George Berci, MD, FACS, FRCS, Ed. (Hon), a general surgeon from Los Angeles, CA, is the recipient of the 2011 Jacobson Innovation Award of the American College of Surgeons (ACS). Dr. Berci was honored with the award in recognition of his pioneering contributions to the art and science of endoscopy and laparoscopy for more than 50 years. His work has included the development—or promoting the development—of advances in optics, illumination, television application, instrumentation, operative radiology, and anesthesiology, resulting in the high level of technology that is currently available for the performance of a variety of endoscopic and laparoscopic surgical procedures. Dr. Berci is an emeritus clinical professor of surgery at the University of California and the University of Southern California, and is currently the Senior Director of Minimally Invasive Endoscopic Research at Cedars Sinai Medical Center, all located in Los Angeles.
The 17th Jacobson Innovation Award was presented to Dr. Berci at a dinner held in his honor on June 10, 2011, in Washington, DC. The purpose of the award is to honor living surgeons who have been innovators of a new development or technique in any field of surgery. The award is made possible through a gift from Julius H. Jacobson II, MD, FACS, and his wife Joan. Dr. Jacobson is a general vascular surgeon known for his pioneering work in the development of microsurgery.
Dr. Berci's pioneering work in endoscopy and laparoscopy began with his studies in mechanical engineering, one of the few educational options available to him in the pre-World War II-era in Hungary. Following time spent in a Nazi labor camp in the mountains of Romania and Poland during the war, he pursued his medical and surgical training in Hungary.
Dr. Berci received his medical degree from the University of Szeged, Hungary, in 1950. He continued further surgical training at Szeged at the University Hospital, before moving to Budapest in 1953, where he helped to establish an experimental surgery division at the Department of Surgery Post Graduate School. During the Hungarian revolution in 1956, Dr. Berci escaped to Vienna, Austria, where he was interviewed for a postdoctoral Rockefeller Foundation fellowship. He emigrated to Australia, where he was mentored by Prof. Maurice Ewing at the University of Melbourne. While at the university, he started his studies on recovery of retained biliary duct stones, as well as biliary endoscopy, and imaging in operative cholangiography.
His work in endoscopy started in Australia in 1957, after he was awarded with a Rockefeller Fellowship in the Alfred and Royal Melbourne hospitals. It was there that he first viewed the inside of a dilated common bile duct with a simple old cystoscope, at which point he realized the poor image quality produced by this tool. That experience marked the genesis of Dr. Berci's lifelong pursuit of endoscopy.
Dr. Berci, who was also interested in operative cholangiography, became concerned about the issue of radiation dosage. He and his Australian research team created a single pulsed fluoroscope X-Ray image storage system that significantly decreased the exposure of radiation to patients and operating room personnel. He became the main advocate for both operative choledochoscopy and operative cholangiography as the subspecialty of biliary surgery. His aim was to recognize the anatomical anomalies and to decrease or discover injuries during surgical procedures. This research initiative also opened the field of improved removal technique (choledochoscopy) of suspected or non-suspected ductal stones during biliary operations.
Following a 1959 meeting with Prof. Harold Hopkins, a renowned physicist and professor of applied optics in London, Dr. Berci became actively involved in launching the Hopkins rod-lens system for the transmission of images into the clinical application of endoscopy. The system was a vast improvement over the technology then being used and significantly improved image quality. Although the system improved the endoscope's ability to provide a quality image, the level of illumination did not go as far as Dr. Berci believed possible.
In 1976, he introduced a stronger, but miniaturized, explosion-proof xenon arc globe, which the military had developed and which he transferred to endoscopy. This form of illumination, which is still used in endoscopes today, increased the quality of endoscopic images as well as recording findings. Even so, Dr. Berci believed there was more that could be done to further enhance the application of endoscopy as a diagnostic and treatment tool, thus, the image-video display and recording of endoscopes captured his interest. His work in that area ultimately resulted in improvements to endoscopic television cameras, which are continually becoming smaller.
Through Dr. Berci's work in illumination, contrast, clarity, and image recording, the creation of instruments for use in endoscopy expanded. In the late 1960s, new versions of the cystoscopes, resectoscopes, and nephroscopes used in urologic surgery had a major impact on how operations in that specialty were practiced. Furthermore, the field of pediatric endoscopy was initiated as a result of the miniaturized equipment that Dr. Berci was instrumental in creating. It was used in examining, diagnosing, documenting, and treating diseases requiring surgical treatment in pediatric patients. As a result, Dr. Berci, working with Stephen Gans, MD, FACS, became the first to document a tracheoesophageal fistula in living infants. His work in developing instruments also included development of an improved laparoscope, the teleotoscope for adult and pediatric patients, the modern rigid choledochoscope, and the indirect laryngoscope (which he developed with Paul Ward, MD, FACS, replacing the 200-year-old mirror) and a new video operative laryngoscope for ear, nose, and throat patients with Edward Kantor, MD, FACS. He also introduced a combined suction-coagulation cannula, which, along with the improved laparoscope and other tools, made it easier to perform laparoscopic procedures.
Even now, more than 50 years after his initial ardor regarding endoscopy began, Dr. Berci continues his work in furthering the marriage of surgery and technology. His recent efforts have included the conception, creation, and utilization of an enhanced endoscopic means of intubation for use in patients with particularly difficult airways (with Marshall B. Kaplan, MD; Carin A. Hagberg, MD; and Denham S. Ward, MD, PhD) exploring the use of the latest electronic technology for improving the imaging and viewing capabilities of endoscopes.
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