Published on December 10, 2018

Cape neurosurgeon learns and teaches in Korea

Cape neurosurgeon learns and teaches in Korea

When Hyannis neurosurgeon Paul Houle MD, FAANS, of Cape Cod Healthcare Neurosurgery arrived in Seoul, South Korea on November 3, he joined the world’s leading experts on minimally invasive spine surgery to treat a herniated disc. Dr. Houle currently is one of only two surgeons in New England who perform transforaminal endoscopic discectomy, or the “Joimax procedure.” As the only American awarded a fellowship of study, he traveled to Korea to learn how his Asian counterparts perform this surgery and their methods of instruction.

Cape Cod Health News recently spoke with Dr. Houle about this trip.

CCHN: Congratulations on your fellowship. What did you hope to learn during your week at the Wooridul Spine Hospital?

Dr. Houle: The Joimax procedure has been the standard of care in Asia and Europe for almost 10 years and it is now becoming more and more popular in the U.S. I was the first to perform it in Massachusetts a few years ago. I went to Korea to visit one of the leaders in the world on this topic. It was an opportunity for me to learn alongside and do surgeries with the best of the best. I learned their instructional methods, so I could bring this back to teach surgeons in the U.S. I was one of the main teachers for Joimax, the German medical device company that makes the equipment.

CCHN: How did you spend your time?

Dr. Houle: There were 10-hour days. It started early morning and we observed surgeries. We then went to a bio skills simulation lab where we practiced techniques that we just observed. There were didactic sessions and then the day was over. And that was Monday through Friday. I was one of the first and only Americans to attend.

Houle Korea 2

“We may all be from different cultures but anatomy is the same no matter where you are from.” – Paul Houle, MD

CCHN: But, this wasn’t only a learning opportunity for you, was it?

Dr. Houle: When the folks in charge of the program found out that I was attending, they reached out and asked me to give a lecture to them and their affiliated hospital. So, the instruction went both ways. And this was also a chance for me to develop a co-branding relationship with my Asian colleagues to explore expanding medical tourism to the Cape. I have patients who travel all the way from China to see me. This was a natural extension of that pattern.

CCHN: You were an early adopter of the Joimax procedure. How did that happen?

Dr. Houle: A little back story. A lot of my patients play golf, and I play golf. Right around 2013 to 2014, I started looking for treatment after surgery to help get them back on the course. Traditional back surgery to treat a herniated disc is invasive and almost always compromises the back muscles, which are vital to playing the game. My search got me thinking “what if when we are doing surgery we don’t injure the back muscles at all?” That’s when I was introduced to this endoscopic approach.

The surgical procedure involves making a tiny incision – no bigger than a number 2 pencil – in the flank side of the body. We take advantage of the natural contours in the spine to access the herniated disc. There’s far less damage done to the muscles and the spine in the process. So people have quicker recovery times, get back to work faster, have little pain after surgery and are better able to resume the play of golf.

CCHN: Part of your fellowship was to learn new ways to teach this procedure to your U.S colleagues. What new aspects did you teach?

Dr. Houle: Since they have been doing this for a decade or more, my hope was to gain from their experience.

I have already taught surgeons from all over this country. I am an invited speaker at our national meetings at the North American Spine Society and the American Association of Neurologic Surgeons. I recently had a surgeon come from Atlanta to watch me do surgery. And I will be training two surgeons from Boston in the next few weeks. Eventually, Brigham and Women’s (Hospital) will be getting the equipment and I will be doing their training as well.

By teaching and travelling and doing these fellowships, I am able to learn new techniques and continue to develop and advance the profession. And that knowledge comes back with me to the community. I went there not so much to learn the procedure as to learn how to be a better teacher and train more people.

CCHN: Was this your first venture overseas to your learn and lecture?

Dr. Houle: No, it wasn’t. I went to Germany early on and that is where I got the confidence. Last year, I went over to Ireland. And was recently invited to speak at the Mexican Neurologic Society. Unfortunately, it conflicted with the trip to Korea. But, I am going to do it next year.

CCHN: Tell us about how you used Facebook live to post about your trip.

Dr. Houle: I think it was really unique that someone local was able to travel all over the world to learn new techniques and to bring it all back to the community.