Félicien M. Steichen (October 13, 1926 – June 27, 2011) was a Luxembourgish-born American surgeon and Professor of Surgery. He was a pioneer in the development and use of surgical staples. He and Mark M. Ravitch are considered the fathers of modern surgical stapling. Steichen was also noted for his contributions to the development of minimally-invasive surgery.
Early life Born the second son and third of five children of Joseph Steichen, a civil servant, and Anne Gonner, a Homemaker, Steichen grew up at 11 rue de la Semois,Ville de Luxembourg, Certificat d'Etat Civil pour les Epoux Joseph STEICHEN-GONNER City of Luxembourg, Certificate of Civil Status for the Steichen-Gonner Family (Service de l'Etat Civil, Commune de Hollerich, Luxembourg City, Grand-Duchy of Luxembourg), January 25, 1946. in the Péitruss (Pétrusse) Valley neighborhood of Luxembourg City, in the Grand Duchy of Luxembourg. In 1946, he graduated from the Athénée.Programme de la Commémoration du 50eme Anniversaire de la Première Athénée 1946, Program of the 50th Anniversary Commemoration of the Athénée Graduating Class of 1946 (Registrar of Students, Secretariat of the Athénée de Luxembourg, 24, boulevard Pierre Dupong L-1430 Luxembourg), May 11, 1996, p. 35."The Johns Hopkins University: Individual Record Card for Faculty Members." The Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. Collection Bio Files, Series S: Steichen, Felicien M.
Medical and surgical training Steichen studied medicine at the University of Lausanne Medical School, from which he graduated first in his class in 1953.Chironian Magazine of New York Medical College, Fall/Winter, 2011. New York Medical College/Chironian, Valhalla, NY 10595. http://issuu.com/newyorkmedicalcollege/docs/chironian-fall-winter_2011/35"This Day in Luxembourg History ", by Fausto Gardini, at: http://luxembourgensia.blogspot.com/2012/10/13-october-1926-felicien-steichen-1926.html Shortly thereafter, he was offered a one-year surgical internship at Lakewood Hospital, near Cleveland, Ohio, by Director of Surgery Carl Hahn. Steichen arrived in New York on September 22, 1953, and in Cleveland shortly thereafter.
From 1954 to 1959, Steichen was surgical resident at Baltimore City Hospital ("BCH," now Bayview Medical Center), led by Director of Surgery Mark M. Ravitch.Johns Hopkins Medicine and Johns Hopkins Bayview Medical Center. Program for the Gardner W. Smith, MD Lectureship at Carroll Auditorium of Johns Hopkins Bayview Medical Center (Baltimore: Johns Hopkins Bayview Medical Center, April 28, 2011), page 3.Johns Hopkins, Gardner Lectureship Program, p. 3. He was Chief Resident from 1959 to 1961, and then appointed fellow in surgery at the Johns Hopkins School of Medicine. At BCH, Steichen and Ravitch also developed a trusting, collegial relationship that extended beyond the hospital ward and lasted for 35 years.
