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AMASI Newsletter

(Association of Minimal Access Surgeons of India)

AMASI 23 JUNE 2019

Executive Committee East Zone

Makhan Lal SahaAlok Abhijit

West Zone

Roysuneel PatankarKaushik Shah

North Zone

Bhanwar Lal YadavNikhil Singh

Central Zone

Devendra NaikRajdeep Singh

South Zone

Parthasarathi R S Soppimath

Co-opted Member P. SenthilnathanBhartendu KumarSamir RegeBiswarup Bose Biju PottakkatRajesh ShrivastavaRoshan ShettyRakesh ShivhareHimanshu YadavManoj K ChoudhuryRajendra Mandia

Founder President C.Palanivelu

Past Presidents Ramesh Ardhanari Om TantiaSuresh Chandra Hari Dilip Gode

Immediate Past President Tamonas Chaudhuri

President

B S Pathania

President Elect

Jugindra S

Senior Vice President Varghese C J

SecretaryKalpesh Jani

Joint SecretaryAbhimanyu BasuN.K. Chaudhry

TreasurerIshwar R Hosamani

Zonal Vice Presidents

Manash R SahooRamesh DumbreG Laxmana SastryRajeev Sharma Deborshi Sharma

IN THIS ISSUE

Dr. Md Yusuf Afaque MS, FNB (MAS), is an Assistant Professor in the Department of Surgery, JN Medical College, AMU, Aligarh, UP. He reviews a meta-analysis of mesh hiatoplasty versus suture cruroplasty for large hiatus hernias..

Dr Soumen Das, MS,FACS,FMAS,FIAGES,FALS(Colorectal Surgery), is a Consultant in Visceral & Peritoneal Surgery, in the Department of Surgical Oncology at Netaji Subhas Chandra Bose Cancer Hospital, Kolkata. He elaborates on the nuances of formulating a research hypothesis in the second installment of our series..

Dr. Prashant Rao, Director GI and Minimal Access Surgery, Global Hospitals, Mumbai reviews the guidelines on ergonomics in laparoscopic surgery for the second instalment of our series...

Plus the regular features like:

✦ Hobby corner

✦ Know your Representative

✦ MAS Masti

✦ Upcoming events update

✦ Past Event

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AMASI 15 APRIL 2019

Journal Watch

Writing a Scientific paper

Guideline Series

“ SAVE THE SAVIOURS ”

Dr. Tamonas Chaudhary, Immediate Past President, AMASI

Recently, on 10th June 2019, an 85 years old person was brought to NRS Medical College & Hospital in a critical condition and died during treatment. This was followed by a confrontation between the junior doctors and the relatives of the patient. The latter threatened the doctors on duty and came back after four hours with two truck loads of goons and thrashed the junior doctors and ransacked the hospital.

The doctors had already informed the authority and police after the first incidence but no security had been provided till the ruffians came, grievously injuring two of the junior doctors (Dr. Paribaha Mukherjee suffered a depressed skull fracture and Dr. Tekwani had a spinal injury). All junior doctors of NRS Medical College & Hospital ceased work from next day onwards, demanding arrest and punishment of the miscreants. This message spread like fire among all the medical colleges of West Bengal and junior doctors across the state started demonstration.

Senior teachers and all private practitioners withdrew all services except emergency care on the next day. They too joined in this movement and the fire spread all over India. Doctors in various states of India, both in government service and private practice, widely condemned the incident and demonstrated their solidarity with the doctors of West Bengal. Various professional bodies, the Indian Medical Association, Association of Surgeons of India and The Association of Minimal Access Surgeons of India (AMASI) expressed their unstinting support to the movement and it became international news. Solidarity and sympathy were expressed by our brethren across borders and was expressed as such by World Medical Association, Medical Associations of Britain, Pakistan, Nepal and Bangladesh.

More than 900 teachers of Medical Colleges submitted their mass resignation to show their support. More than 6000 doctors, paramedics and common people walked in the city to condemn the government’s failure to provide a safe working environment to the doctors. After a week long struggle, ultimately the government bowed down to the demand of doctors, acceding to address all the issues..

