SUMMER 2013

ALSGBI COUNCIL 2013

ALSGBI newsletter

Editor’s Introduction

ALSGBI ExecutivePresidentProfessor Tim A Rockall

President ElectMr Mark N Vipond

Honorary SecretaryMr Simon PL Dexter

Honorary TreasurerMr Donald Menzies

Director of EducationMr Peter C Sedman

Members of ALSGBI CouncilMidlandsMr Martin S Wadley

TrentMr Paul C Leeder

IrelandMr J Andrew Kennedy

Oxford & WessexMr Charles J Ranaboldo

Northern & YorkshireMr Sean Woodcock

North West & MerseyMr Milind S Shrotri

ScotlandProfessor Zygmunt H Krukowski

North ThamesMr Tan Arulampalam

AngliaMr Timothy Justin

South ThamesMr A Mark Gudgeon

WalesMr Umesh P Khot

South & WestMr Nicholas DaviesAUGIS RepresentativeMr Ian J BeckinghamACPGBI RepresentativeMr Mark ColemanASiT RepresentativeMr Jonny WildALS Representative at EuropeanAssociation of Endoscopic SurgeonsProfessor George HannaALTS ChairMrs Jane P Bradley-Hendricks

Mrs Sarah Williams, Business Managerswilliams@alsgbi.orgTel +44(0)20 7869 6940www.alsgbi.org

Welcome to the Summer edition of the ALSGBI newsletter. Life in UK surgery isnever dull. The relentless political drives for change to improve (and secure the nextterm) affect all of us. As of April 2013 we have a new NHS! Alongside the financialshift of power to clinical commissioning groups there is published guidance as tohow we are to deliver a more responsive health service, focused on improvingoutcomes for patients. This caused me to consider what was I doing before?

The document ‘Everyone Counts: Planning for Patients 2013/14’ outlines the‘incentives’ and ‘levers’ that will be used to improve services. One of the centraltenets of the document relates to better data and informed commissioning. Wehave already seen the process stumble in the Leeds Paediatric Cardiac Surgerydebacle that led to the temporary suspension of surgery and the subsequentresignation of Professor Sir Roger Boyle the former ‘Heart Tsar’. In surgery we havethe ‘misfortune’ of having outcomes that are easily measured on a crude basis,but that are often far more complex when analysed in depth. We have howeverbehaved very responsibly as a profession and are far ahead of our medicalcolleagues in conducting regular M&M meetings, AGMs and, like the cardiac

surgeons, have established national databases. TheOG (NOGCA) in gastrointestinal surgery, the HPB(HPB Cancer Resection Database) and in bariatricsurgery (NBSR) are examples of the efforts made.Whilst not perfect they have advanced ourknowledge of ‘real world’ practice and outcomes thathave been published as national reports, available inthe public domain. We have established and worked in dedicated units and in allspecialties the multi-disciplinary team is pivotal. A laudable result of such actionhas been a shift in the belief that outcomes should be regarded as the responsibilityof ‘The Team’ and not solely the responsibility of the surgeon.

Our reward for these phenomenal efforts is that in order to demonstrate‘Everyone Counts’ in action the data from the units submitting to the nationalregisters/audits will not be published as such. Rather than concentrating on unitoutcomes, as services will be commissioned as such, the data will be published asindividual surgeon-level data by June 2013. It will not be risk-stratified and certainly

President’s IntroductionA lot has happened at the ALSGBI since our last newsletter, not least the highlysuccessful Annual Scientific Meeting in Cork. Now we are focusing on the nextmeeting in London in November, which will be my last as President of the Association.

It will be the first time that the meeting comes to London and it is shapingup to be a very exciting program. The venue is The Royal College of Surgeons inLincoln’s Inn where we will also hold the training day in the Raven Departmentof Education. Live surgery will be beamed in high definition from several sites.Live multi-speciality laparoscopic surgery will be beamed in from GuildfordMATTU in 3D HD, which will be a unique conference event. In addition we willhave a retroperitoneal adrenalectomy performed by Professor Martin Walz fromEssen in Germany and a transperitoneal adrenalectomy from the UK.

Dr Jean-Louis Dulucq from Bordeaux, a name very well known andrespected in laparoscopic circles, is our visiting speaker who will give lectureson the subjects of laparoscopy in acute pancreatitis and pancreatic cancer andProfessor Michael Bailey will deliver the BJS Lecture for 2013.

We would like to see as many high quality abstracts, both papers and DVD’s,so if you are involved in research or have a good quality educational DVD I would

encourage you to submit it when the time comes. There are bursaries to supporttraining surgeons who have their submissions selected for presentation as wellas high value prizes for the best. Make sure you put the dates in your diary nowfor what I am sure will be a memorable meeting.

Thank you and congratulations to Mr Mark Vipond who after 6 years ofdedicated service as Honorary Secretary has now been duly elected asPresident Elect. I am pleased to confirm that Mr Simon Dexter has now takenon the role of Honorary Secretary. Congratulations and a warm welcome tonew members of Council; Mr Mark Gudgeon and Mr Tan Arulampalam whohave been elected to represent the South Thames and North Thames regionsrespectively. Our thanks go to the outgoing representatives for the Thamesregions Professor Amir Nisar and Professor Stephen Chadwick. Mr SeanWoodcock now takes over from Mr Simon Dexter as the Northern & YorkshireRepresentative. Finally congratulations to Mr Mark Coleman who is the newACPGBI Representative.

Professor Timothy Rockall, President

Deputy ALTS ChairMs Alice E JonesEditorial SecretaryMr Shaun R PrestonAudit DirectorMr C Richard B WelbournResearch DirectorProfessor George HannaWebsite DirectorMr David MahonRCS Bariatric TutorMr David F HewinRCS MIS TutorMs Avril AP Chang

SAVE THE DATE

ALSGBI ASM 2013 London

14 & 15 Nov

TRAINING DAY 13 Nov 2013

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Association of Laparoscopic Surgeons of Great Britain & Ireland @The Royal College of Surgeons, Room 505, 5th Floor, 35-43 Lincoln's Inn Fields, London WC2A 3PE

CONTACT DETAILSHAVE CHANGED

Mrs Jenny Treglohan, Executive Officerjtreglohan@alsgbi.orgTel +44(0)20 7869 6941www.alsgbi.org

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ALSGBI Industry Partners for 2013

Platinum Silver

for low-volume, high-risk surgery will have denominators that will make anyinformation meaningless. It will not provide useful information to facilitate ‘choice’or ‘influence commissioning’. It will merely cast unnecessary dark clouds overindividual practices and have a deleterious effect on team-working. I am delightedto include, in this issue, an excellent report on the NBSR by the President of theBOMSS, Mr Richard Welbourn.

