Minimal Access Surgery the way to go

Minimal Access Surgery – the way to go By Joseph Ikechebelu. MBBS, FWACS, FICS, FMAS, B. Endos Professor of Obstetrics & Gynaecology. Nnamdi Azikiwe University &Teaching Hospital Nnewi CEO/MD: Life Specialist Hospital Ltd Nnewi Course Director: Life Institute For Endoscopy Tel; 0803 -404 -4189. E-mail: ji. ikechebelu@unizik. edu. ng 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 1

Open Surgery Incision 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 2

OPEN SURGERY - ADVANTAGES n Conventional and time tested n Less costly to set up n Taught worldwide at all levels by senior experienced doctors n Less technology dependent n Regional anaesthesia - cheap, convenient, easy to monitor 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 3

Open surgery scar 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 4

Laparoscopy surgery scar 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 5

Minimal Access Surgery Advantages 1. Improved Diagnosis: 2. Less tissue dissection & disruption 3. Less chance of adhesions 4. Less pain postoperatively 21 Nov. 2014 6

Minimal Access Surgery Advantages 5. Early return to work 6. Documentation of procedure (video evidence) 7. Cosmetically better outcome 21 Nov. 2014 7

Roles in Gynaecology n Hystero-laparoscopy is a gold standard investigation for infertility n Laparoscopic treatment of ectopic pregnancies, tubo-ovarian torsion, ovarian cyst have become universal standard in gynae surgeries. 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 8

Roles in Gynaecology n Laparoscopy is the most sensitive investigation for diagnosis of endometriosis. n Hysteroscopy role in diagnosis & treatment of infertility, polyps, submucous fibroids, fractional endometrial biopsy & intrauterine adhesiolysis is unchallenged. 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 9

My Training n Residency period. No exposure in my centre 1992 -1997 n Training in diagnostic laparoscopy at Silgrey royal hospital – late Dr. S. C. Ikegwuonwu. Every Wednesday for 3 yrs (1995 -1997) n In 2000. FIGO fellow one month training in IVF & MAS at Ottawa Civic hospital Canada 21 Nov. 2014 10

My Training n 1998 – 2006. Life Specialist Hospital Ltd Nnewi. Weekly Diagnostic laparoscopy sessions (thursdays) n 2006. Advance training in MAS in India – FMAS n 2007 started operative laparoscopy/hysteroscopy surgeries n 2005 – 2014. Attended several courses in laparoscopy surgery. 21 Nov. 2014 11

Winners Project @ www. websurg. com ESGE & ESHRE certification 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 12

Lessons from my experience n Long learning curve n Passion and Persistence n Personal funds. n Practice what you have learnt. n Endure frustration from public hospital n Build a team (PON, Technician, Anaesthetist, Operating partner) 21 Nov. 2014 13

Challenges of Training in Nigeria n No postgraduate or post fellowship training programme in Nigeria n No structured curriculum or regular training programme in MAS n Only short courses organized by hospitals ocassionally n Life Institute For Endoscopy. Filling the gap 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 14

Life Institute For Endoscopy (LIFE) n a premier training institute for MAS established in 2010 n Holds Basic & Advanced Training 3 x year (Feb, Jun & Sept. ) n Approved by MCDN for CPD in MAS n Recognized and accredited by World Association of Laparoscopic Surgeons (WALS) n Recently processing accreditation by European Society for Gynae Endoscopy (ESGE) 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 15

ADVANCED GYNAECOLOGICAL ENDOSCOPY SURGERY IN NNEWI, NIGERIA Presented By Prof. Joseph Ikechebelu JI, *Bhamare P, **Eleje GU, +Olajide AA, Okafor CD. Life Specialist Hospital Ltd Nnewi *Elixir Hospital Mumbai India. +Asokoro gen Hospital Abuja. **Nnamdi Azikiwe University Teaching Hospital, Nnewi 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 16

