Minimal Access Surgery – the way to go By Joseph Ikechebelu. MBBS, FWACS, FICS, FMAS, B.Endos...

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 NnewiCourse Director: Life Institute For Endoscopy

Tel; 0803-404-4189. E-mail: ji.ikechebelu@unizik.edu.ng

21 Nov. 2014 1...Life Institute For Endoscopy...

Open Surgery Incision

OPEN SURGERY - ADVANTAGES

Conventional and time testedLess costly to set upTaught worldwide at all levels by

senior experienced doctorsLess technology dependentRegional anaesthesia - cheap,

convenient, easy to monitor21 Nov. 2014 3...Life Institute For Endoscopy...

Open surgery scar

Laparoscopy surgery scar

Minimal Access Surgery -Advantages

1. Improved Diagnosis:

2. Less tissue dissection & disruption

3. Less chance of adhesions

4. Less pain postoperatively

21 Nov. 2014

5. Early return to work

6. Documentation of procedure (video evidence)

7. Cosmetically better outcome

Minimal Access Surgery -Advantages

21 Nov. 2014

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.

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.

Roles in Gynaecology

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 (1995-1997)

In 2000. FIGO fellow one month training in IVF & MAS at Ottawa Civic hospital Canada

My Training

21 Nov. 2014

1998 – 2006. 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 – 2014. Attended several courses in laparoscopy surgery.

My Training

21 Nov. 2014

Winners Project @ www.websurg.com

ESGE & ESHRE certification

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)

Lessons from my experience

21 Nov. 2014

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

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)

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

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 (2009-2014) To determine the rate, indications & scope

of surgeries performed.21 Nov. 2014 17...Life Institute For Endoscopy...

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)

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.

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

Total 210 100.021 Nov. 2014 20...Life Institute For Endoscopy...

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

11 Others 5 2.4

Total 210 100.021 Nov. 2014 21...Life Institute For Endoscopy...

Figure 1: Trend of Major Gynaecological and Endoscopic Surgery performed at LSH Nnewi

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

Laparoscopic Surgery in NAUTH

Hysteroscopic surgery in NAUTH

Laparoscopy surgery in progress

It is team work

All eyes on the monitor

All team members must understand the process and achieve synergy for best results21 Nov. 2014 29...Life Institute For Endoscopy...

Receiving my Endoscopy certificate 30th June 2014. Munich Germany

Sept 2010 pioneer set @ LIFE

21 Nov. 2014 ...Life Institute For Endoscopy... 31

Hands on training

Jan 2011 Trainees

Hands - on session

Lecture in Progress

Animal session during advanced laparoscopy course at LIFE

Animal session in progress

Endoscopy Training in Leuven Belgium

With Dr. Prashant Bhamare in Mumbai India.

Life Specialist Hospital Ltd Nnewi

Minimal Access Surgery – the way to go By Joseph Ikechebelu. MBBS, FWACS, FICS, FMAS, B.Endos...

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