For those who would like to know more about the Mid Staffordshire NHSFoundation Trust Public Inquiry there was a session devoted to this topic at theASGBI International Surgical Congress in Glasgow. This session includedpresentations by Mr Robert Francis, QC (Chairman) and Sir Neil McKay (ChiefExecutive, Midlands and the East Strategic Health Authority). This conferenceallowed delegates to enjoy the ALSGBI session at ASGBI (2 May 2013) where theinteresting topic of the role of laparoscopy in emergency surgery was tackled.

On a lighter note, I was delighted with the great success of the most recentAnnual Scientific Meeting (ASM) held in Cork last Novem ber. The event, hosted byMr Colm O’Boyle, a great raconteur and old colleague from our Registrar trainingdays in Yorkshire, was always set to be a true spectacle. The articles by Mr PaulLeeder and Ms Jane Bradley-Hendricks are testimony to this. He and his team, alongwith the ALSGBI support team and our Industry Sponsors, are to be congratulated.

I regard the ALSGBI as a highly progressive Association. One marker of this is

the way in which new technology is embraced and utilised to improvecommunication and access to information. The use of the ALSGBI App at therecent ASM and the establishment of a Twitter feed are to be commended, anda great credit to Mr David Mahon (see page 3). This is an area ripe for furtherdevelopment that can only enrich the Association.

Looking to the future, I was very pleased to see the rallying cry of ‘LondonCalling’ as the title for the next ASM, organised by our President Professor TimRockall. The conference is to be held at The Royal College of Surgeons ofEngland from 14-15 November 2013. This will be preceded, as usual by theextremely useful training day (13 November). Dates for everyone’s diary! It isfabulous to see so much investment back into the College with developmentof The Raven Department of Education and the work done to improve theHunterian Museum, which celebrates its bicentenary this year. We frequentlytravel the world on meetings but rarely visit our own capital. Indeed the lastscientific surgical meeting, rather than a course, I attended at the College wasthe SRS meeting organised by St Mary’s in 1992! I look forward to the occasionwith great anticipation and excitement and wish to encourage as manymembers as possible to attend.

Mr Shaun Preston Newsletter Editor, ALSGBI Council

Gold

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ALSGBI App Version 1.0.1

The ALSGBI recently launched an app for iPhoneand iPad, just in time for our congress in Corklast November. Since then, it has beendownloaded over 250 times. We recently invitedyou to complete an online survey about the app,our website and about the congress which hasthe highest attendance so far at over 250registered delegates.

I am happy to report that 9 out of 10respondents to the survey, who attended theCork meeting, found it relevant, well structuredand felt that they learned a great deal. Morethan a third of you have already downloadedthe app and whilst we have had suggestions forimprovement, the majority of you found ithelpful and easy to use with good content. Threequarters of our membership have an iPhone andalmost half have an iPad. One quarter now hasan Android phone and if our membershipresembles the general population, this seems setto increase. Given the results of this survey andthe population trend, we have started to developan app for Android and will have this availableprior to the next congress in London. We willalso take the opportunity to ‘freshen-up’ ouriPhone/iPad app at the same time. This willfacilitate regular updates from the executivewith the latest news and course information.

We always welcome additional digital contentfor the website and the app, especially editedDVDs - please feel free to submit anything tojtreglohan@alsgbi.org (or by sending a DVD tothe office) who will pass it on to me.

For those who do not have the app andwould like to download it, it is available freethrough iTunes (App Store > Medical >Association of Laparoscopic Surgeons of GreatBritain and Ireland). The app is compatible withiPhone, iPod touch and iPad and requires iOS 5.0or later. The app is optimized for iPhone 5.

Finally, the eagle eyed amongst you mayhave noticed that the following icon is nowvisible at the bottom of our website.

In addition to reading the latest newson the ALSGBI app, clicking this link willallow you to follow ALSGBI on yourtwitter feed, either on your computer oron your mobile device. It's fun for us butmore importantly, it allows us to provideinformation about news, events andcourses to you really quickly. Why not login and click it now?

David MahonWebsite DirectorALSGBI Council

SAVE THE DATE

ALS ASM 2013 London

14 & 15 Nov

TRAINING DAY 13 Nov 20130.0%

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ALSGBI is mobile!

The smarter, faster way to access informationwhile you are on the move.

The ALSGBI App is available throughout the year to provide quick and easyaccess to keep you up-to-date with all aspects of the ALSGBI, and the ALSGBIIndustry Partners. Download it now to your iPhone or iPad - available fromthe App Store today. Android version coming very soon!

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ALSGBI Annual Scientific MeetingCork, 29-30 November 2012

The ALSGBI Annual Scientific Meeting 2012found us in the glorious Irish city of Cork, thethird largest city in Ireland after Dublin & Belfast.It is on the beautiful west coast and approachedby a short aeroplane journey from the UK. Ourhost for the three days was Mr Colm O'Boyle,deftly supported by his secretary Catriona.Together with the local organisers, our ALSGBIorganisers Jenny & Sarah did an admirable job atbringing together an excellent programme ofevents at an unsurpassed venue.

The meeting was based at the RochestownPark Hotel - one of Cork's premier conferencehotels and an ideal venue for our event. As istradition, the first day was an AdvancedLaparoscopic Surgery Training day, based at theBon Secours Hospital. A lucky group of twelvetrainees had the enviable opportunity of handson practical laparoscopic training. The delegateshad the opportunity to practise upper and lowerGI procedures, supported by our Director ofEducation Pete Sedman and ex-Director ofEducation at The Royal College of Surgeons ofEngland, Professor Mike Larvin, who has recentlytaken up a post of Head of School at TheUniversity of Limerick. The training day wasgenerously sponsored by Covidien and Stryker.

Day two was the first day of the conference.Following on from a welcome by our PresidentProfessor Tim Rockall, we were able to feast on avaried day of operating beamed via satellite fromthe Bon Secours and Cork University MaternityHospitals. The meeting's theme and title of 'Riseof The Machines' was demonstrated by localgynaecologist Dr Matt Hewitt. Although therewere few gynaecologists in the audience, we allappreciated the amazing display of pelvicanatomy that is offered by robotic 3D

laparoscopy. Other surgery of gastric bypass,fundoplication and incisional hernia repair weredeftly performed by local and visiting surgeons,all of whom were positively received. Aninteresting debate ensued in the audience,regarding different techniques utilised infundoplication and also the optimum pouch sizein gastric bypass surgery. Mr Tim Tollens fromBelgium gave a beautiful demonstration ofincisional hernia repair. If not already adopted,many surgeons in the audience will now considersuture repair of the primary defect prior to intra-abdominal mesh placement. The optimum choiceof mesh is still very much up for debate, but alightweight composite mesh appears to befavoured in general. The satellite links weregenerously sponsored by Olympus.