Study Design, Setting and Subjects n A retrospective review of endo-surgical register at Life Specialist Hospital Ltd, Nnewi, Nigeria n All laparoscopic and hysteroscopic surgeries (excluding diagnostic procedures) n Six year period (2009 -2014) n To determine the rate, indications & scope of surgeries performed. 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 17

Results n 210 (39. 9%) laparoscopic and hysteroscopic operations performed on 146 (31. 5%) patients during the study period, - an average of 2 patients or 3 procedures per month. n Majority (61%) of endoscopy patients were between 30 and 39 years n Majority of the patients (89%) had infertility (primary vs secondary at ratio of 1 : 1. 3) 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 18

Results n 317 patients had major gynaecological open surgeries during the same period n open myomectomy 213, n Hysterectomy (abdoninal/vaginal) 41, n Laparotomy 63 n 21 Nov. 2014 Endometriosis, Ectopic pregnancy, Ovarian cysts/tumour, Pelvic adhesions, etc. . Life Institute For Endoscopy. . . 19

Table 1: Indications for Laparoscopic & Hysteroscopic Surgery at Life Specialist Hospital, Ltd. S/N Indications / Clinical Diagnosis Frequency Percentage 1 Pelvic / Intra-peritoneal Adhesions 73 34. 8 2 Uterine Fibroid 40 19. 1 3 Bilateral Tubal Occlusion 30 14. 2 4 Ovarian Cyst / Tumour 16 7. 6 5 Hydrosalpinx 11 5. 2 6 Polycystic Ovary (PCOS) 13 6. 2 7 Endometriosis 7 3. 3 7 Uterine Synaechia 6 2. 9 8 Chronic PID / Chronic pelvic pain 7 3. 3 9 Ectopic gestation 3 1. 4 10 Missing Intrauterine Device (IUD) 2 1. 0 11 Others 2 1. 0 210 100. 0 Total 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 20

Table 2: Laparoscopic & Hysteroscopic Surgery performed at Life Specialist Hospital, Ltd Nnewi S/N Operation performed Frequency Percentage 1 Laparoscopic Adhesiolysis 73 34. 8 2 Laparoscopic Myomectomy 40 19. 1 3 Endoscopic Tubal Canulation 30 14. 2 4 Laparoscopic Salpingostomy 19 9. 1 5 Laparoscopic Ovarian Drilling + Dye Test 13 6. 2 6 Laparoscopic Ovarian Cystectomy 11 5. 2 7 TLH+ BSO / LAVH 6 2. 9 7 Laparoscopic Total Salpingectomy 4 1. 9 8 Laparoscopic Retrieval of IUD 3 1. 4 9 Laparoscopic Sterilization 1 0. 5 10 Hysteroscopic Adhesiolysis 5 2. 4 210 100. 0 11 Nov. 2014 Others 21 Total . . . Life Institute For Endoscopy. . . 21

Figure 1: Trend of Major Gynaecological and Endoscopic Surgery performed at LSH Nnewi 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 22

Conclusion n Our Gynae endoscopy surgery rate is increasing steadily from 13. 5% in 2009 to nearly 50% (ave. 31. 5%) of patients who had major gynaecological surgery. n Qualification and training courses should be followed with regular practice. n Regular update of yourself and equipments. n Establish linkages and collaboration with other centres 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 23

Laparoscopic Surgery in NAUTH 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 24

Hysteroscopic surgery in NAUTH 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 25

Laparoscopy surgery in progress 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 26

It is team work 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 27

All eyes on the monitor 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 28

All team members must understand the process and achieve synergy for best results 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 29

Receiving my Endoscopy certificate 30 th June 2014. Munich Germany 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 30

Sept 2010 pioneer set @ LIFE 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 31

Hands on training 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 32

Jan 2011 Trainees 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 33

Hands - on session 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 34

Lecture in Progress 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 35

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Animal session during advanced laparoscopy course at LIFE 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 48

Animal session in progress 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 49

Animal session in progress 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 50

Endoscopy Training in Leuven Belgium 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 51

With Dr. Prashant Bhamare in Mumbai India. 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 52

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Life Specialist Hospital Ltd Nnewi 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 54

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