The Tribune

By JEFFARAH GIBSON

Tribune Features Wrirter

jgibson@tribunemedia.net

TO BE able to offer minimally invasive surgery for children in the Bahamas is the hope and ambition of one local physician who believes this method is the future of medicine.

Dr G Ashaini Knowles, a paediatric surgeon who is an affiliate of Doctors Hospital, is pushing to ensure this option is performed and available for children.

Minimally invasive surgery (MIS) is not new to the Bahamas, as it is performed on adults. However, it is not performed on children because the tools are not are unavailable.

Dr Knowles spoke during Doctors Hospital’s monthly Distinguished Lecture Series, noting that this method results in less surgical trauma, less pain and a shorter recovery period for the patient.

“Minimally invasive surgery (keyhole surgery) is a method of carrying out an operation without having to make a large incision. If done laparoscopically, it’s an abdominal surgery with video assistance, while thorascopic surgery means doctors enter patients via the chest instead of the stomach,” he said.

“During a minimally invasive procedure, surgeons make several small incisions in the skin – just a few millimeters, in some cases. A long, thin tube with a miniature camera attached at the end (called an endoscope) is passed through one of the incisions.”

Images from the endoscope are projected onto monitors in the operating room so surgeons can get a clear and magnified) view of the surgical area.

“Special instruments are passed through the other openings. These instruments allow the surgeon to perform the surgery by exploring, removing, or repairing whatever’s wrong inside the body.

There are 10-15 standard operation of the key hole surgery that are performed in neonates and young infants. They include, fundoplication, ovarian pathology, malrotation, bowel atresia, lung biopsy and others,” he said.

Dr Knowles said fundoplication surgery is the most common one performed. While he was oversees on a three-month training programme, every other call received was to perform a fundoplication surgery.

“This is for kids who have severe reflux, like kids with cerebral palsy, where they have reflux and it damages their lungs. So what we do is wrap the stomach around where we swallow and that decreases the regurgitation.

“You can do it open, but the problem with doing this surgery open is that these kids are malnourished, so you can have those big scars with malnourished kids and the wounds do not heal well. But if you do it laparoscopically with chopsticks, as we call it, you have little wounds that wold take no time to heal,” Dr Knowles said.

Laparoscopic surgery, he added, is also performed on children with ovarian cysts.

Though minimally invasive surgery can take a longer than conventional surgery, there are several characteristics that makes it a safer method of operation, Dr Knowles said.

“Children tend to recovery more quickly with laparoscopic surgery; the scarring is little because of the instruments that we use. In neonates we use three millimetre instruments, some people use two millimetre instruments, but in the older kids we used five millimetre instruments; in comparison, in adults we use 10 millimetres,” he said.

“The big thing is adhesions and this is when internal organs stick together and form bands of scar tissue which can be painful and cause obstruction.”

With advancements made in technology and the tools used in the surgery, minimally invasive surgery no longer require hours to complete.

“When laparoscopy and thoracoscopy came out you had these guys who were trying to do surgeries, but taking hours to do an operation you can complete in one hour if an open surgery was done. But with training and modules and the importance of setting up these units that has really decreased the time people take do the operations,” he said.

Although not all surgeries should be performed with this method, Dr Knowles said it is a safe and effective method.

“I think this is effective on most operations. There are some that require a lot of training and we should not be cowboys just because we are surgeons. We should not be putting kid’s lives at risk. But we need the expertise and experience, so hopefully in a few years we have a lab and we are training young surgeons to do these,” she said.