Saturday, 4 June 2011

QUANTUM LEAP AND LAPAROSCOPY SKILLS

Last year, I was awarded the Marian & Cristina Ionescu scholarship from the Society for Cardiothoracic Surgery of GB and Ireland. This scholarship is awarded to help surgeons with expenses
they may incur whilst travelling to other centres to learn new techniques. In my application, I stated that I wished to visit other centres to learn techniques in minimally invasive cardiac surgery. I have already visited centres in Belgium and Italy and attended courses in minimally invasive cardiac surgery. My latest destination has been the Royal College of Surgeons in London to attend a Core Skills in Laparoscopy course. I decided to do this because I felt that in order to perform these procedures safely, I should become proficient in the strategic placement of ports and be familiar with minimally invasive instrumentation and techniques of 'endoscopic' suturing and knot tying. All surgical trainees today learn these skills but my basic surgical training took place in an antediluvian era!
The course is quite long at 3 full days. On the first day during introductions, I felt like a bit of an interloper being the most qualified and the oldest (even older than the faculty!) of the participants. The course is predominantly hands on practical, working on laparoscopic simulators. There are a few lectures between the practical sessions and I learnt a few interesting historical facts. The pre-eminence of Storz in laparoscopic instrumentation resulted from a chance meeting on a plane between Harold Hopkins, Professor of Optics in Reading,  and who invented the rod lens (what a laparoscope is) and Karl Storz.  Many of the pioneers in laparoscopy were felt to be abit potty by their peers and many were threatened with legal action and jail. The death of the wife of a prominent businessman after a laparoscopic cholecystectomy in the 1980s was the stimulus for the English college of surgeons to start training courses and various educational activities. One wonders what their function was between 1800 and then! It is clear how far laparoscopy and minimally invasive general surgical procedures have come in 20 years - with cholecystectomies and many upper GI procedures being done through a laparoscope as day case procedures. Cardiac and thoracic surgery seem to be stuck in a brutalistic time-warp and have a long way to go. Technically, the cardiac surgical procedures we perform are no different to those performed 20 years ago and although operative mortality has fallen, morbidity and length of stay have not really changed much. In the meantime, there is always the danger (for cardiac surgery) of cardiologists providing the future based on a wire and catheter and consigning cardiac surgery to the dustbin of history! Surely the time is long overdue for specific courses in minimally invasive CT surgery and for these courses to be made compulsory - oh yeah and pigs might be taught to fly.
Anway, during this course, there were training sessions in instrument dexterity , knot tying and suturing. In addition there were sessions in three specific general surgical procedures on clever prostheses - namely closure of a perforated duodenal ulcer, appendicectomy and cholecystectomy. The last time I performed these procedures was more than 20 years ago and through a large hole in the abdomen! It was weird - I felt like that guy in the series Quantum Leap! I was ably assisted by the other participants who had seen and often performed these procedures in real life. It is often said that the younger (playstation) generation learn these techniques much more readily than old codgers like myself. 20 plus years experience of performing cardiovascular surgical procedures does help and this experience showed. I surprised myself and the guys who were training us (even though I say so myself!). Although at 3 days it is a tad bit long, the course  is really enjoyable and as a result I feel enthused.
Although it is a general surgical course, I would recommend this skills course to anyone training in cardiac or thoracic surgery who aspires to perform minimally invasive/thoracoscopic procedures. The course is held several times a year in many centres.