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Endoscopic Surgery Gone are the days when surgeons would slice you open to remove an appendix. Nowadays, a small incision is all that is needed for complex operations and surgeons can even be in a different country to the patient when performing the operation. Sally Burdett, "In Touch" presenter, goes behind the scenes to investigate.
In the field of medicine, technology is allowing us to do precisely that - with a small, surgical camera called the endoscope. The endoscope is revolutionizing modern surgery by allowing doctors to perform operations that are more gentle on the patient.
Sally talks to Dr Johan van der Wat, Gynaecologist & Obstetrician at Park Lane Clinic: The medical benefits are undisputed, but given the expense of the equipment and the cost of training doctors, is endoscopy really the way forward for developing countries like South Africa, and can we even afford to use it?
CAN WE AFFORD ENDOSCOPIC SURGERY IN AFRICA? CAN WE AFFORD NOT TO?
The charismatic Dr Rosser has strong views about the relevance of endoscopy in Africa:
ELECTRONIC HOUSE-CALLS
TOO EXPENSIVE FOR DEVELOPING COUNTRIES?
What about the current infrastructure in South Africa? Dr Norman Mobasa from SAMOP comments: So is there no need to build new hospitals? All this technology is already working in third-world counties as far afield as Equador and India.
Besides, not everyone agrees that endoscopy is that expensive. One of them is Prof Allan Gordon, of the International Society for Gynaecological Endoscopy:
But whatever the pitfalls and prejudices that are causing delays in its implementation, there is widespread agreement that endoscopy is the intelligent option in the future of healthcare. "As we go into the year 2000 and beyond, I see more and more the ability of these kind of technologies to increase the quality of care and the quality of life for both patients in our country, and the rest of the continent," says Dr Kadish. Just as endoscopy makes surgery more efficient, so it may streamline the delivery of healthcare in South Africa, making the most of the resources, and reaching more people in need of medical care. And that means better healthcare in the new millennium.
CONTACTS:
Dr James (Butch) Rosser
Dr Ian Kadish
Dr Norman Mombasa
Prof Alan Gordon |
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"Looking into the future is a little like peeping through a keyhole," says Sally. "You can never quite see the whole picture. If only we could slip through and take a look inside!"
But how do we get this technology to rural areas with little or no infrastructure? Firstly, because there is less risk of infection, it means that hospitals are not the only places where doctors can meet patients and perform operations. Dr Ian Kadish from Netcare says:"The technology will allow our surgeons to both do diagnoses in remote locations and also allow us at Netcare the ability, for the first time, to put together something like remote or mobile operating theatres."
Secondly, since the video image seen by the endoscope can seen digitally anywhere on the Internet or via a Wide or Local Area Network(WAN/LAN), a specialist can watch the operation from his city office, advising and assisting a surgeon who is performing the operation in another building or even another city. In a country such as ours (South Africa) where specialists are thin on the ground, this technology allows their knowledge to stretch a lot further.
"Now for the first time, a doctor, from the comfort of his or her own consulting room, can actually do a number of house calls on a number of different patients during a day, simply by having those patients visited by nursing sisters or paramedica, while the doctor communicates via videoconference from his rooms. The doctor can not only communicate with the patient and the nurse at the same time, but also can visually see the patient and in real time, make diagnoses and institute treatments from remote locations."
Dr Rosser is referring to a project initiated by him called "Project Rain Forest", in which a truck was fitted out as a mobile operating room (OR), equipped with endoscopic and laparoscopic instruments, and successfully deployed in the rain forests of Equador. The truck also utilised video-conferencing technology via satellite to the main centre at Yale. The project proved conclusively that endoscopic surgery CAN be utilised in a mobile OR in developing areas, and Dr Rosser received a Smithsonian award for the project.
The biggest obstacle to endoscopy is not the cost of equipment or training, it's that old bogeyman - the fear of change. "There is always a resistance to change," says Prof Gordon. "Some doctors will say I am too old to learn new tricks, but I learnt this kind of surgery when I was sixty years old!"