Why does such Violence occur ?

Communication Failure:

The healthcare personnel have had no formal training in communicating with the relatives. In government set-up, they are over-burdened. This situation is compounded by arrogance and intolerance in the society.

Socio-Economic condition of our country and affordability of health care:

Quality health care is not accessible to all. Government expenditure is very much inadequate on the healthcare sector. Private healthcare expenditure is beyond the reach of family.

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AMASI 15 APRIL 2019

Health education:

Mismatch between expectation of Patients Relative and reality about the outcome of treatment

There is a massive failure of communication between the doctors and the patient’s relatives. Expectation of patients and their relatives are are often beyond the capacity of care given. Infrastructural deficiency, problem in system, out of pocket expenditure of patient are multiplied by the small miscommunication of lack of empathetic attitude.

Doctor:patient ratio in India is much less than the WHO recommended ratio of 1:1000, especially in the public healthcare sector.

GDP expenditure in health is much less. Tertiary care is mostly in private institute which is less accessible to most people. Health care personnel are overburdened, doctors exhaused and suffer from lack of appropriate communications skills.

How we can minimise this violence? Some measures recommended are:

Zero tolerance attitude towards any violent incident. Law must be enforced, security system must be tightened and there must be implementation of stringent law to punish the law breakers.

Acquisition of good communication skill. Communication, just like clinical examination, should be compulsory subject to be taught to all medical students.

Health must be a priority subject. Budgetary allocation must be increased. Medicines, equipments, technological innovations must be accessible to all segments of the population.

Doctors must be allowed to work in a fearless environment.

All Medical Associations must channelise their efforts for health education of the society.

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AMASI 15 APRIL 2019

The Process of Guidelines and Position Statement Formation under AMASI was envisioned in four phases:

Phase I: An expert reviews available evidence on each topic and suggests guidelines/position statement.

Phase II: The suggested guidelines/position statements are presented before a panel of experts who then critically evaluate them and suggest any amendments, if needed.

Phase III: The amended guidelines/position statements are presented before the members of AMASI through the newsletter and comments are invited, based on available evidence in published literature.

Phase IV: Once all the comments are analysed critically in light of the evidence submitted, any changes, if required are made and the final guidelines/position statements are released.

What follows is the phase 3 in the Guidelines and Position Statement Process of AMASI.

The AMASI members are requested to carefully go through them and if required, any changes can be suggest along with the evidence supporting such changes. Your suggestions along with the relevant references can be emailed to amasiguidelines@gmail.com

Improving Surgical and Surgeon Outcomes: Ergonomics in Laparoscopy

Ergonomics is derived from Greek words ‘ergon’ meaning work and’ nomos’ meaning natural laws or arrangements. It is the study of people’s efficiency in their working environment. Studies have shown that proper employment of ergonomics can improve the safety, comfort and efficiency of the operating team and reduce stress and the time taken for complex tasks like knotting and suturing by as much as 75%.

Recommendation 1: OT table height: The table height should be such that the angle between the lower and upper arm should be between 90° and 120°. This has been found to be the optimum ergonomic position of the elbow joint for laparoscopic surgery. The table may need to be raised or, usually lowered, to achieve this height. For short statured surgeons, even with maximum lowering of the table, this angle may not be achieved and to obtain it, the surgeon should be standing on an elevated platform, broad and wide enough to allow comfortable movement, without the risk of falling off. Most modern laparoscopic operation tables are adjustable to a height between 64- 77 cms above floor level.

Recommendation 2: Monitor: In the horizontal plane, ideally the surgeon, the organ of interest and the monitor should be in one straight line, making it a co axial set up. In the sagittal plane, the monitor should be such that the viewing is about 15° to 25° downward. The distance between the surgeon and the monitor depends on the monitor size and resolution of the image. It should be close enough to avoid loss of detail and far enough to prevent continuous excessive accomodation of the eyes by contraction of extra-ocular muscles. There is some evidence to show that the placement of an additonal monitor near the operative field improves the oculo-motor axis co-ordination while performing fine precision tasks.

