IN a decisive move towards providing Nigerians with taste of some of the latest cutting edge medical technology in the world, the management of Lagoon Hospitals, Lagos, officially  launched the hospital’s upgraded surgical strategy using endoscopy/minimally invasive surgery and joint replacement surgery.

The healthcare facility also brought together a team of Nigerian surgeons based in the United Kingdom to update  local surgeons on what it described as “surgery for the future” as well as carry out surgery procedures using novel techniques such as the minimally invasive surgery or “keyhole surgery” and colposcopy amongst others.

In separate chats with Chioma Obinna, the surgeons shed light on the whole essence of the initiative and what Nigerians stand to benefit from it. Excerpts:

Prof. Ade Elebute, Chairman Hygeia Nigeria Limited, owners of Lagoon Hospitals speaks on cutting edge surgery

Surgery for the future actually starts now in Nigeria. The initiative encourages the retention of a portion of the significant healthcare funds being taken out of the country. With availability of world class facilities and skills, Lagoon Hospitals is raising the standard of tertiary care in Nigeria. The significant investment made in upgrading its facilities to this level creates an enabling environment for specialities trained in the best facilities abroad to put this training to user back home whilst transferring knowledge to their professional colleagues in the country.

Dr. Eki Emovon, Consultant Obstetrician and Gynaecologist and UK Coordinator, West African College of Surgeons (WACS)  These procedures have been done for almost 20 years in the UK, but because of a lack of the investment opportunity, the necessary equipment was not in Nigeria to enable the practice with such state of the art in surgery. Now that Lagoon Hospital has provided that, a lot of us feel that we can actually come home and practice the same standard of treatment that we do in the UK.  I see at least two to three Nigerians who come from Nigeria to see me in the UK for surgery. With this partnership, patients don’t have to go to the UK  anymore. They can have it done here.

Emphasis is to try to move to minimally  invasive  surgery, although it is the same type of operation with a difference. “Previously, we would have had to slash open the abdomen, for example, to take the bowels and gall bladder out but now we can still do that by using a camera with a telescope at the end of it and a special instrument without having to give a big cut. We can do the same thing for a hernia and  the appendix.

In Nigeria, we have to start from somewhere. There is wide access to telecommunications now, our hotels and hospitality industry, some of them are the best in the world. So, if we can provide these facilities why is it that we cannot provide the best healthcare facilities for our people? Some of these facilities are not actually that expensive.

What it requires is that level of access and that is where training comes in and it costs money. So it is, a situation one has to come after the other and if that investment in training is made, then the equipment itself and the treatment is not any more expensive like the old-fashioned operation.

If you are properly trained, then you’ll understand the principles and because now there are different forms of trainings, we are able to perform this using computer generating simulation before we come on to human beings. But to make an important point, the operation we are doing is still the same. It is just the access that is different.

The biggest problem for the patient is the access. The wound can get infected, it can break down, it causes pain. The body itself internally heals within three to five days and at most one week. The  beauty of keyhole surgery is that it promotes faster healing and is less incapacitating.

Benefits

There is the trauma for the general system when this sort of operation occurs, for example if we are doing an operation on the abdomen, if we do the old- fashioned operation, we have to bring the bowel out to get access to the different kinds of organs and we have to pull the part of the abdomen apart for this access. All of these,  exposes the body to the atmosphere, which drys the bowel, but with keyhole surgery, every thing is contained within the body and you are still able to perform the operation. The recovery is a lot quicker. The negative effects of the operation are lessened and this has been proved experimentally. Patients also go home almost immediately

Rate of mortality and complications

The point with any modern equipment is that in an untrained hand, it is a weapon. Initially with the advent of laparoscopic surgery, surgeons thought yes, because I can do an open operation I can handle it. There were all sorts of problems initially and that was the reason why a lot of emphasis is now put on training and competency so that such injuries or damaged do not occur.

Laparoscopy

It is used for every thing. There are those who argue that just because you can do it does not mean you should do it but there are certain conditions that lend themselves to laparoscopic surgery. Simply because you are taking a small organ out from a far distance, for you to get to that distance you have to create a space like making a big wound. Take for example, the gall bladder. It is very small, placed just beneath the liver but for you to get to it you must make a big cut.

