1. Minimal Access Surgery – the way to go By Joseph Ikechebelu
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;
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Open Surgery Incision
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3. OPEN SURGERY - ADVANTAGES
Conventional and time tested
Less costly to set up
Taught worldwide at all levels by senior experienced doctors
Less technology dependent
Regional anaesthesia - cheap, convenient, easy to monitor
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Open surgery scar
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5. Laparoscopy surgery scar
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6. Minimal Access Surgery -Advantages
Improved Diagnosis:
Less tissue dissection & disruption
Less chance of adhesions
Less pain postoperatively
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7. Minimal Access Surgery -Advantages
Early return to work
Documentation of procedure (video evidence)
Cosmetically better outcome
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Roles in Gynaecology
Hystero-laparoscopy is a gold standard investigation for infertility
Laparoscopic treatment of ectopic pregnancies, tubo-ovarian torsion, ovarian cyst have become universal standard in gynae surgeries.
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Roles in Gynaecology
Laparoscopy is the most sensitive investigation for diagnosis of endometriosis.
Hysteroscopy role in diagnosis & treatment of infertility, polyps, submucous fibroids, fractional endometrial biopsy & intrauterine adhesiolysis is unchallenged.
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10. My Training Residency period. No exposure in my centre 1992-1997
Training in diagnostic laparoscopy at Silgrey royal hospital – late Dr. S.C. Ikegwuonwu. Every Wednesday for 3yrs ( )
In FIGO fellow one month training in IVF & MAS at Ottawa Civic hospital Canada
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11. My Training
1998 – Life Specialist Hospital Ltd Nnewi. Weekly Diagnostic laparoscopy sessions (thursdays)
2006. Advance training in MAS in India – FMAS
2007 started operative laparoscopy/hysteroscopy surgeries
2005 – Attended several courses in laparoscopy surgery.
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12. Winners Project @ www.websurg.com
ESGE & ESHRE certification
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13. Lessons from my experience
Long learning curve
Passion and Persistence
Personal funds.
Practice what you have learnt.
Endure frustration from public hospital
Build a team (PON, Technician, Anaesthetist, Operating partner)
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14. Challenges of Training in Nigeria
No postgraduate or post fellowship training programme in Nigeria
No structured curriculum or regular training programme in MAS
Only short courses organized by hospitals ocassionally
Life Institute For Endoscopy. Filling the gap
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15. Life Institute For Endoscopy (LIFE)
a premier training institute for MAS established in 2010
Holds Basic & Advanced Training 3x year (Feb, Jun & Sept.)
Approved by MCDN for CPD in MAS
Recognized and accredited by World Association of Laparoscopic Surgeons (WALS)
Recently processing accreditation by European Society for Gynae Endoscopy (ESGE)
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ADVANCED GYNAECOLOGICAL ENDOSCOPY SURGERY IN NNEWI, NIGERIA Presented By Prof. Joseph Ikechebelu.
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
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17. Study Design, Setting and Subjects
A retrospective review of endo-surgical register at Life Specialist Hospital Ltd, Nnewi, Nigeria
All laparoscopic and hysteroscopic surgeries (excluding diagnostic procedures)
Six year period ( )
To determine the rate, indications & scope of surgeries performed.
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Results
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.
Majority (61%) of endoscopy patients were between 30 and 39 years
Majority of the patients (89%) had infertility (primary vs secondary at ratio of 1 : 1.3)
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Results
317 patients had major gynaecological open surgeries during the same period
open myomectomy 213,
Hysterectomy (abdoninal/vaginal) 41,
Laparotomy 63
Endometriosis, Ectopic pregnancy, Ovarian cysts/tumour, Pelvic adhesions, etc.
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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
3.3
Uterine Synaechia
2.9 8
Chronic PID / Chronic pelvic pain 9
Ectopic gestation
1.4 10
Missing Intrauterine Device (IUD)
1.0
Others
Total
210
100.0
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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
2.9
Laparoscopic Total Salpingectomy
1.9 8
Laparoscopic Retrieval of IUD
1.4 9
Laparoscopic Sterilization
0.5 10
Hysteroscopic Adhesiolysis
2.4
Others
Total
210
100.0
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Figure 1: Trend of Major Gynaecological and Endoscopic Surgery performed at LSH Nnewi
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Conclusion
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.
Qualification and training courses should be followed with regular practice.
Regular update of yourself and equipments.
Establish linkages and collaboration with other centres
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24. Laparoscopic Surgery in NAUTH
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25. Hysteroscopic surgery in NAUTH
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26. Laparoscopy surgery in progress
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It is team work
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All eyes on the monitor
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All team members must understand the process and achieve synergy for best results
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30. Receiving my Endoscopy certificate 30th June 2014. Munich Germany
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Sept 2010 pioneer LIFE
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Hands on training
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Jan 2011 Trainees
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Hands - on session
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Lecture in Progress
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48. Animal session during advanced laparoscopy course at LIFE
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49. Animal session in progress
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50. Animal session in progress
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51. Endoscopy Training in Leuven Belgium
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52. With Dr. Prashant Bhamare in Mumbai India.
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MAS is a Team Work!
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54. Life Specialist Hospital Ltd Nnewi
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THANK YOU!
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