Following the President's Drinks Reception,coaches ferried delegates to Cork City Gaol forthe Annual Conference Dinner. We wereserenaded by the Roaring Forties Band, perhapshinting at the average age of the audience ratherthan the genre of music. Following a marvellousmeal and the usual acknowledgements by ourPresident, the audience were treated to aninsightful speech by Irish Rugby International Mr Frankie Sheahan. His philosophy of 'giveyourself a 10 yard line to vent your frustrationsbefore moving on' could be applied in the oftenhighly charged field of laparoscopic surgery.

Day three started with a worthy display ofDVD and oral presentations. The winning DVDpresentation was of 'Laparoscopic Low AnteriorResection with Inter-sphincteric Dissection AndColo-Anal Anastomosis', given by Mr N Siddiqui.The winner of the David Dunn Free Paper Prizewas 'Is Stroke Volume Optimisation ReallyNecessary In Laparoscopic Colorectal Surgery?',given by Mr A Day. The winner of the bestlaparoscopic poster prize was 'Female GenderAnd Diabetes Increase The Risk Of RecurrenceFollowing Laparoscopic Incisional Hernia Repair',given by Mr F McDermott.

An asset of the ALSGBI is the support oflaparoscopic theatre staff. Many were able toattend this year thanks in part to the generousbursaries offered by SIGH Ltd. A parallel sessionon Friday morning was well attended. A largepart of the meeting is the collaboration with

Industry Partners. Our specialty is very muchtechnology driven and we value both theirfinancial support and the opportunity to reviewthe latest equipment entering the market.Exciting developments include 3D imaging. Thiswas demonstrated for the first time at the 2011Cardiff meeting and is now standard in manydomestic screens. Probably of most practical,immediate use is the development of microinstruments. These promise to make virtuallyscarless surgery a reality, without compromise ofthe laparoscopic technique.

The BJS Lecture was given by Professor LeeSwanstrom, Head of Upper GI & MinimallyInvasive Surgery in Oregon. He presented athought-provoking talk on robotic surgery.Robotic prostatectomy is now the primarytreatment for prostate cancer in the US. There islittle evidence of cost effectiveness unless a unithas the ability to undertake volumes of over 200cases per year. In the words of ProfessorSwanstrom 'a bad laparoscopic surgeon can be agood robotic surgeon'.

The debate was taken further by ProfessorCraig Ramsay, Health Services Research Head inAberdeen, who has recently completed a reviewof robotic surgery for NICE. He pointed out thatthere is no evidence of a reduced learning curvewith robotics compared to laparoscopy. At best,outcomes are equivalent to laparoscopy, butmore expensive. The move towards roboticsurgery is however very much driven by publicdemand. Whatever your feelings on the subject,we have to be prepared because the robots aredefinitely coming!

Feedback from the meeting has been excellent.The broad subject material, sessions, hosts andvenue have all led to this being one of the mostsuccessful ALSGBI meetings to date. We verymuch look forward to increasing interest andmembership and hope you can encourage bothyour trainees and theatre staff to becomemembers. We look forward to meeting you allwhen the 2013 meeting comes to our spiritualhome at The Royal College of Surgeons in London.

Mr Paul C LeederTrent Representative, ALSGBI Council

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ALTS @ ALSGBI Annual Scientific Meeting Cork, 29–30 November 2012

I am delighted to report on yet another extremelysuccessful ALSGBI Annual Scientific Meeting. Eachyear we think it can’t get any better and it surpassesthe previous year. Where do I begin?

The delegate numbers were up for a meetingheld out of UK; a good indicator that people are keento attend our Annual Scientific Meeting andprepared to travel to do so. The Irish hospitalityprevailed throughout the meeting; everyone wasvery welcoming and extremely helpful. The contentof the meeting was as usual excellent, varied withsomething for everyone.

The live operating was sponsored by Olympusand transmitted by satellite from the Bon Secoursand Cork University Maternity Hospitals to theRochestown Conference Centre. The ‘wow factor’ ofbeing greeted by 3 huge screens when entering thelecture theatre set the scene and expectation for agreat day of live operating. The image quality wasexcellent as was all of the surgery performed. Ourthanks go to all of the surgeons and theatre staff forputting on such a great day, to Olympus forsponsoring the high definition link and of course toMr Colm O’Boyle, who as the local organizer, broughtit all together.

We all went to Gaol on the Thursday night. Wedid not pass go and did not collect £200(approximately € 234!) but were treated to anexcellent evening’s entertainment including some‘gaol house rock’ from the Roaring Forties band.Fortunately the dinner was not ‘themed’ and did notmirror that previously supplied to the inmates.Thankfully all ‘escaped’ back to our hotels at the end

of the night to sleep in comfort, rather than on avery cold hard floor! The dinner was lovely and theentertainment that followed was provided by theformer Munster and Ireland rugby player Mr FrankieSheahan, who kept us amused over coffee withsome (clean!) rugby jokes and anecdotes.

Friday was split into two separate sessions theALSGBI session and an ALTS session. The theme ofthis year’s ALTS was advancing practice for theatrepractitioners and progression from a traditional roleof theatre practitioner to an ASP (advanced scrubpractitioner) or SCP (surgical care practitioner). Thiswas an interactive session with lots of discussion onthe roles and how they are developing. There was a

great deal of interest from the Irish practitioners onhow these roles work in practice within the UK andthe education available to support it. We had a veryinformative presentation from SIGH Ltd., who hadsponsored some of the practitioners present at themeeting. We are extremely grateful for theirinvestment in our members and hope it is somethingthat they will continue to support.

Olympus also provided significant support for thesession and gave an excellent presentation on howto get the best out of your stack. Everyone enjoyedthis and afterwards felt much more confident insetting up a camera stack and ensuring the systemis functioning at an optimal level. Mr Peter Sedmanalso gave an insightful presentation on theimportance of being a good camera assistant andhow crucial it is to the safe and expedientprogression of an operation.

The delegates were then able to put all theirknowledge to good use in the afternoon skills basedsession. Most delegates started off by thinking thetasks we had set were going to be easy. They soonfound that this was not the case! There was a great‘buzz’ and the air was thick with competition! Funwas had by all and we once again extend anenormous thanks to Olympus for providing thestacks and setting them up for us.

I hope everyone enjoyed the two days as muchas I did and I look forward to another outstandingmeeting next year in London. See you all there!