If however you can still have to get to that organ without making a big cut, it is better for the patient because there is earlier recovery. So gall bladder operation is one, another one is hernia. Appendix operation also, most appendix operations are done with a keyhole surgery. So there are a lot of advantages to doing such surgeries but there are certain indications where it is not safe to do keyhole surgery and that comes with training and expertise so that you can well identify the right patients to do the operations.

Most times, it depends on the fitness of the patients. For example, if they have heart ailments or if they have multiple operations on the abdomen, where the abdomen is completely plastered up because you need to put air in the abdomen to expand the abdomen to create space but everything is all matched then, there is no space to be able to work on.

So for people who have significant chest breathing problems because when we put the air in; it pushes the diaphragm, that is, the muscle in between the chest and the abdomen also used for breathing. It is important to select the right patients but majority of operations taking the kidneys out, gall bladders out, the bowel out all of them can and it is being done using the keyhole operation now.  You can take the kidney out without making a big hole.

Dr Segun Abudu, Consultant Orthopaedic Surgeon, Orthopaedic Hospital Birmingham speaks on correction of bone deformities — “We are trying  bring in expertise to save the limbs amputated in the past or people with bone damage etc. or even cancer of the bone. Previously, we have had amputation but we are now able to save the limbs in more than 90 percent of those patients.

With joint replacement surgery, a lot of people who suffer from arthritis would benefit tremendously. For several years, people just believe that arthritis is the disease of the age and that once you have arthritis, they just pack you in one corner of the house, where you cannot go out or do anything.

What we are saying now is that, the disability can easily be corrected and we want to bring the expertise. Again, when you have pain from a damaged joint,  we are able to put in an artificial joint to replace that and not just an artificial joint  that will last for a year or two but an artificial joint that would last for 15 to 20 years so that you can resume back to functions.

There are a lot of advances, we are now able to replace somebody’s hip bone, knee joints in one operation. So we are talking of making people that perhaps in the past, abandoned or left lying down fallow another lease of lives. We are trying to provide the best level of care that is comparable to anything you can get anywhere in the world.

Cost must have been quite high before, because facilities were not available and patients were going abroad. As the facilities are becoming available and we are now able to offer the procedures to a large number of patients in the country and the cost is coming down and becoming more affordable.

Beneficiaries

These include people with poliomyelitis that have been discriminated against and left disabled, we are now able to restore some functionality to their knees. We are able to correct deformities and it is not just the deformity of the bone alone but deformities of the soft tissues as well.

Young children with bone deformities either by  birth defects or abnormal bone and those with cancers of the bone are included. In the past the problem has been that even if we could replace the bone how would we get the bone to grow with the child?  We now have the ability to put in bones that grow with the child.

We do also have bone transplants. We can transplant bone from one person to another. I have spent a lot of time going around the world demonstrating to people on how to do that, and for me, it is a  honour to do so in my own country.

Sickle cell patients

One of the things that sickle cell disease does is that it damages the bones and joints. Joint damage is a major cause of disability. To make it worse, the disease tends to afflict  young people. So there is a lot of personal problems as well as economic problems. They are not able to walk and contribute meaningfully to the society.

It is not unusual to have somebody with sickle cell disease to experience  blood supply cut off  to the joints and this leads to death of the joints.  In the past nothing was available for those patients and all of them got deformed. Now we are able to help them.

Dr. Tinuola Oyekan   Consultant and Head of Dept. Obstetrics & Gynaecology, Lagoon  Hospitals speaks on cervical cancer screening — “It is the commonest genital cancer in women. “Colposcopy has been around for years. But in this country we have a few centres that have the procedure. We are hopefully starting a screening programme which is going to involve pas smears which we are already doing but the problem is once we get the result and it shows abnormal cells, what do you do next?

This is where colposcopy comes in. It is such a simple procedure, it pays in treating or removing pre cancerous cells.  Most of the cases are done outpatient setting. It takes only about 15 to 20 minutes and they go home immediately. It is like a patient coming to say hello to a doctor. It is not done under local anaesthesia.”