Developing modern surgical stapling
Baltimore City Hospital In late 1958, Steichen, Ravitch, and Ravitch's then-current chief resident, Peter Weil, began laboratory experiments with stapling instruments.Medical Terminology Daily: "History of Surgical Stapling" (Clinical Anatomy Associates Online Learning Systems: May 8, 2014) https://www.youtube.com/watch?v=ur08uBhQdsA.Ravitch, Mark M. and Félicien M. Steichen, Guest Eds. The Surgical Clinics of North America: Symposium on Surgical Stapling Techniques, vol. 64, No. 3. (Philadelphia: W.B. Saunders Co. June, 1984), p. 423.Steichen, Félicien M. and Mark M. Ravitch, Stapling in Surgery (Chicago: Year-Book Medical Publishers, 1984), p. 79.Steichen, Félicien M. and Ruth A. Wolsch, History of Mechanical Sutures in Surgery (Woodbury, CT: Ciné-Med, Inc., 2008), p. 174. The staplers they used had been procured by Mark Ravitch in Moscow during a medical experts' visit to the Soviet Union earlier in 1958Steichen and Ravitch, Stapling in Surgery, p. 79.Steichen and Wolsch, History of Mechanical Sutures in Surgery, p. 174.Ravitch, Mark M. and Félicien M. Steichen, Guest Eds. The Surgical Clinics of North America: Symposium on Surgical Stapling Techniques, vol. 64, No. 3. (Philadelphia: W.B. Saunders Co. June, 1984), pp. 423–4.Ravitch, Mark M., Félicien M. Steichen & Roger Welter, Eds. Current Practice of Surgical Stapling. (Philadelphia: Lea & Febiger, 1991), Chapter 1, pp. 3–11. that was unrelated to stapling. In early 1959, the BCH team began to use the staplers clinically.Medical Terminology Daily: "History of Surgical Stapling." Video mark: 7 minutes 55 seconds. (Clinical Anatomy Associates Online Learning Systems: May 8, 2014) https://www.youtube.com/watch?v=ur08uBhQdsA.Ravitch, Mark M., Félicien M. Steichen, R.H. Fishbein, P.W. Knowles and Peter H. Weil. Clinical Experience with the Soviet mechanical bronchus stapler (UKB-25). Journal of Thoracic & Cardiovascular Surgery. 1964. Vol. 47, p. 446. In 139 pulmonary lobectomies and segmentectomies for tuberculosis through 1961, the BCH team showed a significant reduction in life-threatening complication of bronchial fistula, from 14% using manual closures to 4.6% using staplers.Steichen and Wolsch, History of Mechanical Sutures in Surgery, p. 167. This work was published in the Journal of Thoracic and Cardiovascular Surgery, Steichen's first appearance as a major author of a scientific paper.Ravitch, Mark M., Félicien M. Steichen, R.H. Fishbein, P.W. Knowles and Peter H. Weil. Clinical Experience with the Soviet mechanical bronchus stapler (UKB-25). Journal of Thoracic & Cardiovascular Surgery 1964. Vol. 47, p. 446.
In May, 1961, Steichen finished his residency and returned to set up a private practice in Luxembourg. In July, 1961, he wed Michèle Steichen (née Queinnec), to whom he remained married for the rest of his life.Louis R.M. DelGuercio, author of Steichen's obituary in the Westchester Journal News, July 1, 2011, as found online at Legacy.com. http://www.legacy.com/obituaries/lohud/obituary.aspx?pid=152296518
Lincoln Hospital: establishing the viability of surgical stapling In 1963, after two years in Luxembourg and at the U.S. Air Force Hospital in Wiesbaden, Germany, he was recruited to Lincoln Hospital and the Albert Einstein College of Medicine, in New York City, by Peter Weil,Steichen and Ravitch, Stapling in Surgery, p. 80.Steichen, Félicien M. and Ruth A. Wolsch, History of Mechanical Sutures in Surgery, p. 175. his friend, colleague and fellow former chief resident at Baltimore City Hospital. Shortly after returning to the United States, he became an American citizen.Ward O. Griffin, Jr.: "Stapling in Gastroesophageal Surgery. (Chapter 8 in "The Surgical Clinics of North America: Symposium on Surgical Stapling Techniques," vol. 64, No. 3. Mark M. Ravitch and Félicien M. Steichen, Guest Editors. W.B. Saunders Co., Philadelphia, June, 1984, p. 536.
Steichen and Ravitch were the first to understand the importance of the modern instruments, and the first to develop many of the procedures in which the instruments could be applied. In that sense, they can legitimately be called the Fathers of Modern Stapling, not just American Stapling. Ravitch and Steichen were always scrupulous about crediting their predecessors in the development of mechanical sutures; indeed, if the names Hultl and von Petz survive, it is largely because Ravitch and Steichen habitually cited their elegant and brilliant work in all their major monographs. Yet large-scale applicability of mechanical suturing did not come about until Ravitch and Steichen began developing techniques for modern instruments and popularizing them in the surgical community through their writings, films and teaching seminars. As the Surgeon and Historian, A.P. Naef, has stated: "[in 1963,] extended clinical use and potential industrial production [of surgical staplers] were far from obvious."