Mrs Jane P Bradley-HendricksALTS Chair Person, ALSGBI Council

The National Bariatric Surgery Registry (NBSR)continues to thrive and evolve. To March 2013 thecontributing surgeons have contributed over 29,000patient operations. This already makes the NBSR oneof the largest bariatric registries in existence and isthe largest in Europe, with the possible exception of

the Swedish Registry (SOREG). Although we think that the operative outcomes ofthe first 8,000 operated patients, published in the 2011 report, are a clearrepresentation of the results in those patients, there are sceptics from outside theNBSR and the bariatric community. The reason? High rates of non-compliancewith practising bariatric surgeons who are clearly not entering their data.

It's well-established from the colorectal cancer registry in the UK that thosewho do not submit data to established national registries have worse results thanthose who do. This may reflect the fact that the NBSR started out on a voluntarybasis. The NCEPOD report from October 2012 showed that only 57% of the bariatricoperations surveyed in July 2010 had been entered into the NBSR. Although 81%of all bariatric patients were entered into either the NBSR or some local database,this is still disappointing coverage, and the bariatric community needs to addressthis issue, otherwise the validity of our data (and therefore also bariatric surgeryas a specialty) will still be questioned.

A driver for this is going to be Sir Bruce Keogh's mandate that individualsurgeon-level data is going to be released into the public domain by June 2013 -announced in the Commissioning Board document 'Everyone Counts - Planning

for Patients 2013/2014' released in December 2012. Bariatric surgery is one of the10 surgical specialties mandated to ‘take part’. This is a big challenge for all of the10 specialties and is the biggest jolt that bariatric surgery in the UK has faced.Sensitive discussions are on-going with The Royal College of Surgeons of Englandand the Healthcare Quality Improvement Partnership (HQIP) on what data are tobe released and the process of consent from contributors to allow this to happen.

Another driver is the Commissioning Board’s requirement, in the ServiceSpecification for bariatric surgery, that from 1st April all NHS bariatric surgeryproviders must submit their data to the NBSR. We don't know how this will bepoliced but it would appear foolish not to see this as an opportunity to propel theNBSR onto the next level and seek appropriate public funding. If we can ensureexternal validation of our data we have the greatest opportunity to quell thosewho think that our published data so far are misrepresentative. After the FrancisReport about the Mid Staffs scandal we cannot avoid the publication of outcomes.

On a lighter note, we are planning a Version 2 Upgrade for summer 2013 to makedata even easier to enter, with only minor adjustments to the data set. We are alsoplanning to publish the 2nd Biennial Report in time for the IFSO Congress to be heldin Istanbul this August. Anyone who wishes to contribute please get in touch withthe NBSR Committee at the ALSGBI/BOMSS/AUGIS offices (Jenny Treglohanjtreglohan@alsgbi.org, Sarvjit Madhar sarvjit@augis.org) or contact me directly.

Mr Richard WelbournNBSR Chairman

The National Bariatric Surgery Registry (NBSR)

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Report of the B. Braun AesculapTravelling Scholarship

In March 2011, thanks to the B. Braun AesculapTravelling Scholarship, I was able to visit theCentre for Adolescent Bariatric Surgery at theMorgan Stanley Children's Hospital of NewYork-Presbyterian and to attend the SecondWorld Congress on Interventional Therapies forType 2 diabetes (T2D) in New York.

The prevalence of morbid obesity inadolescents and young adults has increased inthe last two decades mirroring the rise in

morbidly obese adults. These younger patients have decreased life expectancyand increased physical morbidity when compared to their non-obesecounterparts. They develop conditions including impaired glucose tolerance,T2D, hypertension, dyslipidaemias, heart disease, sleep apnoea and degenerativejoint disorders that one would usually associate with much older individuals.Teenagers with morbid obesity also have a higher incidence of low self-esteem,depression, anxiety and other psychological problems. The majority of obeseadolescents remain obese as adults.

Bariatric surgery in adolescents is still somewhat controversial as the long-term results and consequences on growth have not been fully elucidated. Aspart of the guidelines for the management of morbid obesity, NICE advised

that surgery could be considered in young people in exceptional circumstancesand insisted on the importance of a multi-disciplinary approach to thesepatients. Although bariatric surgical operations in older and younger patientsare similar, the pre-operative workup and post-operative follow-up tend to bemore intense and extensive in the young.

The Morgan Stanley Children's Hospital of New York-Presbyterian has a longhistory and a vast experience in the management of adolescent obesity. Thisunit has a multi-disciplinary programme for weight management includingspecialists in paediatric endocrinology, nutrition, psychiatry, diabetes, surgery,gastroenterology and other specialties. In 2006, the centre became one of onlya few U.S. centers approved to offer weight loss surgery to adolescents andwas one of only four U.S. centers approved by the Food and DrugAdministration (FDA) to evaluate the outcomes of gastric banding in thispatient group.

The Medical Director for the centre, Dr Jeffrey L Zitsman, kindly allowed meto visit the unit. I was be able toattend sessions with differentmembers of the team and beinvolved in the pre-operativeevaluation, discussions, operationand post-operative care of youngadults and adolescents undergoingsurgery for morbid obesity. I wasmade to feel very welcome by thewhole team.

As part of their morbid obesitywork-up, the adolescents undergo

extensive health and metabolic screening, as well as bone age and bone densitystudies. Patients are given individualised exercise programmes and areevaluated by nutritionists and psychiatrists. Nutritional guidance, dietarymanagement and education are offered not only the adolescents themselves

but to the entire family, care givers and oftenthe schools they attend. I was able to be partof the multi-disciplinary team reviewing andassessing these patients. The goal of the teamis to help patients lose weight withoutsurgery if possible. Patients who fail to lose20% of their excess weight after six monthsand are considered to be able to understandand comply with the post-operative changeswould be considered for surgery.

The two bariatric operations performed inthe centre are laparoscopic adjustable gastricbanding and sleeve gastrectomy. As the bandis not licensed for use in adolescents,laparoscopic adjustable gastric banding was being performed under guidelinesapproved by the FDA and Columbia University's Institutional Review Board atthe time I visited the unit. The mean pre-operative BMI for adolescentsundergoing surgery at the center is 48 kg m-2. Most patients are younger than17 years and about 40% have evidence of metabolic syndrome pre-operatively.Most of the girls also have irregular periods and polycystic ovary syndrome.Initial results show that after a year after bariatric surgery, most of the patients

have lost approximately one-third of their excess body weight. Most patientsshow improvement in metabolic syndrome as early as 6 months post-operatively.

Patients are followed up very carefully post-operatively and any problemsare carefully sought out and managed by the multi-disciplinary team. Patientsare followed up for at least 5 years after their surgery. There are at least 6 visitsin the first post-operative year and then continues 6 monthly thereafter.

There is ongoing research in the unit evaluating the safety and success ratesof bariatric surgery and the natural history of obesity-associated conditions.They are also studying changes in metabolic parameters and gut hormonesafter weight loss surgery in adolescents.

