Medicine: Master Stonebreaker
The story begins with a 16-year-old boy who first hears of a cutting-edge technology on television and grows up to not only operate the machine he saw on television, but also to garner global recognition for Israel in the discipline it serves.
This story, of course, is true. That boy is today 41-year-old Dr. Mordechai Duvdevani, head of Endourology and Lithotripsy in the Hadassah–Hebrew University Medical Center’s Department of Urology. The technology is lithotripsy, today’s gold standard for urinary-stone treatment, which uses acoustic pulses or shockwaves to shatter kidney stones from outside the body. And the global acknowledgement is twofold: In 2008, Hadassah was recognized by the world Endo-Urological Society as a center for fellowship training—the first such unit in the Middle East and one of very few outside North America and Europe to be so recognized. Two years later, in March 2010, Dr. Duvdevani was appointed to the society’s seven-member fellowship committee, the body that essentially determines the scope and direction of the specialty for years to come. He is its youngest member and the first and so far the only Israeli to serve on any of the society’s committees.
“Would it be megalomaniacal to accept the nomination?” Dr. Duvdevani asked a colleague before responding to the society’s invitation. “A little,” replied the colleague. “But success needs a touch of megalomania. You’re a fine endourologist and you’ve been nominated because you’ll do a great job!”
Doing a great job was the way that Mordechai Duvdevani was raised. “If I’d get 95 percent in a school exam,” he recalls, “my parents would say: ‘That’s a good grade, Moti. But there’s still another 5 percent to go….’”
A Holocaust survivor who fled Romania as a child, Dr. Duvdevani’s father lost his entire family to Hitler. “My father gave me the name of the grandfather I never knew, gave my sister that of our grandmother, and my siblings the names of our murdered uncle and aunt,” says Dr. Duvdevani. “As long as I can remember, I’ve felt proud to carry my grandfather’s name, and conscious that I must do all I can to honor it.”
One of the ways he is honoring his grandfather’s name is through his profession. Medicine was a longtime goal for Dr. Duvdevani and, by the time he was a resident at the Sheba Medical Center in Tel Aviv, he knew he wanted to specialize in endourology, a field then barely a decade old and still developing rapidly.
“Endourology is a minimally invasive approach to treating kidney stones and other urologic conditions, such as tumors, ureteral/intra-renal strictures and other disorders that obstruct the urinary flow,” he explains. “It’s an intensely interesting and fast-expanding area of medicine, and it’s also one with easy interventions that help people who are suffering greatly and actually heal them. There aren’t many disciplines in medicine where you can heal so widely and completely.”
Dr. Duvdevani’s fascination with endourology, the research he undertook as a resident into the genetic background to kidney stones and his securing of a Fellowship under a global leader in the discipline reached the ears of Dr. Dov Pode, head of Urology at Hadassah Hospital. “Moti was about to leave for a two-year fellowship in Canada in endo-urological and laparascopic surgery,” says Dr. Pode. “I invited him to come to Hadassah when he returned and direct our Endo-Urology and Lithotripsy Unit. I’ve never had cause to regret that invitation. Moti has proved one of our finest physicians. He’s a skilled surgeon and a gifted administrator as well as a highly intelligent and very likeable man.”
Dr. Duvdevani’s fellowship was at the University of Western Ontario in London. Ontario. “I left Israel knowing how to swim in a pond,” he says. “I arrived in Canada to discover that I’d reached the sea, and that the sea is very different from a pond. My immense good fortune was that I joined the team of Dr. John Denstedt, a senior endourological surgeon with a deserved global reputation. It was he, with his team, who taught me to swim in the sea. He remains my mentor and my inspiration.”
While he credits Dr. Denstedt for his professional inspiration, Dr. Duvdevani has equal praise for the family that encourages and supports him. “My wife, Carmit, not only works as a software quality assurance engineer, she is often both mother and father to our three children—Roei, 8, Noa, 4, and Eyal, 1—because of the long hours demanded by my job,” he says.
Back in Israel in August 2006, Dr. Duvdevani took up his post at Hadassah—and met the lithotripter whose installation he had watched on TV as a boy. “It was a powerful and sophisticated machine, but it was by then 20 years old,” he says. “Not only was it showing its age, but there was far more advanced technology on the market. It was time to change.” It was also time to make changes within the unit, and Dr. Duvdevani began bringing in practices in which he had trained during his Fellowship. He introduced new methods and developed surgical techniques, increasing the annual number of complex procedures to over 100, of regular procedures to upward of 150, and extracorporeal treatment for kidney stones to more than 600 patients a year.
“I’d been at Hadassah about two years and was surfing the Endo-Urological Society’s Web site, when it struck me there was no Israeli hospital listed for Fellowship training,” he says. Established in 1983 by a group of international urologists, the society is a nonprofit organization that promotes scientific dialogue among endourologists worldwide through annual meetings, circulation of scientific literature, surgical skill training courses and hands-on laboratory sessions. “I knew that our unit was easily on a level with those listed,” he says. “I spoke to Professor Denstedt, who was society treasurer, and told him what we do in Hadassah, how we’re growing and that I thought we met the criteria to grant fellowships. His response: ‘Moti, you do indeed meet the criteria. Go ahead and good luck!’”
Dr. Duvdevani put together what he describes as “a book” of documents detailing the unit’s work, personnel, equipment and research, and submitted it to the society’s fellowship committee. Recognition as the first hospital in the region for fellowship training quickly followed. Two endourology fellows are currently training at Hadassah—one from Israel and one from India.
Two years later, Dr. Duvdevani was invited onto the society’s fellowship committee for a three-year term. “It came as a complete surprise!” he says. “I didn’t even know I had been nominated. I contacted John Denstedt at once and, of course, it was he who had put forward my name. “‘I did it because you’re very good at what you do and you have a major contribution to make,’ he told me.”
Five months after that nomination was announced, Dr. Duvdevani took delivery of Hadassah’s new lithotripter, one that is several technological generations removed from Israel’s first lithotripter, the historic Dornier HM3 installed at Hadassah in 1985. A nonsurgical answer for many of the 10 to 15 percent of the population afflicted with kidney stones, the lithotripter bombards the kidney with extracorporeal shockwaves that shatter stones into fragments small enough to pass through the urinary system.
“Hadassah’s original lithotripter was one of our first models,” says Thomas Műhlhan of Dornier Medtech, the lithotripter’s Munich-based manufacturer. “Today’s machines are based on new technology, making them more accurate, less invasive and, guided by computer, very hard to misuse. The pulses they emit are electromagnetic rather than the old rapid, high-voltage underwater spark discharges, which means that the patient is no longer submerged in a bath during treatment, the whole setup occupies far less space and there’s no need to change the electrode after each treatment.”
The electrode used to treat the first patient to receive lithotripsy at Hadassah in 1985 lies in Perspex on Dr. Duvdevani’s desk. “It reminds me of the road traveled until now,” he says, smiling. “And hopefully it points to a road ahead that will take us as far or further than we have already come.”