If the assistant surgeon is standing on the opposite side of the surgeon, then a second monitor facing him/her will greatly improve his/her ergonomic functioning.

Recommendation 3: Port placement and optimal working angles:

Elevation angle is the angle between the instrument and the horizontal plane. Azimuth angle is the angle between the instrument and the optical axis of the endoscope. Manipulation angle is the angle between the two

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AMASI 15 APRIL 2019

Guideline Series

instruments. I/E ratio is the ratio of the length of the instrument inside the body to that outside the body.

It is recommended that the ports be placed such that the manipulation angle is between 450and 750, ideal beinng 60°, with equal azimuth angles on either side.

It is recommended that the distance between the target organ and the ports should be such that the elevation angle is around 30°–60°, ideal being 45°. While there is no consensus as to port placement, a placement of the optics about 15- 20 cms from the target organ and working trocars on either sides with a 15- 20 cms arc so as to give an optimal Azimuth angle is desirable.

It is recommended that the length of the instrument and the site of the ports from the target organ be selected in such a way that the I/E ratio is between 1:1 and 2:1, ideal being 1:1.

Recommendation 4: Knotting and suturing:

4a. Suturing towards the surgeon rather than away has been found to be efficient. 4b. Suturing in a vertical line rather than horizontal has found to be more facilitative. The maximum ergonomic benefit is if the suture line is oriented from 1O’clock to 7O’clock position. 4c. An appropriate length of suture material should be used. About 8-10cm are required for the first knot and 2cm for every subsequent knot, up to 20cm.

Recommendation 5: Equipment and Instrumentation:

5a. Problems related to depth perception, vision and loss of peripheral visual fields can be reduced by magnification and high definition display attained on modern camera and monitors. It is recommended that surgeons use HD cameras for surgery. There is some evidence to show that the learning curve is shortened by the use of high resolution systems and 3D camera systems.

5b: The surgeon should use ergonomically designed instruments that increase the work efficiency. The important features to look for in laparoscopic instruments include the following:

i. The handles should be smooth and without ridges or rings to avoid trapping of fingers during manipulation as well as undue pressure on the palm or finger surfaces of the surgeon.

ii. The control mechanism for opening and closing the jaws, locking the tip should be easy to operate, not requiring undue force or pressure.

iii. If the instrument is used for specialized functions, the triggers for activating these specialized function like activating the energy source, suctioning, irrigating, locking the jaws etc. should be located on the handle such that they are easily located and operable, do not require undue force and are not unduly activated while manipulating the instrument for other functions.

iv. Instruments meant for delivering electrosurgery energy should have sturdy insulation right from the base of the tip to the handle.

In general, instruments with a power grip hand position (i.e., as in holding a hammer or a gun) are useful for delivering force while those with precision grip position (i.e. pencil grip or fine forceps grip) are useful to delicate maneuvers.

Consequences of not adhering to Ergonomics: Poor ergonomics can have far reaching consequences on the health of the surgeon.

a. Cervical spondylitis and neck sprains are common from having to look the wrong way while operating.

b. The so called ‘laparoscopic back’ due to shoulder and back pain caused by excessive and prolonged abduction due to wrong table height has been well described.

c. The novice tends to use excessive force in the grip, causing the whitening of the knuckles and this has been rightly described by Cuschieri as ‘ white knuckle surgery”.This can cause numbness at the thumb. Reports of thenar neuropathy have arisen due to use of awkward thumb grips in case of laparoscopic pistol-grip instruments.

d. There have been multiple reports of carpal tunnel syndrome among surgeons performing multiple laparoscopic procedures in high-volume centres.

e. Muscle cramps and muscle spasms due to build up of lactic acid in muscles in a state of continual contraction, e.g. upper thighs, lower back and flanks, etc is known.

Conclusion The advances in laparoscopic surgery have come

at the cost of a tremendous learning curve causing eye-strain, mental and physical fatigue to the surgeon. The FDA estimates that about half of the 1.3 million instrument related injuries at surgery could be due to poor instrument design.

