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Minimal Access Surgery – the way to go By Joseph Ikechebelu. MBBS, FWACS, FICS, 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. [email protected] edu. ng 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 1

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

OPEN SURGERY - ADVANTAGES n Conventional and time tested n Less costly to set 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. . Open surgery scar 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 4

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

Minimal Access Surgery Advantages 1. Improved Diagnosis: 2. Less tissue dissection & disruption 3. 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 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 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. 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 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 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 . 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 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 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 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 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 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%) 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 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 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 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 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 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. Laparoscopic Surgery in NAUTH 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 24

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

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

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

All eyes on the monitor 21 Nov. 2014 . . . Life Institute For 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 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 . 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 Sept 2010 pioneer set @ LIFE 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 31

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

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

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

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

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

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

With Dr. Prashant Bhamare in Mumbai India. 21 Nov. 2014 . . . Life 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 Life Specialist Hospital Ltd Nnewi 21 Nov. 2014 . . . Life Institute For Endoscopy. . . 54

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