Whilst in New York, I was also able to attend the Second World Congresson Interventional Therapies for T2D. This had a very interesting scientificprogramme with international experts in the field of bariatric surgery and T2Dincluding Professor Francesco Rubino, Professor Sir George Alberti and ProfessorJohn Dixon. The International Diabetes Federation (IDF) position statement waspublished during this meeting (www.idf.org/webdata/docs/IDF-Position-Statement-Bariatric-Surgery.pdf). The position statement stated that bariatricsurgery is a cost-effective therapy for T2D and obesity with an acceptable safetyprofile and that surgery for severely obese people with T2D should beconsidered much earlier in management rather than considered as a last resort.

This Travelling Scholarship has allowed me to visit a high-volume adolescentmorbid obesity and bariatric centre in the USA and also attend a related WorldCongress in the same city. Both have been great experiences that havecontributed vastly to my ongoing education and understanding of thisfascinating subject. I would like to take the opportunity to thank Dr Zitsmanand his team, along with the ALSGBI and B. Braun Aesculap for facilitating thisfantastic visit.

Ms Cynthia-Michelle Borg MD FRCS Winner of B. Braun Aesculap Travelling Scholarship 2010

8

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The Aesculap Academy has been offering a broad range of surgical Endoscopy courses since 1995. All of our courses are directed by a renowned international faculty. Quality is the key and our courses are all accredited.

Our state of the art training facilities in Tuttlingen and Berlin offer 6 - 10 workstations for a maximum of 12 - 20 participants. Different training modules have been developed for dry and wet lablaparoscopy training workshops, across a wide range of surgical procedures in upper GI surgery, colorectal surgery and laparoscopic urology.

Intensive hands-on sessions on animal specimens are supervised within small working groups, providing the best environment for maximum learning and 1st class practical hands-on experience. Our facilities offer the ideal set-up for an intensive exchange of knowledge.

Horizons of knowledge - Competence to master the future.

Date Course Venue

12–14 June 2013 Advanced Laparoscopic Colo-Rectal Surgery Berlin

20–22 June 2013 Advanced Laparoscopic Urology, Prostate Berlin

1–2 July 2013 Basic Nephrectomy Berlin

3–5 July 2013 Laparoscopic Training Course Hernia Surgery Berlin

18–20 November 2013 Advanced Laparoscopic Surgery Berlin

Olympus KeyMedContact: Mrs Tracy Bray, Events Manager, Olympus KeyMed | Direct Line: +44 (0)1702 616333 | Email: info@olympus.co.uk | Web: www.olympus.co.uk

Details of these course are available on our website or will be in due course.

Date Course Venue

18-20 June 2013 Surgical Energy Masterclass for Theatre Practitioners Olympus, Southend-on-Sea

24–25 June 2013 Laparoscopic Anti-Reflux Surgery with THUNDERBEAT IMACS, Maidstone Hospital

4–5 July 2013 Minimally Invasive Oesophagectomy with THUNDERBEAT IMACS, Maidstone Hospital

15–16 July 2013 Laparoscopic Radical Prostatectomy Cadaveric Workshop Newcastle Surgical Training Centre

12-13 September 2013 Laparoscopic Anti-Reflux surgery with THUNDERBEAT IMACS, Maidstone Hospital

26–27 September 2013 Laparoscopic Retroperitoneal Workshop Eastbourne District General Hospital

3-4 October 2013 Advanced Technique in Benign Oesophageo-Gastric Surgery with THUNDERBEAT IMACS, Maidstone Hospital

11-12 November 2013 Laparoscopic Colorectal Surgery with THUNDERBEAT IMACS, Maidstone Hospital

11–12 November 2013 Expert Skills in Laparoscopic Partial Nephrectomy Newcastle Surgical Training Centre

19–21 November 2013 Surgical Energy Masterclass for Theatre Practitioners Olympus, Southend-on-Sea

LIGHT Hernia Course(Laparoscopic Incisional and Groin Hernia Training)

The STEPS (Seeing, Training, Enhancing, Perfecting, Solo)

LIGHT Course, established by ETHICON Products offers

training in Laparoscopic Hernia surgery over 3 days split

between various training centres in the UK.

Module OneThe first module will be held at the MATTU in Guildford. This will

involve Observing Live Operating, using Simbionix computer

simulators and taking part in a JOURNAL CLUB.

Module TwoModule two will be held at Newcastle Surgical Training Centre and

will involve hands on surgery of all techniques learnt to date on

fresh frozen human cadavers.

Module ThreeModule three will involve Supervised operating in a training centre

with patients (2 delegates per session). Venue to be confirmed.

Finally, all Modules are compulsory.

Application Process• Yr ST 7/8 (or equivalent)

• CV including covering letter

• Letter of support from your consultant approving

the application and confirming advanced

laparoscopic skills.

• Evidence of previous hernia / laparoscopic

meeting attendance

• 8 delegate places available

To apply, please send the above to:

Lauren Clarke-DowsonJohnson & Johnson Medical Ltd,

c/o Universal World Events Limited, Ashfield House,

Resolution Road,

Ashby de la Zouch, Leicestershire, LE65 1HW

E-mail: lclarke2@its.jnj.com

www.agoralive.com/EthiconProducts/Event4

GBI

Based on an original concept

by Simon Monkhouse, SpR Surgery, Southwest.

L.

I.G.H.T

COURSES

13 November10

09:00 hrs -16:00 hrs at The Royal College of Surgeons of England24 available placesAimed at ST 1-4 (the course will appeal to trainees who have only performed 4 or 5 hernias procedures)

If you are interested please provide a personal statement as to why you want to attend the course and send it to Mr Peter Sedman, Director ofEducation, Association of Laparoscopic Surgeons of Great Britain & Ireland @ The Royal College of Surgeons, Room 505, 5th Floor, 35-43 Lincoln'sInn Fields, London WC2A 3PE. Applications to arrive by 27 September 2013. To qualify for a FREE place, trainees must register for the full AnnualScientific Meeting by 27 September (£165) and be current paid-up members of the ALSGBI.

Laparoscopic Training DayWednesday 13 November 2013Kindly supported by Ethicon and Stryker

Dear ALS Delegate,

We would like to invite you to attend the ALS Welcome Drinks Reception hostedby Fisher & Paykel Healthcare. The Welcome Drinks Reception is taking place at The New Zealand High Commission, Penthouse Suite from : 0 – 2 :00 hours on Wednesday 13 November 2013 and is inclusive to registered delegates only.

We hope to see you there.

