ISGE-Pune kicks off debate over open vs telescopic surgery

October 10, 2018 0 By CH Unnikrishnan

The three-day regional meeting of International Society of Gynaecology Endoscopy (ISGE) in Pune shined the spotlight on one of the most critical discussions in the field: Should new generation gynaecology surgeons restrict themselves to telescopic procedures or also look at the benefits of a complementary approach involving traditional surgeries? The debate came up in the wake of the increasing trend of promoting endoscopic surgeries in India despite the fact that both procedures have their merits and demerits as far as patient safety is concerned.

The conference, which had several theoretical lectures presented by renowned speakers in the field of gynaecological endoscopy, was also filled with panel discussions and practical workshops on different aspects of endoscopic surgical skills and the relay of live surgeries from different parts of the world.

Though the event could successfully highlight the latest technical advances and innovations which are making surgeries safer and cost effective, a discussion over the traditional approach versus the new was an eye-opener, especially to new age clinicians.

Sharing his decades-long experience in open as well as endoscopic gynaecological  surgeries in India and abroad, Prof. Bhaskar D Goolab, Department of Obstetrics and Gynaecology, University of Witwatersrand, Johannesburg, South Africa, said that there are merits in both procedures. But, doctors, especially new-age gynec-surgeons, should not get carried away by technology campaigns and blindly say that they are exclusively laparoscopic surgeons. These kind of conferences are there to put such issues in perspective, he added..

“There is a debate that has come up now as to what is the role of telescopic surgery and what is the role of the conventional and long-trusted open surgery. There are merits, indications and pitfalls on both sides of the equation, but the key point of contention here is the paradigm shift that is predominantly driven by technology players towards these expensive surgeries. Gynaecologists simply follow the trend of telescopic surgery, unnecessarily turning some simple traditional procedure into an expensive technology procedure instead of weighing the specificity, fit case, patient choice and safety,” Dr Goolab said.

“Of course, there is merit in suitably chosen cases. For example, diseases like endometriosis or massive uterine fibroids, which makes the removal process difficult through the vaginal route, need to be done through telescopic surgery, depending on the skill of the doctor. There are also risk factors like burn and other complications associated with endoscopic surgeries as it uses electric power,”  he added.

While others agreed with the view that the debate remains relevant as far as some specific cases are concerned, they argued that laparoscopic technologies have actually made procedures much easier for the patient and the surgeon, both technically and in terms of indirect costs.

According to Dr P G Paul, one of the most senior gynaecology and endoscopic surgeons in India and the chairman of Paul Hospital, it is natural that technology development drives the industry to better options, though doctors always have the opportunity to choose the best according to his/her skill-set and the benefit of the patients.

“It is not only the procedure cost that matters in the overall treatment. Although the cost of laparoscopic surgeries are higher compared to conventional procedures, these new methods help reduce the days of hospital stay and the patients can resume their routines faster after the surgery,” Dr Paul said.

“The advanced and innovative technologies in endoscopy have effectively helped in saving both cost and time for patients, though the cost of the procedure as such is comparatively higher. Since the hospital meter starts running from the very moment the patient gets admitted, a reduced hospital stay is often a big saving for the patient,” said Dr Rishma Dhillion Pai, Senior Gynaecologist & Endoscopist and President, Indian Association of Gynaecological Endoscopists (IAGE).

Dr Sunita Tandulwadkar, the organising chairman of the 2018 regional conference, said the conference was unique in several aspects, including the presence of live workshops, academic sessions and a number of senior national and international speakers.

“Also, we wanted to showcase the Indian skill-set in endoscopy to the world through this event and, at the same time, wanted our young gynaecologists to learn from the experienced doctors from all over the world, who shared their 25-30 years’ experience in handling unique cases,” she said.