done by Dr. Paul Cartier of Montreal in 1959.² McPhail reviewed the history of vascular surgery in Canada in 1995.³ It mentioned the origins of the in situ vein bypass in Montreal, Canada, and in London, England, followed by progression of the original techniques in Europe and the United States. However in 1969, there was criticism of the procedure in the United States, but with the perseverance of Dr. Cartier in Montreal and Dr. Hall in Norway, there was a revival of interest in the technique by Leather and Karmody in Albany, New York.³ Dr. Paul Cartier was made officer of the Ordre National du Québec in 2000, not only for the in situ bypass achievements, but also for the world’s first femoro-femoral bypass in 1959, axillo-femoral bypass, and carotid endarterectomy without shunt in 1962, at the Hotel-Dieu de Montreal.

Let’s not forget the development of minimally invasive surgery of the pituitary gland. During a period when transsphenoidal surgery was on the edge of disappearance, 3 crucial surgeons, Drs. Norman Dott, Gerard Guiot and Jules Hardy, revived the operation, each succeeding at further perfecting the procedure.⁴ Dr. Jules Hardy, a fellow of Guiot, from Montreal, revolutionized transsphenoidal microsurgery with the introduction of the binocular microscope and selective adenomectomy. The principles of these pioneers have endured and are now extensively employed by neurosurgeons worldwide.^4,5 Dr. Hardy was made officer of the Order of Canada in 1987, and chevalier of the Ordre National du Québec in 1989.

The contribution of the department in the advancement of breast cancer surgeries and treatments is undeniable, making them less mutilating and increasing survival with numerous publications and participation in National Surgical Adjuvant Breast and Bowel Project (NSABP) randomized controlled trials. Under the mentorship of Dr. Bernard Fisher, Dr. Andre Robidoux became the Director of the Clinical Research Group for breast cancer at Hotel-Dieu and brought NSABP-sponsored trials to more than 5000 breast cancer patients in Montreal. This was supported by 1 of 3 awarded National Cancer Institute treatment and prevention grants for 27 years. In 2010, Dr. Robidoux was a recipient of the Distinguished Investigator Lifetime Achievement Award in recognition of his extraordinary commitment to the NSABP and oncology research. He served as an elected member of the NSABP Foundation board of directors for many years.

Laparoscopic surgery in the early 1990s led to extraordinary developments at the Hotel-Dieu de Montreal, an hospital affiliated with the Université de Montréal. Adrenal surgery changed course with the first report of laparoscopic adrenalectomy (using the lateral decubitus approach) for Cushing syndrome and pheochromocytoma in the New England Journal of Medicine in 1992.⁶ This new laparoscopic position also led to facilitating laparoscopic splenectomy in the lateral decubitus, first performed at Hotel-Dieu and now practised worldwide. The first laparoscopic distal and proximal pancreatectomies were also performed in 1992 and 1993, and the first report of laparoscopic liver resection was in 1991.^7,8 Also the developmental research of endoscopic thyroidectomy using a porcine model at the Research institute of the Hotel dieu de Montreal led to the first world endoscopic neck surgery the following year at the Cleveland Clinic, and the first endoscopic parathyroidectomy in Canada a few years later, also at the Hotel Dieu de Montreal.⁹

I have mentioned only a few surgeons and techniques, and I am sure the list can be elongated.