From conventional to minimal invasive surgery

Dr Rajive Gupta
There is an old and famous saying “big surgeons make big incisions”. This thing doesn’t hold true in the present era of minimal invasive and minimal access surgery which has revolutionized the concept of surgery and has many advantages over the conventional open surgery including minimum scar in the form of key holes.
In the laparoscopic surgery technique, 3-4 key holes of 5-10 mm size are made over the abdomen instead of a single big incision performed in conventional open surgery. There are many advantages of laparoscopic surgery technique over traditional open surgery like less pain, less duration of hospital stay, early recovery, early resumption to routine activities, less chances of wound infection and incisional hernia and better cosmetic satisfaction of the patient as per scar is concerned. There is definitely a learning curve for any technique and for laparoscopic surgery, younger the age of a surgeon better are the chances to emerge as a fantastic laparoscopic surgeon due to quick reflexes and better hand eye coordination.
As the laparoscopic surgery advanced, transition from conventional open surgery to laparoscopic surgery was very difficult to adopt by the senior surgeons because they were trained only in open surgery during their post graduation training and residency period and their whole career was based on open surgery in which they have been masters and experts beyond any doubt. Learning a new technique and mastering the same at age of fifty and above is really difficult. Consequently, many of old surgeons though holding the posts of Professors and Head of the Surgical units could not adopt and did not advocate this newer and better technique and also didn’t encourage their junior colleagues to perform such surgeries in their Operation theaters. As a result of hierarchy in the system especially in the Government set up, this technique took more than a decade to develop that too only for the very basic procedures. On the contrary, laparoscopic surgery has touched heights in a short span of time in corporate hospitals and almost all abdominal surgeries are presently being performed by this patient friendly technique. In small cities where the new surgeons who were well verse with the laparoscopic surgery, but were never given an opportunity to show their worth in Government set up and continued their endeavor by explaining the advantages of this new technique for years together by distributing video recordings and by comparing results with the patients operated in a conventional manner and ultimately patients themselves started demanding surgery by laparoscopic method. This compelled old senior surgeons to go for this method of surgery, but obviously they could not give results compared to the results produced by the newer well trained surgeons in this field because old surgeons lacked proper training and due to weak reflexes and poor hand eye coordination with advancing age, they could not master the technique. Talent and skill of many trained young laparoscopic surgeons was wasted and many patients were deprived of the advantages of this newer and better technique due to the hierarchal system prevailing in the Government set ups where the prerogative is with the surgeon holding senior post whether to allow or not allow the junior colleague to perform surgery by the better technique for the benefit of the patients. How can professors of surgery in a Government Medical College face the situation where a beginner with better skill and better technique perform successful surgeries by laparoscopic method with which they are not well versed.
The height is some heads had kept the laparoscopic instruments under lock and keys so that they were not made available to other colleagues for years together, thus resulting in delay in the establishment of this novel technique of laparoscopic surgery in Government hospitals of the present union territory of Jammu and Kashmir. Moreover, laparoscopic equipment worth crores of rupees is lying unused in various district hospitals of the union territory for years. Due to the wrong practice being adopted in the Government hospitals, laparoscopic surgery is still in the stage of infancy even after three decades of world wide establishment of this wonderful technique and is far behind the private and corporate hospitals where all abdominal surgeries including Whipple’s operation for Pancreas is being done laparoscopically and also Robotic laparoscopic surgery is being performed routinely. I am a live example of a laparoscopic surgeon who faced this attitude of senior Surgeons and Professors during my surgical career.
Inspite of the Government order No 379-HME of 2004 dated 16/9/2004 and Hon’ble High court order of utilizing my services as a Laparoscopic Surgeon in the Surgery Department , GMC, Jammu , I was never allowed to perform laparoscopic surgery. Instead the whole surgery faculty of GMC Jammu stood against this Government order only because I was not holding the faculty post and many patients were deprived of the benefits of this novel technique in my hands. As the present Government is making useful changes in many fields for everybody’s betterment, one can hope that administration in union territory of Jammu and Kashmir gives a positive thought and bring a significant change in the system where skill and talent will have upper hand over the seniority and post in the real interest of the patients.
(The author is a senior Laparoscopic Surgeon in Jammu)