Medical Meccas: Eye-Surgery Assembly Line

Moscow may not spring to mind as a center of medical excellence. Ordinary Russian hospitals are dismal places, and those wealthy enough to afford it usually leave the country for medical care. The exception is the network of clinics founded by Dr. Svyatoslav Fyodorov, a pioneer in microsurgery of the eye.

Fyodorov invented the technique of radial keratotomy--better known as surgical correction of shortsightedness--back in 1977. Now one of the standard eye-microsurgery techniques used all over the world, the procedure involves making deep incisions in the cornea in a spokelike pattern to correct the curvature that causes nearsightedness. (Lasik is a different technique invented in the United States.) "Before Fyodorov started to operate with a microscope, eye surgeries were pretty much made with picks and shovels," says Khristo Takhich, general director of Moscow's Eye Microsurgery Center. Fyodorov was killed in a helicopter crash in 2000.

Fyodorov invented not just the eye-surgery technique, but also an assembly-line operation that brings industrial efficiency to the operating room. Anesthetized patients lie on tables mounted on polished rails, and arrive, five at a time, through a port in the wall of one end of the operating theater. Two surgeons and their assistants work down the line spending about two minutes on each patient, and when they're done the patients glide away to be replaced with a new set. The method allows surgeons to treat 40 patients in a single shift; Russia's 12 Fyodorov Centers perform 27,000 eye surgeries per year. The vast majority of patients walk out of the clinic on the same day they are admitted. Although the conveyor-belt method may sound distasteful, it forces doctors to standardize their practices, which keeps mistakes low.

Among Fyodorov's innovations was to set up his clinic as a semiprivate institution, even under communism, which gave it enough autonomy to pay competitive wages and expand the research program. U.S. and European doctors still come to train at the Fyodorov Centers, which also do a brisk trade in surgical equipment to China and India. And the centers are working with a major U.S. ophthalmological company to develop artificial corneas. They may be factories, but the clinics put out a world-class product.