At a time of enormous change and uncertainty for the health care industry, the San Fernando Valley region is home to many who are embracing the challenges boldly with new ideas and fresh vision. The 10 innovators profiled in the following pages are emblematic of the important work performed by health care workers every day. They are working to improve care and lower costs — and answer the urgent need for a better health care system. Atraditional colectomy — the surgical procedure to remove the colon — would leave most patients with a six inch scar across the abdomen. Do it using laparoscopic surgery and patients still wind up with three to six small scars. But imagine walking out of major surgery with no scars whatsoever. That’s the technique that Dr. Sam H. Carvajal is pioneering at Glendale Adventist Medical Center. He makes one small slice through the belly button, and through that tiny hole, he is able to insert multiple instruments allowing him to perform some 24 different operations from appendectomies to hysterectomies. The surgery is not without controversy. Many surgeons are resisting the new Single Incision Laparoscopic Surgery (SILS), which is still in its infancy. They argue that it’s unproven and difficult to perform. What’s more, insurance companies do not reimburse surgeons any more for the procedure, partly because it’s so new, which leaves most surgeons unwilling to try the new technique. But that has not stopped the Glendale surgeon from enthusiastically embracing its possibilities. He has performed 1,100 SILS procedures in the last three years, making him one of the most experienced, if not the most experienced, SILS surgeon in the country. “It’s really the future of surgery,” said Dr. Carvajal. “People cannot tell you’ve had surgery.” While the cosmetic results are great, there are other benefits. Dr. Carvajal says his patients experience less pain, go home from the hospital much sooner and are at much less risk of acquiring an infection. As such, the surgery has significant implications for health care. The difference between spending five days post-operation in the hospital and spending just two, as is typical with most SILS surgeries, can add up to tens of thousands of dollars. He says many patients feel well enough to go home the same day. But such savings may be down the road. For now, the procedure costs hospitals more, if only because it’s so new. That also makes hospitals reluctant to support them. Dr. Carvajal says he feels lucky that his institution supports him. “The business of medicine can be funny,” he said. “What’s good for hospitals is not necessarily what’s best for patients. It means fewer hospital beds are occupied, but if we’re able to get patients home quicker, they can get back to work and resume their lives faster.” SILS is not the only revolutionary surgery technique to emerge in recent years. Surgeons at the University of San Diego Medical Center recently removed a U.S. Marine’s appendix through his mouth. Both scarless surgeries share the same challenges: namely a lack of good instruments and surgeons who are trained, or willing to be trained, in the method. The tools are coming along. Mansfield, Mass.-based Covidien is one of the leading manufacturers of the SILS port, through which laparoscopic instruments are inserted into the belly button. Other instrument manufacturers are in hot pursuit of what they hope will eventually be a significant new market. Adoption by surgeons may be a bigger obstacle. It’s one reason Dr. Carvajal is leading multiple training programs at Adventist. Surgeons from across the country and the Valley have learned from him. Adoption is all about practice, Dr. Carvajal said. A standard operation to eliminate heartburn used to take him one hour. When he switched to SILS, his first few operations took him 2 ½ hours. With each surgery, he has reduced his time by 15 minutes to the point where the SILS procedures now only takes him an hour and 15 minutes. “It’s definitely a technical challenge and there is a learning curve,” Dr. Carvajal said. “But for me, it’s about the patients.”