How did Daniel Eun become among the best robotic surgeons in the world? Sweat, skill, serendipity, and to some extent, his lucky socks.
Daniel Eun’s father, a physician in Korea, was on his deathbed, but recovered. He decided then to devote his life to Christ and became a medical missionary, and moved the family to the West Bank in Palestine.
Because the family was Asian, and not seen as a threat, the doctor and his children could move easily through checkpoints, and young Daniel remembers often looking down the barrels of machine guns, but never having any trouble.
When his father grew ill again, he moved his family to Philadelphia, where his Presbyterian mission was based. Daniel’s faith was rooted at an early age, as was his admiration for his father, who never quit, and whose willingness to follow his passion and beliefs took him around the world.
For many years, Daniel and his parents and siblings lived in Olney, then Cheltenham, and eventually settled near Penn State, where he became a Nittany Lion.
His youth was defined by two things: He was always a tinkerer, always taking apart phones and radios and watches and anything and everything mechanical and putting it back together again. Always trying to figure out a way to make things work. The second thing that defined his youth was wrestling.
“Medicine has more to do with tenacity than how smart you are,” he said. “What taught me about tenacity was wrestling. It taught me how to not quit. That’s what I needed to get through medical and surgical training.”
As a boy, Daniel always wanted to be a doctor like his father, and came to medical school at Temple because he considered Philadelphia his hometown.
He wanted to be a urologist because it looked like fun, blasting kidney stones with lasers. But a residency in urology is competitive and he didn’t match. “I was devastated,” Dr. Eun said, “and I couldn’t shake it.”
He got a one-year internship at Pennsylvania Hospital. “I was an orphan for a year and they abused me,” he said. A urologist in the department, Dr. Terrence R. Malloy, quickly noticed the intern. “He came early, stayed late and had good surgical skills for that early in his career,” Malloy said. “He was a people person. He would laugh and giggle with nurses in the OR. He had no pretension.”
Malloy called colleagues at Henry Ford Hospital in Detroit, and told them to take Daniel Eun into their urology residency the next year.
Detroit just happened to become the epicenter of robotics in urological surgery. The robot was intended for cardiac surgeries, Dr. Eun said, but no one at that time in cardiac surgery embraced it, believed in it the way Dr. Mani Menon in Detroit did for the possibilities of robotic, non-invasive urological surgery. Dr. Eun was there at the formation, and he took to it.
What made Eun so promising was that he was a tinkerer. This was all new, and he would conceive and execute surgeries never attempted, never imagined. He was constantly pushing the boundaries. He would literally create and improvise in the surgery itself. In the early days, he’d wake up at 4 a.m., terrified. Could he do these complex surgeries? In time, he developed the experience, and confidence, to complement his creativity.
He returned to Penn after his fellowship, and came to Temple five years ago, when Dr. Larry Kaiser, president and CEO of the health system, made him an offer he couldn’t resist. Dr. Eun told Dr. Kaiser he wanted to build a robotic operating room unlike anywhere else in the world. And if he could build it he would come. He came. And Dr. Malloy came with him.
“He is one of the leading investigators of new uses for robotic surgery in urology,” said Malloy. “He’s a great innovator.”
Eun’s faith remains strong. In his office, taped to the cabinet door above his desk, is a biblical verse written in crayon by his six-year-old daughter: “His mercies never end. They are new every morning. Great is your faithfulness.”
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A patient story:
Donna Fortune went into a Philadelphia area hospital in December to have her uterus scraped, a routine vaginal procedure she’d had done before. The doctor thought she saw a polyp and went to remove it.
Unfortunately, without realizing it, the doctor had broken through the uterine wall, and accidentally removed the ureter, which carries urine from the kidney to the bladder.
“My whole world changed that day,” Fortune said.
Doctors at that hospital told her to go to Temple, to Dr. Daniel Eun.
“Any conventional surgeon, any sane surgeon, is going to look at her and say we’re going to remove her kidney,” Eun recalled. “She doesn’t want to hear it.”
She was a “ten out of ten,” on the scale of difficulty, he recalled.