Fisher & Paykel Healthcare

Delegate, Dear ALS

Delegate,

see you there. We hope to

on Wednesday 13 November 2013 The New Zealand High Commission, Penthouse Suite from

Fisher & Paykelby We would like to invite you to attend the ALS

el HealthcarykaFisher & P

see you there.

and is inclusive to registeredon Wednesday 13 November 2013 The New Zealand High Commission, Penthouse Suite from

Healthcare. The Welcome Drinks Reception is taking place at Fisher & PaykelWe would like to invite you to attend the ALS

eel Healthcar

delegates only. and is inclusive to registered0 – 2:The New Zealand High Commission, Penthouse Suite from

Healthcare. The Welcome Drinks Reception is taking place at Welcome DrinksWe would like to invite you to attend the ALS

delegates only. :00 hours 0 – 2

Healthcare. The Welcome Drinks Reception is taking place at Reception hosted

ALSGBI ASM 2013-14 & 15 November 11

ALTS (Association of Laparoscopic Theatre Staff) Members 2013 Bursaries

The deadline for receipt of applications is Friday 27 September 2013. This offer is on a ‘first come, first served basis’ and only one bursary perhospital will be awarded. Bursaries are NOT available to nurses who have been sponsored in previous years. We look forward to seeing you in November!

The ALSGBI is pleased to offer a number of SIGH (Surgical InstrumentGroup Holdings Ltd) Bursaries. The purpose of these awards is toenable Senior Theatre Staff to attend the 2013 ALSGBI AnnualScientific Meeting in London on Thursday & Friday, 14 & 15 November2013. The Bursaries will cover the cost of the registration fee for thetwo days and also accommodation for one night (Thursday).Bursaries will be awarded to Senior Theatre Staff who candemonstrate significant experience of teaching, defining roles andassisting with procedures in the MAS Teams of their hospitals.

In order to be considered for one of the SIGH Bursaries it is aprerequisite that candidates should be current ALTS membershowever you may join on application.Initially email jtreglohan@alsgbi.org to request an application formand membership form if necessary. The completed form(s) must bereturned to Mrs Jenny Treglohan, ALS Executive Officer, Associationof Laparoscopic Surgeons of Great Britain & Ireland at The RoyalCollege of Surgeons of England, Room 505, 5th Floor, 35-43Lincoln’s Inn Fields, London WC2A 3PE.

Save the dateALSGBI Annual Scientific Meeting 2013

Thursday 14 & Friday 15 November 2013@ The Royal College of Surgeonsof England

12

Is stroke volume optimisation really necessary inlaparoscopic colorectal surgery?

There is an ongoing debate surroundingperioperative fluid therapy in surgery,particularly the appropriate volume toadminister. Considerable research has beenconducted to explore the relative benefits of“restrictive” or “liberal” fluid regimes. Theevidence is both conflicting and confusing butwhat is apparent is that administering thevolume of fluid precisely tailored to theindividual patients requirement is probably

optimal (1). In order to achieve this a goal-directed approach is required. There is evidence that the use of goal-directed fluid therapy (GDFT) in

colorectal surgery is associated with a reduction of length of hospital stay,reduced critical care admissions and morbidity (2). As such the EnhancedRecovery After Surgery (ERAS) group and the ASGBI ERAS guidelines bothrecommend the use of GDFT in colorectal surgery. NICE have also issuedguidelines in 2011 recommending the use of the CardioQ- oesophageal Dopplermonitor in major surgery to guide GDFT. However there has been some recentevidence that has questioned these benefits in patients within an enhancedrecovery programme suggesting that a formulaic approach to peri-operativefluid administration is adequate (3,4) .

We aimed to identify the quantity of fluid administered by GDFT inlaparoscopic colorectal surgery in order to achieve stroke volume optimisationprior to creation of the pneumoperitoneum. Data was drawn from a randomisedclinical trial (NCT 01128088) conducted between 2010 and 2011 investigatingthe surgical stress response. All patients were within an established enhancedrecovery programme, received oral carbohydrate loading prior to surgery andno oral bowel preparation. To be eligible to participate in the trial patients hadto undergo a laparoscopic rectal or colonic resection without stoma formation.120 patients were required and randomised to four groups to receive eitherspinal analgesia or morphine patient controlled analgesia and either crystalloid(Hartmann’s solution) or colloid (6% Volulyte) fluid. The volume of fluidadministered as guided by the oesophageal Doppler monitor to achieve strokevolume optimisation in the anaesthetic room was recorded.

There was no significant difference between the two fluid groups in termsof age, weight, BMI, P-POSSUM scoring and ASA classification. There was asignificant difference (p<0.0005) in the mean volume of fluid by weight thatwas administered: Hartmann’s (10 mls/kg) vs 6% Volulyte (7.3 mls/kg). Onewould expect this as these fluids function differently in the intravascularcompartment. However the range of fluid that was required for SV optimisationwith both fluid types across the whole cohort was notably variable, see figure1. 50% of patients in the Hartmann’s group and 25% in the 6% Volulyte grouprequired greater than 8 mls/kg of fluid to achieve SV optimisation. A possibleconcern is that those patients receiving larger volumes of fluid of either typemay be in excess of requirements. If this were so a difference in weight gain orrate of post-operative ileus would be expected, but none was identified.

Despite the use of oral carbohydrate loading and enhanced recoveryprotocols there is a still a large range of fluid required to achieve SVoptimisation, with 35% of patients in this study requiring greater than 8 mls/kg.One is unable to predict the exact amount of fluid required on an individualpatient basis and therefore fluid administration can only be adequatelyachieved with a goal-directed approach. Essentially the right amount of fluidat the right time for each individual patient.

Mr A Day, Mr R Smith, Mr W Fawcett, Mr M Scott, Professor T RockallThe Royal Surrey County Hospital

References:1. Bundgaard-Nielsen M, Secher NH, Kehlet H. 'Liberal' vs. 'Restrictive'

perioperative fluid therapy--a critical assessment of the evidence. ActaAnaesthesiol Scand 2009, Aug;53(7):843-51.

2. Abbas SM, Hill AG. Systematic review of the literature for the use ofoesophageal doppler monitor for fluid replacement in major abdominalsurgery. Anaesthesia 2008, Jan;63(1):44-51.

3. Challand C, Struthers R, Sneyd JR, Erasmus PD, Mellor N, Hosie KB, MintoG. Randomized controlled trial of intraoperative goal-directed fluid therapyin aerobically fit and unfit patients having major colorectal surgery. Br JAnaesth 2011, Aug 26.

4. Brandstrup B, Svendsen PE, Rasmussen M, Belhage B, Rodt SÅ, Hansen B,et al. Which goal for fluid therapy during colorectal surgery is followedby the best outcome: Near-maximal stroke volume or zero fluid balance?Br J Anaesth 2012, Aug;109(2):191-9.