Correct application of Ergonomics along with suitable operating room environment and instrumentation can go a long way in reducing the stress factor to the surgeon as well as minimizing avoidable instrument related complications.This is essential to improve surgeon and surgical outcomes.

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AMASI 15 APRIL 2019

Introduction

Scientific research is the backbone of development of any discipline. Surgeons are often afraid of research work mostly due to lack of time and interest . But research is the need of hour. To start any research, one should begin with formulation of hypothesis. Hypothesis has been defined in many ways like - ‘Hypotheses are single tentative guesses, good hunches –assumed for use in devising theory or planning experiments intended to be given a direct experimental test when possible” (Eric Rogers, 1966), “A hypothesis is a conjectural statement of the relation between two or more variables”. (Kerlinger, 1956). Basically hypothesis is a question , the answer to which is sought for, through the research.

The Problem…

The hypothesis is a clear statement of what is intended to be investigated. It should be specified before research is conducted and openly stated in reporting the results. This allows the readers to identify the research objectives. Identify the key abstract concepts involved in the research. Identify its relationship to both the problem statement and the literature review. A problem cannot be scientifically solved unless it is reduced to hypothesis form. It is a powerful tool of advancement of knowledge, consistent with existing knowledge and conducive to further enquiry. For Example… imagine you want to do

research on laparoscopic cholecystectomy. You have devised a technique of single port laparoscopic cholecystectomy , and you claim that its better than conventional cholecystectomy. Now how to conduct a study on this? First you have to formulate a research question. A proper research question or hypothesis is formulated following PICO format.

P- Problem/Patient/Population,

I- Intervention,

C-Comparison,

O-outcome.

So, for the above scenario, the ideal research question would be – Is Single port cholecystectomy (I) is better than Conventional LC (C) in terms of blood loss, operative time (O) in patients with chronic calculus cholecystitis (P)?

Formulating a hypothesis is important to narrow a question down to one that can reasonably be studied in a research project. The formulation of the hypothesis varies with the kind of research project conducted: QUALITATIVE or QUANTITATIVE.

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AMASI 15 APRIL 2019

While the first installment in our series was brought to you from the madhouse that is Mumbai, for the second installment, we obtained our contributor from the other end of the country. This hilsa-devouring, rosagulla slurping bhadralok resides in the metropolis on the banks of the Hooghly. Another bookwork – Soumen loves to read books, writes novels and gets cajoled by your friendly neighborhood editor into penning articles for AMASI newsletter. He claims to be very good at cricket. Quite smartly, he doesn’t specify whether his talents are in playing cricket or watching it on TV! His motto in life is ‘Simple Living and High Thinking’. Well, Soumen, you can always gift me that Rolex watch and Cartier pen, since my take on life is “Gimme more, my thoughts can’t get any dirtier!”

Dr Soumen Das

MS,FACS,FMAS,FIAGES,FALS(Colorectal Surgery) UICC Fellow:SurgicalOncology,TMH,Mumbai IACA Fellow: Robotic Surgery,COHHospital,Los Angeles Consultant,,Visceral& Peritoneal Surgery, NSCB Cancer Hospital,Kolkata

Formulating the Research Hypothesis

Writing a Scientific paper

Types of Hypothesis

NULL HYPOTHESES ( HO)

ALTERNATIVE HYPOTHESES (H1)

The null hypothesis represents a theory that has been put forward, either because it is believed to be true or because it is to be used as a basis for argument, but has not been proved. It has serious outcome if incorrect decision is made!

The alternative hypothesisis is a statement of what the hypothesis test is set up to establish. It is the opposite of the Null Hypothesis. It can only be established if null hypothesis is rejected. Frequently “alternative”is actual desired conclusion of the researcher!

EXAMPLE In a clinical trial of a new drug, the null hypothesis might be that the new drug is no better, on average, than the current drug. We would write H0: there is no difference between the two drugs on average.

