In Memoriam: John Wickham (1927-2017)

Tue, 7 Nov 2017 • Jonathan Goddard

John Wickham was born in 1927 in West Sussex on England’s south coast. He studied medicine at St Bartholomew’s Hospital Medical School in London just after the Second World War. Initially he planned a career in neurology and then neurosurgery but developed an interest in renal medicine and surgery after working in the renal unit under Ralph Shackman at the Hammersmith Hospital in London. There, along with Geoff Chisholm he ran the early Necker Dialysis Unit. A spell at Bart’s under Alec Badenoch and Ian Todd further enhanced his enthusiasm for urology. A Fulbright Scholarship took him to Lexington, Kentucky where he was exposed to the technique of intra-operative cooling for ischaemic renal surgery. He almost remained in America as a Professor of Urology but realising he wanted his children to grow up in Britain returned to St Paul’s urological hospital in London and then took up a consultant post at St Bartholomew’s in 1968.

Minimally Invasive Surgery

John Wickham had an enquiring and innovative mind and was quick to recognise and adopt new techniques. He constantly strived to minimise the trauma caused to patients by surgery and pioneered and named the surgical movement of Minimally Invasive Surgery. Using his American experience of renal cooling, and controlled ischaemia he promoted radial nephrotomies increasing total stone clearance in open stone surgery. He further strived for reduced invasion by introducing percutaneous nephrolithotomy to the UK. Not deterred by the resistance of conservative British surgeons at the 1980 British Association of Urological Surgeons (BAUS) annual meeting in Liverpool he showed his PCNL’s reduced hospital stay from 6 weeks to 2 days, decreased operative mortality and improved patient satisfaction. He famously recalled one PCNL patient, a London bus driver, who stopped his No.38 bus outside the hospital just one week following his surgery to come in to say, “Thank you”!

Wishing to further minimalise stone surgery he was the first to bring extracorporeal shock-wave lithotripsy to the UK securing a Dornier HM1 Lithotripsy machine in the private sector, but insisting that a proportion of the patients must be from the NHS and trainees must be allowed access to learn the technique.

Wickham, recognising the possibilities of the laparoscope assisted Malcolm Coptcoat to perform the first European laparoscopic nephrectomy at King’s College Hospital, London in 1991; the first laparoscopic nephrectomy for renal cell carcinoma in the world. He was also one of the first British surgeons to perform retroperitoneoscopic ureterolithotomy.

As director of the Academic Unit at the Institute of Urology he worked with many talented registrars. One of these, “clever young fellows” was Graham Watson. He suggested to Wickham that a 504nm laser fibre would fragment ureteric stones; they put it up a ureter and had a go; it worked; another modality in the minimally invasive weaponry for stone treatment.

Robotic Pioneer

John Wickham, in collaboration with Professor Brian Davies of Imperial College, developed and engineered the first robotic device in urological surgery named the PROBOT; it robotically carried out the TURP operation. First tried clinically in April 1991 the PROBOT is considered to be the first use of an active robot to remove soft tissue from a patient. Although the PROBOT was the first robot to operate on a patient autonomously it was too expensive to produce and like Wickham, was before its time.

John Wickham’s other great legacy was encouraging similarly enlightened urologists to communicate, not just in Great Britain but internationally. In 1976 he was a founding member of the European Intrarenal Surgical Society (EIRSS) and, in 1983 with Peter Alken of Mainz, Joe Segura from the Mayo Clinic, Arthur Smith of New York and Ralph Clayman from St Louis, he set up the Endo-urological society, of which he was also it’s first president.

Despite retirement in 1992, Wickham continued to maintain an interest in minimally invasive surgery. His invention of the “Syclix”, a novel surgical instrument which allowed surgeons to handle tissues with a pen-like grip, as opposed to a conventional scissor grip, won the prestigious Horners Award in 2006. In 2013 Wickham was awarded one of the highest professional honours from the Royal College of Surgeons of England, the Cheselden medal in recognition of his outstanding contributions to innovation in stone surgery and laparoscopic urology.

John Wickham’s contribution to urology cannot be underestimated and is best appreciated in his editorial piece “The new surgery”, which was published in the British Medical Journal in December 1987 where looking back to the “the rough and brutal” surgery of the past he looks forward to the elegant or minimally invasive surgery of the future.

Mr John Wickham passed away on 26th October 2017.