Mindy Coopman and Shouldice Hospital

Abstract

Mindy Coopman, a sales representative of a large medical equipment company, approaches the staff of Shouldice Hospital with a proposal to sell laparoscopic equipment for hernia repair surgery. The students must decide whether or not to recommend the hospital to purchase the equipment. The two-page case can be used as a handout after discussion of the Harvard Shouldice case. Excerpt UVA-OM-0790 MINDY COOPMAN AND SHOULDICE HOSPITAL Mindy Coopman, a sales representative from a major medical equipment supplier, was deep in thought. She had heard about the wonderful reputation of Shouldice Hospital and its “Shouldice technique.” In repairing hernias, the traditional “darning” techniques, including the Shouldice variation, were yielding to the new “tension-free” techniques. Rather than overlapping the herniated muscles and stitching them together, surgeons were laying a mesh patch successfully in the abdominal wall. The patch could be placed through an incision (the open method) or through a small tube inserted in the abdomen (the laparoscopic method). The patch was made by Coopman's company, and so she was encouraging Dr. Shouldice and his staff to try the new procedures. Most surgeons were addressing the possibility of mesh hernia repair with both curiosity and concern. Although mesh had been used as early as 1957, only recently had it gained a following in the medical community. The open procedure was quick and simple to perform, and because the abdominal wall was not stretched, patients spent only a short time convalescing with little pain. Mesh, however, was more expensive than steel sutures. The Lichtenstein Hernia Institute in Los Angeles used the open technique almost exclusively and reported a recurrence rate as low as Shouldice's. The mesh operation could also be performed with a laparoscope. In other areas of abdominal surgery, the laparoscope had already been vigorously adopted. Repairing a hernia with a laparoscope was a relatively new procedure, and few surgeons had extensive experience with it. The laparoscope was an expensive and demanding instrument with a steep learning curve, and success depended on the surgeon's skill and experience in repairing hernias. Although the laparoscopic procedure took longer than the open procedure, patients experienced less pain, returned to work twice as quickly, and had a recurrence rate of 1%. Mindy Coopman pondered about these procedures. On the one hand, the Shouldice technique was widely acclaimed as the leading procedure in hernia repair. Other surgeons were adopting the technique and lowering their recurrence rates as they gained experience. Why would Shouldice want to abandon the technique that it had pioneered and that had brought it so much renown? . . .