The alternative hypothesis might be that: the new drug has a different effect, on average, compared to that of the current drug. We would write H1: the two drugs have different effects, on average. Or it could be that the new drug is better, on average, than the current drug. We would write H1: the new drug is better than the current drug, on average.

We give special consideration to the null hypothesis, This is due to the fact that the null hypothesis relates to the statement being tested, whereas the alternative hypothesis relates to the statement to be accepted if / when the null is rejected.

The final conclusion, once the test has been carried out, is always given in terms of the null hypothesis. We either 'reject H0 in favor of H1' or 'do not reject H0'; we never conclude 'reject H1', or even 'accept H1'.

Hypothesis Testing

Hypothesis testing is a four-step procedure:

1.Stating the hypothesis (Null or Alternative)

2.Setting the criteria for a decision

3.Collecting data

4.Evaluate the Null hypothesis

Errors in hypothesis

Two types of mistakes are possible while testing the hypotheses: Type I & Type II

Type I Error: A type I error occurs when the null hypothesis (H0) is wrongly rejected. For example, a type I error would occur if we concluded that the two drugs produced different effects when in fact there was no difference between them.

Type II Error: A type II error occurs when the null hypothesis (H0) is not rejected when it is in fact false. For example:A type II error would occur if it were concluded that the two drugs produced the same effect, that is, there is no difference between the two drugs on average, when in fact they produced different ones.

Conclusion

Establishment or rejection of hypothesis is the fate of all research. Therefore a good research hypothesis formulation is extremely important to conduct any research. Getting started is important, if you don’t go to the water, you will never learn swimming.

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AMASI 15 APRIL 2019

MAS MastiDr. Jobi Abraham

Article Reviewed:

‘Mesh hiatal hernioplasty’ versus ‘suture cruroplasty’ in laparoscopic paraoesophageal hernia surgery; a systematic review and meta-analysis

Rajeev Sathasivam , GopinathBussa, YirupaiahgariViswanath, Reece-Bolton Obuobi, Talvinder Gill, Anil Reddy, VenkatShanmugam, Andy Gilliam, PremThambi

Asian Journal of Surgery (2019) 42, 53e60

Introduction:

A “Giant” paraoesophageal hernia has been defined as all type 3 and 4 paraoesophageal hernias (POH), but many limit this term to those POHs with greater than 50% of the stomach in the chest. Laparoscopic cruroplasty for giant POH’s with nonabsorbable suture cruroplasty has been found to be safe with good symptom relief with recurrence rates between 12% and 42%. In order to decrease the recurrence, hiatoplasty with synthetic mesh was introduced. Mesh use remains controversial due to reports of complications, especially oesophageal erosion. Biological mesh was proposed as an alternative, but it comes at a higher cost and inconclusive results on efficacy. There is uncertainty regarding the preferred technique of repair of the large hiatus hernia with many studies reporting conflicting outcomes.

Objectives: The aim of the study was to systematically retrieve the existing literature from

1995 to 2016 on ‘Laparoscopic POH’ repair methods of ‘mesh hiatal hernioplasty’ and ‘suture cruroplasty’ and to analyze the recurrence, operative time, reoperation rate and complications. The authors strived to provide an up to date assessment of the two techniques on safety and efficacy.

Trial Design: Systematic review with meta-analysis of recent and up-to-date studies.

Inclusion Criteria

RCT, Cohort and Retrospective study on large hiatus hernia comparing mesh repair versus suture cruroplasty and those publications should have studied outcome and recurrence.

Exclusion Criteria

The study not in English and in children, animals, less than 20 patients, emergency surgery and open surgery were excluded.

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Journal Watch

Dr Md Yusuf Afaque, MS, FNB (MAS) Assistant Professor, Department of Surgery, JN Medical College, AMU, Aligarh, UP

AMASI 15 APRIL 2019

Intervention:

Studies were assessed for external validity and applicability and internal validity was assessed according to the criteria recommended by the Cochrane Back Review Group. Studies published between January 1995 and December 2016 were reviewed and scrutinised after applying the inclusion and exclusion criteria.

