A little more than an hour after he started cutting a tiny incision in Michelle Highland's neck, David Terris steps back from the table and looks around the operating room at Medical College of Georgia Hospital.

"OK, we're all done," he said. "Is the next patient ready?"

Dr. Terris, the chairman of the Department of Otolaryngology at MCG, is known for working quickly and for taking on smaller and smaller openings.

Surgeons from around the country, and around the world, are starting to take notice. The procedure on Mrs. Highland, for instance, was observed by two surgeons from the Netherlands.

"Dr. Terris is known for his minimally invasive surgery and we wanted to see this surgery," said Jose Hudillo of Erasmus Medical Center in Rotterdam.

While other surgeries have been performed using minimally invasive techniques for years, such as hysterectomy or gallbladder surgeries, the neck and thyroid area was slower to develop and not widely practiced. Dr. Terris, however, talks with zeal about converting others in his field to the approach.

"A lot of my colleagues around the country have been skeptical, although they're all getting on board now," he said. "I've got people coming from Pittsburgh and Oklahoma. People are starting to flock from around the country because now they say, 'Well, maybe there is something to this.' But even my own partner was kind of skeptical."

Doug Villaret made the trip from the University of Florida to Augusta to observe Dr. Terris perform a minimally invasive procedure.

"There's very few people doing that here in this country," said Dr. Villaret, the program director for otolaryngology at Florida, who has since tried the procedure himself.

The problem was the structure of the thyroid area itself, Dr. Terris said. Minimally invasive surgeries in the abdomen can employ air or carbon dioxide to inflate the skin flap and create more space for the surgeon to operate.

There is no such sack in the neck area, Dr. Terris said. Instead, the incision is pulled open by two residents, Charles Mixon and David Walters, using large Army-Navy clamps and the opening is moved around as needed.

"It would be hard to do with just two people," Dr. Terris said as he bent over the opening. "One of the advantages of an academic medical center is there are always extra hands around."

And it's another reason Dr. Terris preaches the benefits of up-to-date equipment.

"I'm a huge believer in technology," he said.

In this case, it is an endoscope that allows him to see inside the small opening and guide him around crucial structures such as the nerve to the voicebox, which he carefully isolates, and the carotid artery.

"I wouldn't be able to live with myself if, gosh we used this tiny incision but we cut your carotid artery," he said.

HIS PROCEDURES ALSO make use of a harmonic scalpel, which vibrates 55,000 times a second and seals blood vessels as it cuts them. The scalpel allows Dr. Terris to cut around the thyroid leaving very little blood to contend with, eliminating the need for a drain and the need to keep the patient overnight in the hospital.

"That allows us to send a patient home the same day as surgery," Dr. Terris said. "When I was a resident (10-12 years ago), we never sent patients home after the surgery."

The patient also heals much faster.

"It's so much better and easier and faster," Dr. Terris said. "And the cost is a modest incremental cost for the benefit. Everywhere I go, I make sure they hear about the harmonic."

AND IT WON'T stop there.

Dr. Terris flies to California (he came to Augusta from Stanford University) to continue work with a robotic surgery company, where the physician sits at a control panel, seeing the inside of the small opening through twin scopes that provide a three-dimensional view, and manipulates robotic arms tipped with instruments.

The system allows for much finer control and a much clearer view, Dr. Terris said.

"What that means is when you're in the neck and operating, you feel like you're in the neck," he said.

The machine could allow minimally invasive techniques to extend to many more traditionally open surgeries.

And it turns out going smaller actually increases the visual field through the camera and the image projected on the screen, Dr. Terris said.

"You don't need big incisions," he said. "As it turns out, you can see so much better through small incisions and with magnification and technology."

That's the gospel according to Dr. Terris.

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.