Teaching goes high-tech
Surgeons at Greater Niagara General Site launched a new training program in May with a telementoring initiative. From left, Dr. Anantasivan Subramanian (back of head visible) observes Dr. Kreasan Rajagopaul during the surgery, who is assisted by Dr. Craig Muir, right.
The lights are off, there’s no blood but there is a voice coming from somewhere. Welcome to the high-tech world in the Operating Room, as surgeons in Niagara Falls take up a new method of learning surgical techniques. The goal – less invasive surgical procedures to improve patient outcomes.
To keep pace with medical advancements, surgical specialists must constantly refresh and learn new skills in a high-tech operating environment. Laparoscopic surgery is a procedure that is used in more and more surgical procedures.
Minimal Access Surgery
“Laparoscopic or keyhole surgery is a minimally-invasive procedure used in abdominal surgeries, where scopes go through small incisions and attachments such as micro-scissors, blades and fibre-optic cameras fit on the end,” explains Niagara Health’s Patty Welychka, Surgical Program Director. “Laparoscopic procedures are commonly used for gall bladder removal, appendectomy, hernia and other abdominal surgeries.”
A new focus is using this minimal-access type of surgery to remove cancerous tumours. The traditional way of performing colorectal cancer surgery is with a 20 to 25 cm (eight to 10 inch) incision down the centre of the abdomen. Taking about three hours for this open surgery, the portion of the bowel that contains the tumour is removed, called a bowel resection. The bowel is then stapled together and the patient spends seven to 10 days recovering in the hospital and about six weeks total recovery time before he or she can get back to normal.
The laparoscopic scissors (just one cm long) are visible on one of the monitors in the OR, as surgeons cut the section of the bowel that contains a cancerous tumour. The camera which allows surgeons to see deep into the abdominal cavity is attached to the end of another scope inserted in the patient’s abdomen.However, the laparoscopic procedure of making only small incisions makes this surgery much more manageable for the patient. Just three or four keyhole openings for the scopes and one five cm (two inch) incision are made to remove the small section of bowel. Not only is the surgery time reduced to about two hours, the patient has less post-op pain and discomfort, explains Dr. Kreasan Rajagopaul, a Niagara Falls general surgeon.
“The control of cancer is the same for both types of surgery, but the advantage to laparoscopic surgery is that bowel function returns faster, the patient is in hospital for only three to four days and the total recovery time is just three weeks,” he says. “It’s better for the patient and ultimately, this reduces the strain on the hospital system, both in the OR and in the surgical inpatient unit.”
Telementoring Program – Teaching via Audio/Video Link
An innovative way for surgeons to learn the keyhole procedure is through a new mentoring program for surgeons. For the first time in Niagara, a surgeon from McMaster University’s Centre for Minimal Access Surgery is providing instruction remotely through an audio/video link, called telementoring, that connects St. Joseph’s Healthcare Hamilton with Greater Niagara General Site. Dr. Rajagopaul is the telementoring lead at Greater Niagara General Site to help bring this technology-based program to the ORs, through a different learning methodology. Other surgeons in the NHS at St. Catharines and Welland perform this same procedure but this is the first time the NHS has used telementoring as a teaching tool.
The telementoring program uses the tie-in the Niagara Health System has to the Ontario Telemedicine Network, which connects hospitals with healthcare partners throughout Ontario. Through the Telemedicine Network, hightech fibre-optic equipment allows specialists in other locations to see exactly what the surgeon sees. The mentors can provide instruction remotely on new techniques. This is the way of the future to train surgeons already familiar with minimally-invasive surgery.
Partners Throughout Ontario
Thanks to special funding from Cancer Care Ontario, Niagara Health has so far upgraded OR suites at a cost of about $150,000 in Niagara Falls and St. Catharines, with Welland’s ORs to also get the necessary hardware and software in the coming months.
“We’ve been working on the telementoring program for about a year, and it is exciting to get it off the ground in Niagara,” Dr. Rajagopaul says. “We work with Dr. Mehran Anvari, the Director of the Centre for Minimal Access Surgery at St. Joseph’s Healthcare Hamilton, and it is his voice and expertise we hear during our surgeries in Niagara Falls. We’ve done two cases now with his help remotely, and they have both been excellent.” “The world of surgery has changed irrevocably through the years, with continuous advancements in technology,” says Dr. Anvari. “Telementoring is just one new and effective way of progressing surgical advancements at multiple sites remotely.”
The Centre for Minimal Access Surgery has been using telementoring for over 10 years to help support surgeons from various community hospitals across Canada. This is the first routine clinical use of telementoring to improve quality of cancer surgery across the whole province. This initiative has been made possible by the collaboration of Cancer Care Ontario, Ontario Telemedicine Network, Juravinski Cancer Centre, St. Joseph’s Healthcare Hamilton and a number of hospital systems including Niagara. If successful, it will enable more community hospitals to offer the latest cancer surgery and avoid the need to refer patients to larger cancer centres.
“Patients want laparoscopic surgery more and more, because they’re confident in the knowledge that there are a great many benefits,” Dr. Rajagopaul says.
Other surgeons in the NHS at St. Catharines and Welland perform this same procedure but this is the first time the NHS has used telementoring as a teaching tool.