Results:Recurrence rates are reduced when mesh is used (OR 0.48, 95% CI 0.32, 0.73, P < 0.05) with no increase in risk of complications (OR 1.3, 95% CI 0.74 2.29, P Z 0.36). Operative time with suture cruroplasty is less (SMD 15.4, 95% CI 7.92,22.8, P < 0.0001) and there is no statistically significant difference in reoperation rate (OR 0.35, 95% CI 0.09, 1.31 P Z 0.12).

Review:

Commentary:

This systematic review with meta-analysis of the recent and up-to-date studies has analyzed paraoesophageal hernia repairs for the rates of recurrence, reoperation, complication rates and operative time of the two techniques. Randomized controlled trials (RCT) and observational studies comparing mesh repair versus suture cruroplasty

were selected by searching Medline, Embase, and Cochrane Central database. Nine studies (RCTs = 4 and Observational studies = 5) were selected with 942 patients (Mesh = 517, Suture cruroplasty = 425). The recurrence was less in mesh repair compared to suture cruroplasty. The operation time is significantly less in suture cruroplasty as mesh placement time is reduced. Reoperation and complications were similar in two groups.

Major limitation of the paper: Uniformity is not there in studies regarding the type of prosthetic meshes used and its method of placement. Also, the definition of what constitutes large hiatal hernia varies between studies. Finally, the review includes a large proportion of observational studies as compared to RCTs.

Takeaway point:The study favors mesh placement in large paraoesophageal hernia as it has better outcome with no increase in complications and reoperations.

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AMASI 15 APRIL 2019

Dr VK Kapoor, Professor of Surgical Gastroenterology at SGPGIMS Lucknow, a member of AMASI, has launched a FREE online education portal - Prashna India - where students/ surgeons can ask (post) their questions. The questions are answered by experts in respective topics/ areas and the answers are posted online. 

In the last 5 years, more than 300 students/ surgeons from all parts of India have asked more than 700 questions which have been answered by more than 70 experts from India as well as abroad. These questions and answers are available on Prashna India website for free.

Prashna India also conducts live online case presentations/ discussions and open-house question-answer sessions called Ru-Ba-Ru. More than 25 such sessions have been conducted so far with a maximum of 44 students from 22 centers attending one such session. Audio recordings of these sessions are available on request. Videos of last two Ru-Ba-Ru sessions are available to view on Facebook site of Prashna India 29th January and 3rd February 2019.

Prashna India can be visited at http://prashna-india.weebly.com/

Prashna India

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AMASI 15 APRIL 2019

Hobby Corner

Manojda, as we fondly call him, is a well-known figure in the laparoscopic circles in India, especially the North-East. His karmabhumi is the Gateway to the North-East, the city famous for the Kamakhya Temple, Guwahati. An avid traveller, he is a grassroots sort of guy, very much attached to his village and its development. He uses his spare time in philanthropic activities. An open book, he does not harbour any skeletons in his cupboard. Or so he claims.

Professor Manoj Kumar Choudhury

With the list of degrees after his name matching his height, this blue-eyed, or rather, in Roy’s case, hazel-eyed man of Minimal Access Surgery is an avid traveller. While he may come across as world-weary and ‘been there, done that’ sort of guy, when one gets to know him better, one realizes that he is deeply spiritual and tends to philosophize a lot. He lives by the motto of “Work hard, play harder”. He is currently striving on improving his already wonderful sense of humour as his ultimate ambition is not to take himself seriously!!

DR. ROY PATANKAR MS,FICS,FMAS,FRCS(Glasg), FALS, FICS, FRCS (Ed), PhD

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AMASI 15 APRIL 2019

Upcoming Events

Event Venue Date Organizer

Basics in laparoscopic surgery

JIPMER, Puducherry 13th - 14th July 2019 Dr. Biju Pottakat

Operative Workshop Nazareth Hospital, Shillong 1st-2nd August, 2019 Dr. Jayanta Kumar Das

FMAS Skill Course & Examination Shillong 2nd-4th August, 2019 Dr. Jayanta Kumar Das