Caption CompetitionEntries have to be sent to Jenny Treglohanjtreglohan@alsgbi.orgby 1 July 2013 and the winner will receive a bottle of champagne.

Figure 1: The range of fluid required to achieve SV optimisation withHartmann’s solution or 6% Volulyte.

13

BOMSS Annual Scientific Meeting23-25 January 2013, Glasgow

January 2013 heralded not only a New Year butthe 4th BOMSS Annual Scientific Meeting inGlasgow. The meeting was held at the RadissonBlu hotel, a stone’s throw from Glasgow CentralStation, and was BOMSS’s first venture north ofthe border. The Lord Provost of Glasgowwelcomed us with a civic drinks reception and atour of the impressive City Chambers.

The format of the meeting was, as before, alate start on the Thursday to allow delegates toarrive from afar, and for training day delegatesto sleep off their first hangover, dinner onThursday evening and a full Friday session,winding up at a civilized 3pm.

The Scientific meeting was preceeded by anexcellent and greatly oversubscribed Training Day,organized by Mr Sean Woodcock. This was jointlyattended by surgical trainees and AHPs, whoshared the same programme. Surgical traineesgained much from the mock MDTs and AHPsappeared delighted to be able to fire staplers anddissect stomachs! Our Industry Partners pulledtogether to provide a fabulous educationalenvironment, which was greatly appreciated.

Mr Alberic Fiennes introduced the mainmeeting as his Presidential swan song and wasrightly applauded for his contribution to theSociety, before handing over the reins to MrRichard Welbourn, the incoming President.

The meeting started with a review of bariatrictraining and education from various perspectives.Dr Mathias “Mal” Fobi gave a historical review oftraining in the USA, reminding us not to reinventthe wheel. Our predecessors have much to offer,having previously faced many of the questionswhich appear new to us now. Mr Alan Osborne

presented the trainees’ view. His enthusiasm waspalpable as he invited us to meet the challengeof training our fellows adequately. ProfessorGeorge Hanna showed us how the LapCoprogramme has been used by our colorectalcolleagues to disseminate safe laparoscopiccolorectal surgery. The scientific analysis of thismodel for training was thought provoking, andshould certainly be considered for assessingbariatric training.

The afternoon session on metabolic medicinebegan with an update from Professor Mike Lean’sinternationally acclaimed academic unit atGlasgow University. In addition to his work,which has shaped the accepted definition ofmetabolic syndrome, his UK CounterweightProgramme, has been adopted by the NHS atprimary care level. He challenged us to thinkabout the cost-benefit of bariatric surgicalintervention for individuals compared to theirevidence-based strategies using low-energyliquid diet achieving 10-15% sustained weightloss (enough to achieve diabetes remission) forlarger populations. His humorous “health-enhancing sabotage” approaches to fightingcalorific vending machines reminded us thatsimple strategies can also change establishedbehaviours!

Professor Roy Taylor presented some of hisresearch from Newcastle University, updating thedelegates on current evidence for the beneficialmetabolic changes of gastric bypass, which hehas simulated by fasting and significant calorierestriction. Through specialised MR techniquesthey have shown quantifiable reduction in liverand pancreatic fat in diabetic volunteers provingthat the reversal of type 2 diabetes is notnecessarily due to foregut exclusion and can beachieved by dietary restriction of energy intakewith weight loss.

Finally, in his comprehensive review ofmetabolic surgery, Dr Torsten Olbers presentedthe most recent analysis of the Swedish ObesitySubjects Study; a landmark controlled study inthe field. This data showed bariatric surgeryconferred significant reduction in cardiovascularevents and deaths. He reminded us that the studywas analysis was performed on an intention totreat basis and, as such, the significance of the

findings were impressive when one considerssome controls had since availed themselves ofbariatric surgery since enrolment.

The early evening talk was provided byProfessor David Haslam, Chairman of theNational Obesity Forum, and a GP “by trade”. Hegave a thought provoking and entertaining talk,and highlighted the role of primary care inengaging and identifying patients who wouldmost benefit from weight loss interventions.

Friday’s timetable was based around the 2 freepaper sessions, and series of breakout sessions toexplore a number of relevant topics. The 5 topicschosen for debate were “How to make the

National Bariatric Surgery Register (NBSR)compulsory”, “NHS tariffs and can the NHS affordrevisional bariatric surgery”, “Follow up, by whom,how and for how long”, “Most effective use ofAHP skills within the MDT” and “What don’t weunderstand about eating behavior”. All sessionswere mediated and debated and were hence trulyinteractive.

Dr Mal Fobi gave a sponsored lunchtimeseminar on the history and development of hiseponymous banded gastric bypass, whichcontinues to provide impressive results. Theafternoon wound up after lunch with thepresentation of prizes. The winners were: MrWilliam Carr (best poster presentation, Mr JamesBrown (best oral presentation), Mr James Young(the training day prize) and Mr Nicholas Carter(best training day AV presentation).

The meeting was the best subscribed to date,with significantly increased representation fromour Allied Health Professionals. The BOMSSAnnual Scientific Meeting certainly continues torepresent the multi-disciplinary workingenvironment in which bariatric and metabolicsurgery is performed. If the success of Glasgowcan be repeated we can look forward to anexciting BOMSS 2014 meeting in LeamingtonSpa.

Mr Simon DexterHonorary Treasurer BOMSS

Mr Mike PellenYear 6 SpR Leeds

14

EAES MembershipIf you are interested in becoming an EAES member, please complete and return

this reply card or visit our website: www.eaes.eu and click on the ‘Membership tab’.

For any questions, please mail to membership@eaes.eu.

Reply card to obtain membership application form

Name

Address

City + ZIP Code

Country

Phone Fax

Email

Physician Resident in Training

EAES Offi ce

P.O. Box 335

5500 AH, Veldhoven

The Netherlands

Phone: +31(0)40 252 5288

Fax: +31(0) 40 252 3102

Email: congress@eaes.eu

Internet: www.eaes.eu

21st InternationalCongress of the EAESVienna, Austria19 - 22 June 2013

HOFBURGVienna Convention Centre

Congress President:

Prof. Selman Uranues

Program Committee Chair:

Prof. Nicola di Lorenzo

HIGHLIGHTS- Postgraduate courses

- Hands-on training

- New technologies

- “How I do it” video session

- Challenges in colorectal surgery

- Laparoscopic surgery of solid organs

- Diverticular disease

- Management of complications

- Pro and contra discussions

- Role of laparoscopy in advanced rectal cancer

- Robotic surgery

- Single vs. reduced port surgery

- Laparoscopy in emergencies

- Free paper sessions: oral, video and poster

- Special awards and grants

- Technical exhibition

To register for the congress,please go to our website at www.eaes.eu and click on the ‘EAES Meetings tab’.