He went into the surgery thinking he would create a new ureter using a piece of bowel, or maybe intestine, each presenting its own risks and drawbacks.
Once inside her pelvis, he improvised.
“She had literally the longest appendix I’d ever seen,” he said.
Essentially, Dr. Eun pulled down the kidney, and pulled up her bladder. Instead of using the “front door” of the kidney, where the ureter normally attaches, he said, he cut off the bottom of the kidney and created a “basement entrance.”
Prominently displayed in his office is a ball from a Penn State football game. That may explain his use of this analogy to describe Fortune’s surgery: “Open up the playbook, combine all the trick plays into one super play.”
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Working the robot, the Da Vinci, is a thing to see.
On a case the other day, not Fortune’s but similarly challenging, Eun sat at that console, like a submarine captain peering into the periscope. He saw the inside of the patient’s pelvis — bladder, prostate, blood vessels — all in three dimensions and magnified 10-fold. Eyes looking into the lenses, arms resting on a pad, he worked the hand controls. He could move the controls in any direction, his hands sliding and spinning like the Millennium Falcon as it eludes Imperial Forces.
Meanwhile, on the other side of the glass, in the operating room, the actual robot had been “docked” on the patient. Through small incisions, the four arms of the robot had been placed inside the patient’s abdomen and were able to go more deeply and move more precisely under Eun’s control than with traditional laparoscopic surgery.
He cut. He sewed. He probed. He cauterized. All the while, he was working foot pedals in his socks with a puppy’s face on the heel, a little black nose and whiskers. He works in socks to feel the pedals more precisely. In fact, his whole team works in what he calls “Lucky Asian socks” with animals that bring good luck. The pedals function much like a clutch in a car, allowing him, for instance, to flick the camera in one of the robotic arms into different modes.
Dr. Eun will talk through a microphone with nurses and residents in the operating room who are assisting him. The surgeries last for hours, and there can be time for banter. At one point, Dr. Eun advised a resident, “You gotta go find love man. Love is calling.”
Eun, chief of robotic surgery, often teams up with Dr. Michael Metro, a non-robotic surgeon who specializes in reconstructive urology. At Temple they’re known as MacGyver because they solve so many seemingly impossible problems together. “I have been able to tackle much bigger cases because of his expertise and guidance,” Eun said.
In the case of Donna Fortune, what Eun did sounded like something from Olympic gymnastics, and this was only part of the procedure: Lower pole calycostomy and downward nephropexy with psoas hitch.
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Three months after her 10-hour surgery, Donna Fortune came back to see Eun in his office, to have the last tube removed from her back.
Dr. Eun walked into the examination room.
“Where’s my hug?” he asked.
He leaned over and gave his patient a big embrace.
“Let me take a look,” he said.
There was still a tube in her back, a drain, and three small holes, scars the size of thumbtacks, on her abdomen from the robotic surgery. A fourth was hidden by her belly button. “Anything like this with open surgery would have been a huge incision,” he says.
He reviewed the latest scans and tests on his computer.
“So your kidney did take a hit from all this,” he explained. A healthy kidney functions at 50 percent, with two kidneys equaling 100 percent. Her repaired kidney was functioning at 28 percent, Dr. Eun said. But it was working. She was appliance free. She was peeing.
“Lets get this last tube out,” he said.
Fortune’s sister, Michelle Fortune Harmon, got up to leave.
“No you’re not,” ordered the patient.
“My sisters have been with me through it all,” she said to Dr. Eun.
“Thank God for family,” said Eun.
“Thank God for you, too,” said the sister.
Out it came.
“That’s it,” said Eun
“Thank you,” said Fortune. “You’re a blessing.”
She has other health issues and consequences, she says, from the original surgery that caused the harm.
But this was a very good day.
Patient and doctor hugged one last time. Donna Fortune would be back in three months, for what both doctor and patient hoped to be a very routine check-up.
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Michael Vitez, winner of the 1997 Pulitzer Prize for Explanatory Journalism at The Philadelphia Inquirer, is the director of narrative medicine at the Lewis Katz School of Medicine at Temple University. Michael.firstname.lastname@example.org