Orientation Programme in Stoma Care

JIPMER, Puducherry 30th August, 2019 Dr. Biju Pottakkat

FMAS Skill Course & Examination Gurgaon 6th-8th September, 2019 Dr. Anshuman Kaushal

FMAS Skill Course & Examination Bengaluru 27th-29th September, 2019 Dr. Srikantiah

FMAS Skill Course & Examination Jaipur 11th-13th October, 2019 Dr. Rajendra Mandia

AMASICON2019 Nagpur 7th-10th November, 2019 Dr. Prashant Rahate

FMAS Skill Course & Examination Rajkot 3rd-5th January, 2019 Dr. Nikunj Patel

For more details visit www.amasi.org

1. ORIENTATION PROGRAM IN BASIC LAPAROSCOPY (JIPMER, PUDUCHERY)

Who Should Attend:

All general surgeons, surgical gastroenterologists, urologists, gynecologists who wish to get oriented and develop basic hand-eye co-ordination skills to enable performance of basic laparoscopic surgeries.

Course Length: 2 days

Intake: 8 delegates in each batch on first come first serve basis.

Inclusion:

1. Lunch on both days.

2. Tea/coffee during the two breaks along with cookies/biscuits.

3. Course material

Exclusion: Anything not mentioned above. The candidates will have to make their own arrangements for transportation and local accomodation. If available, accomodation at the JIPMER guesthouse will be provided on payment of necessary charges.

Course Fees: 8000/- + 1440/- (GST@18%) = 9440/-

2. ORIENTATION PROGRAM IN OSTOMA (JIPMER, PUDUCHERY)

Who Should Attend:

PG residents in surgery, or freshly passed out M.S/DNB General Surgeons.

Course Length: 1 day

Intake: 8 delegates in each batch on first come first serve basis.

Inclusion:

1. Lunch on both days.

2. Tea/coffee during the two breaks along with cookies/biscuits.

3. Course material

Exclusion:

Anything not mentioned above. The candidates will have to make their own arrangements for transportation and local accomodation. If available, accomodation at the JIPMER guesthouse will be provided on payment of necessary charges.

Course Fees: 2500/- + 450/- (GST@18%) = 2950/-

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AMASI 15 APRIL 2019

Training Programmes

3. ORIENTATION IN ADVANCED MINIMAL ACCESS GI SURGERY (JIPMER, PUDUCHERY)

Who Should Attend:

Trainees and faculty of surgical specialty like General Surgery, Surgical Gastroenterology, Onco Surgery, Pediatric Surgery who had completed the Orientation in Basic Laparoscopy course

Course Length: 2 days

Intake: 8 delegates in each batch on first come first serve basis.

Inclusion:

1. Lunch on both days.

2. Tea/coffee during the two breaks along with cookies/biscuits.

3. Course material

Exclusion: Anything not mentioned above. The candidates will have to make their own arrangements for transportation and local accomodation. If available, accomodation at the JIPMER guesthouse will be provided on payment of necessary charges.

Course Fees: 15000/- + 2700/- (GST@18%) = 17700/-

4. ORIENTATION IN BASIC ROBOTIC SURGERY (JIPMER, PUDUCHERY)

Who Should Attend:

Surgeons performing basic and advanced laparoscopic surgery and seriously considering progressing to robotic surgery

Course Length: 3 days (Monday – Wednesday)

Intake: 2 delegates in each batch on first come first serve basis..

Inclusion: 1. Lunch on both days.

2. Tea/coffee during the two breaks along with cookies/biscuits.

3. Course material

Exclusion:

Anything not mentioned above. The candidates will have to make their own arrangements for transportation and local accomodation. If available, accomodation at the JIPMER guesthouse will be provided on payment of necessary charges.

