The keys to women’s health

losing weight - for verve. Picture Steve Lawrence. 09/01/03 Dieting, losing weight, slimming, woman, stomach,

Keyhole surgery, rather than traditional open surgery, is “the way to go” for gynaecological procedures, a visiting international expert and leading endoscopic surgeon has said.

“It is a better option. Recovery is faster and the results are better,” said Dr Rafique Parkar, a consultant obstetrician and gynaecologist and a specialist in hysteroscopic and laparoscopic surgery in Kenya, Nairobi, who was on the international panel at an endoscopic workshop at eThekwini Hospital and Heart Centre, Durban, last week.

Women in Kenya were demanding keyhole surgery, rather than be left with scarring after being cut during open surgery, Parkar said.

He was giving “tips and tricks” and passing on his expert surgical skills to local delegates – gynaecologists, general surgeons with an interest in the subject and theatre sisters from the public and private sector.

Dr Shailesh Puntambekar, a world-famous laparoscopic cancer surgeon, from Pune, India, who has treated thousands of patients, was also on the panel, along with his doctor wife Seema, and five leading South African experts.

Hailed as one of the best surgeons in the world, the multi-award-winning Dr Puntambekar is known for his pioneering work and for performing advanced laparoscopic surgeries, having developed laparoscopic radical hysterectomy for cancer of the cervix, known worldwide as the “Pune technique”.

(Laparoscopic surgery, also called minimally invasive surgery or keyhole surgery, is a technique in which operations are performed through tiny incisions. Images are displayed on TV monitors to magnify the surgical elements.)

As well as giving lectures, the experts also went into the operating theatre to perform 12 operations… and the procedures were then projected live on to television monitors and relayed to delegates sitting in nearby auditoriums.

Three patients underwent laparoscopic radical hysterectomy procedures for cancer of the cervix, the most common cause of cancer in South African women.

The operating surgeons gave running commentaries, explaining what they were doing and delegates were able to pose questions as the procedures, some of them difficult, unfolded on the television screens in front of them.

The workshop was organised by the Durban Obstetrics and Gynaecology Society in association with the Department of Obstetrics and Gynaecology at the Nelson Mandela School of Medicine, the University of KZN.

As more complicated cases are being undertaken in South Africa, but with surgeons on a learning curve, the aim was to keep medical professionals, including newcomers, abreast of the more recent advances.

As well as teaching them skills, the workshop was also held to improve patient care and to reduce the possibility of things going wrong down the line, with techniques taught to prevent that happening.

It was held against a global increase in litigation against obstetricians and gynaecologists: a high-risk field compared to other medical specialities.

South African obstetricians and gynaecologists have to cough up a whopping R220 000 a year in insurance… and that is going to be increased, said Dr Kamlan Subrayan and Dr Siva Moodley, who were on the workshop organising committee.

The reality was that there was no higher complication rate with laparoscopic procedures than with traditional surgery, but as it was new technology, patients looked at it more suspiciously, and if something went wrong, they believed their surgeons must have been responsible.

Complications were not negligence, Moodley said, adding that a surgeon did not wake up one day and decide to make a complication that day.

“The intention is to provide the best possible care for a patient,” he said.

But when surgeons failed to recognise a complication during a procedure “that was when the problem comes in”.

Specialists needed to know when to detect a complication, what methods to use to detect it and then correct it.

One of the presenters, Dr Viju Thomas of the University of Stellenbosch, said that while the risk of complications “appears to increase proportionally” as traditionally trained surgeons attempted minimally invasive surgery, data suggested that the incidence of complications may perhaps be lower than for open surgery.

There were many advantages to endoscopic (which means looking inside) surgery.

The procedure, which improved precision, needs less theatre time than traditional surgery. It also enables most patients to be discharged on the same day or the following day, with the cost of care reduced.

There was less post-operative pain and the recovery time was quicker. A hysterectomy patient for instance, would be completely recovered in about 10 days, compared to five to six weeks with the traditional method.

The workshop was held at the eThekwini Hospital and Heart Centre as it is the only local hospital with the technical facilities to transmit the operations to delegates in the auditoriums and where no outside equipment was needed.