Two events served to catalyze the development of modern surgical stapling: at Lincoln Hospital, Weil gave Steichen full freedom to use the hospital's surgical laboratory to focus on testing and developing surgical stapling. In Baltimore, Mark Ravitch met with an Entrepreneur named Leon Hirsch (later Founder of the United States Surgical Corporation) about whether surgical stapling could be commercially viable. The result was an informal group, comprising Ravitch, Steichen, Hirsch and eventual Executive Vice President of U.S. Surgical Turi Josefsen. Hirsch has called this group "a model of the way in which the private sector and Academia can work together."Remarks by Leon Hirsch at the Inauguration of the Felicien M. Steichen Chair in Surgery at the New York Medical College, March 25, 1993. Program, Grand Opening Ceremony for the St. Agnes Hospital Institute for Minimally Invasive Surgery. Ravitch and Hirsch focused on de-constructing the Soviet instruments and creating American prototypes. Steichen's priority became to test the new instruments, adapt them to surgical procedures, and develop new operations for their use. Initial prototypes for the workhorses of surgical stapling, the TA and GIA staplers, were created by 1964.Steichen, F. M. and Mark M. Ravitch, Stapling in Surgery, p. 80.
At Lincoln, from 1963 to 1969, Steichen was the first to study, then apply clinically, many of the surgical stapling techniques that are in routine use today.Steichen, F. M. and Ruth A. Wolsch, History of Mechanical Sutures in Surgery, p. 175. These include the first:
clinical functional end-to-end anastomosis;Steichen, Félicien M. and Mark M. Ravitch, Stapling in Surgery, p. 80. clinical gastrectomy using a stapling instrument;Steichen, F. M. and Mark M. Ravitch, Stapling in Surgery, p. 80. clinical pulmonary lobectomy using the GIA stapling instrument; clinical Hunt-Lawrence and Paulino Roux-en-Y pouches using a stapling instrument, with Fernando Paulino in attendance.Steichen, F. M. and Ruth A. Wolsch, History of Mechanical Sutures in Surgery, p. 175.
The functional end-to-end anastomosis, in particular, is credited to Steichen.Steichen, F.M. The Use of Staplers in Anatomical Side-to-Side and Functional End-to-End Enteroanastomoses. Surgery. 1968. Vol. 64, pp. 948–953.Kusunoki, M., et al. (2nd Dept. of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan): "Review of 200 Stapled Functional End-to-End Anastomoses. Digestive Surgery, vol. 10, No. 5, 1993, pp. 245–248.University of South Carolina (USA) School of Medicine: Syllabus for Elements of Surgery: Stapled GI (Gastro-intestinal) Anastomosis. Suggested Reading: "Steichen, FM. Mechanical Sutures in Operations of the Alimentary Tract." In Lloyd M. Nyhus and Robert J. Baker, Eds.,Mastery of Surgery. Boston: Little, Brown & Co., 1992. pp. 455–474.
The team also: studied use of the GIA stapling instrument inserted from above and below to avoid any cul-de-sac at all in the Duhamel Procedure; developed esophageal coloplasty using the stapling instruments; started the practice of making permanent tube gastrostomies with the GIA instrument; started the practice of transecting and closing bowel with the GIA instrument.
The six years from 1963 to 1969 mark the transformation of surgical stapling from a curiosity, practiced in almost no hospitals outside of the Soviet Union, to the technological vanguard in wound closure.
Geneva: the First Use of Modern Staplers in Europe Steichen finished his period at Albert Einstein with a Sabbatical year in Switzerland, as visiting professor at the University of Geneva Medical School and in the Division of Cardiovascular Surgery of the Hôpital Cantonal de Genève from 1969 to 1970. During that year, Steichen introduced the new American staplers into clinical practice in Europe, performing a number of successful surgical interventions at the Hôpital Cantonal.
The University of Pittsburgh Medical Center