Course Fees: 22500/- + 4050/- (GST@18%) = 26550/-

For Programs 1-4, contact for registration and assistance: 7094640190, sgecourses@jipmer.edu.in (CC to amasi.india@gmail.com)

OBSERVERSHIP IN BASIC LAPAROSCOPIC SURGERY:

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AMASI 15 APRIL 2019

Observership to be offered for 15 days in basic laparoscopic surgery, viz. laparoscopic cholecystectomy, hernia and appendectomy. Observers should be AMASI life members and should have attended a FMAS skills course (not the examination). The cost of travel, accomodation and food to be borne by the delegates. The following centers have offered Observerships:

North Zone:

1. SMS Medical College, Jaipur, Dr. Rajendra Mandia.

2. CMC Ludhiana, Dr. Navneet Kumar Chaudhry

3. Government Medical College, Chandigarh, Dr. Rajeev Sharma

Central Zone: 1. RML Medical College, Delhi, Dr. Deborshi Sharma.

2. Balaji Hosital, Raipur, Dr. Devendra Naik

3. Apollo Hospital, Indore, Dr. Rakesh Shivhare

4. Rainbow Hospital, Agra, Dr. Himanshu Yadav

West Zone:

1. MGM Medical College, Aurangabad, Dr. Pravin Suryavanshi.

2. Panchsheel Hospital, Ahmedabad, Dr. Kaushik Shah.

3. GMC, Nagpur, Prof Raj Gajbhaiye

4. Joy Hospital, Mumbai, Roy Patankar

East Zone:

1. AIIMS, Bhubaneshwar, Dr. Manas Sahoo

2. ILS Kolkata, Dr. Om Tantia/Dr. Tamonas Chaudhary

3. Nemcare Superspeciality Hospital, Guwahati, Dr. Manoj Kumar Chaudhary

4. IPGMER Kolkata, Dr. M. L. Saha

5. Shija Hospital, Imphal, Dr. Jugindra

South Zone:

1. Gem Hospital Trichur, Dr. Varghese

2. Yashoda Hospital, Secunderabad, Dr. Laxman Sastry.

For allotment of observership, please contact amasi.india@gmail.com

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AMASI 15 APRIL 2019

For registration and more details visit https://amasicon2019.com/

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JAWAHARLAL INSTITUTE OF POSTGRADUATE MEDICAL EDUCATION AND RESEARCH (JIPMER) & ASSOCIATION OF MINIMAL ACCESS SURGEONS OF INDIA (AMASI)

Centre for Advanced Surgical Simulation, Department of Surgical Gastroenterology, JIPMER, Puducherry, India

Orientation Program in Stoma Care

30th August 2019 Who Should Attend: PG Residents in Surgery, or freshly passed out M.S/DNB General surgeons

Course duration: One day

Course Curriculum: Session Time Topic Audio Visual

Aids I 9.00AM-

10.00AM Introduction to Ostomy Services Surgical Videos: Technical Videos for Ileostomy, Loop Colostomy and End Colostomy

PowerPoint Video

II 11.00AM-1.00PM

Presentations • Stoma Site Marking • Management of High Output Stomas and

Fistulas • Case Discussion on Complicated Stomas • Discharge Advice • Ostomy and Wound Care Products

demonstration

PowerPoint

III 2.00PM-3.00PM Hands on Training on Ostomy Simulator

Susie Simulator

IV 3.00PM-5.00PM Ward rounds with stoma specialist for practical tips on stoma care

Clinical rounds

Intake: 2 delegates on first come first serve basis Inclusion: Lunch, tea/coffee during the two breaks, course material Exclusion: Anything not mentioned above. The candidates will have to make their own arrangements for transportation and local accommodation. If available, accommodation at the JIPMER guesthouse will be provided on payment of necessary charges Course Fee: 2500/- + GST Contact for registration and assistance: sgecourses@jipmer.edu.in, (cc to amasi.india@gmail.com). Please log in to www.jipmer.edu.in or www.amasi.org for upcoming events. Certificate of attendance will be provided at the end of successful completion of course Organizing chairman: Organizing Secretary: Dr. Biju Pottakkat, Maheswari.P, Head of the Department, Stoma therapist, Surgical Gastroenterology, JIPMER. JIPMER.

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AMASIAssociation of Minimal Access Surgeons of India

45-A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641 045. Ph : 0422- 4223330

Email : amasi.india@gmail.com

Web : www.amasi.org