From there you will be guided to the online registration or the registration form

that can be downloaded. For any questions, please mail to registration@eaes.eu.

Visit the ALSGBI

Booth 31

15

21st International Congress of the EAES at the Hofburg convention centreVienna, Austria, 19 - 22 June 2013Congress theme: Do better, be better.

PG and hands on courses 19th of June 2013

Technology Symposium I

Morning ProgramArticulating, bending and fl exible tools:

the new generation of OR instruments

Course Directors: G. Dapri (Belgium), Y. Mintz (Israel)

Technology Symposium II

Aft ernoon ProgramAmazing Technologies

Course Directors: N. Di Lorenzo (Italy), A. Szold (Israel)

Postgraduate Course I

Groin and ventral hernia / AMIC

Course directors: R. Bittner (Germany), R.Fortelny (Austria)

Postgraduate Course II

Colon and rectal surgery

Course directors: M. Morino (Italy), R. Bergamaschi (Norway)

Postgraduate Course III

Diagnosis, surgical approach and outcomes

of motility disorders of the oesophagus

Course directors: G. Zaninotto (Italy), E. Targarona (Spain)

Hands-on I

MorningLaparoscopic course BASIC

(suturing, knotting, coagulation & hemostasis)

Course directors: A. Fingerhut (France), R. Schrittwieser (Austria)

Maximum attendees: 16. Only available to registered Congress Participants

Hands-on II

Aft ernoonLaparoscopic course ADVANCED

(anastomosis techniques, use of stapler, advanced hemostasis)

Course directors: A. Shamiyeh (Austria), W. Brunner (Switzerland)

Maximum attendees: 16. Only available to registered Congress Participants

Program overview 20th, 21st and 22nd June 2013

Consensus conference

Th e management of Gastro-Esophageal Refl ux Disease (GERD)

Coordinator: K-H. Fuchs (Germany)

Lectures

Jacques Périssat lecture Title: ‘Th eodor Billroth - the surgeon in his time’

Speaker: W. Wayand (Austria)

Sir Alfred Cuschieri Technology lectureTitle: Mobile technologies and opportunities for surgeons

Speaker: E. Chan (USA)

Key note lecture: Title: MIS in esophageal cancer

Speaker: M. Cuesta (Th e Netherlands)

Meet the Professor - Luncheon session

Meet the Professor session is designed to provide the opportunity to attendees

to interact with experts in an informal setting

Award sessions

Scientifi c Sessions

Tips and tricks in hernia surgery (AMIC)

Bariatric and Metabolic Emergencies for the non-Bariatric Surgeons (AMIC)

Introduction of Minimally Invasive Surgery into UK Cancer Services (ALS)

Minimally invasive surgery worldwide:

EAES Offi ce

Th e Netherlands

Email: congress@eaes.eu

Internet: www.eaes.eu

For more information, please refer to: www.eaes.eu

16

Every year sees the birth of newtechnologies and innovationswithin the medical marketplace.This year is no exception, withOlympus launching its SONICBEATdevice in the UK. Part of Olympus’enhanced range of energyproducts, the SONICBEAT is thesister product to the acclaimedTHUNDERBEAT that has taken themedical device market by storm.

Launched at the beginning of2012, THUNDERBEAT is the world’sonly integrated surgical devicewhich combines advanced bipolarand ultrasonic energies in a singleinstrument. Such a combination ofenergy forms allows a fastest-in-class cutting speed together withhigh levels of haemostasis,including the ability to seal vesselsof up to 7mm diameter.Consequently, THUNDERBEAT maycontribute to operatingdepartment efficiency throughreduced instrument usage, fewerinstrument exchanges,uninterrupted operation flow, andtotal theatre time savings.

The latest SONICBEAT harnessesultrasonic energy alone but itsdesign is based upon the sameprinciples as THUNDERBEAT. Inparticular, a ‘wiper jaw’ mechanismand fine tip design allow fastercutting, easier dissection, morehomogenous grasping force, plusequivalent sealing and homeostasiswhen compared to existingultrasonic energy devices. Thedesign also minimises mist,allowing a clearer laparoscopicview which may further improveoperating theatre efficiency.

In addition to the obviousclinical benefits of the SONICBEAT,cost-efficiency is another centralattribute and one likely to strike achord within both the public andprivate health sector, wherespending is under the microscope.Pressure on the NHS to cutexpenditure and the need forprivate practices to drive profitsputs a particular emphasis on cost-conscious purchasing. So whileTHUNDERBEAT and its obviousefficiency is undoubtedly thedevice of choice for advancedlaparoscopic surgeries, theeconomical SONICBEAT isparticularly well suited forintermediate procedures. Used incombination, the platform providesaccess to new technologieswithout necessarily increasingoverall spend on energy devices.

Both THUNDERBEAT andSONICBEAT are driven by the latestOlympus Surgical TissueManagement System generatorplatform, a device with an intuitivetouch screen interface which isalso equipped to provideconventional diathermy energy.Further efficiencies can thereforebe realised through generatorstandardisation across anoperating department.

Simona Esposito, Head ofSurgical Energy at Olympus said:“Olympus is committed to bringingcutting edge technology to themarket. The launch of our newSONICBEAT device is furtherevidence of our dedication toproviding the very best surgicaldevices, while presenting cost-

effective solutions.”To find out more about

Olympus’ enhanced range of

energy products, including the newSONICBEAT device, please visit:www.olympus.co.uk/medical

Product innovation marches to a different beatOlympus launches The Sonicbeat - A new laparoscopic device

INDUSTRY NEWS

17

Cook Common Bile Duct Exploration

Although Cook Medical is known for theBiodesign biologic graft, the company’s roots liein catheter technology. In 1963, Bill Cookattended the RSNA meeting in Chicago with someradiopaque tubing and a blowtorch. Through hiscollaboration with some of the pioneers ofangiography and interventional radiology, theworld’s largest privately-owned medical devicecompany was formed. Cook Medical will celebrateits 50th anniversary this summer.

There are now more than 15,000 products, 10business units, and over 10,000 employeesworldwide.

The same catheter technology, developedaround the Seldinger over-the-wire technique,led Cook into many other areas of medicine andsurgery, including Aortic Intervention, Endoscopyand Urology.

Cholangiography and Common Bile DuctExploration are often neglected in thedevelopment of specialist equipment, butcooperation with surgeons such as Olsen, Berci,Nathanson and Fanelli has produced somededicated devices, where otherwise productsintended for Urology have been used.

There is evidence that a laparoscopicapproach to common bile duct stones reducespost operative pancreatitis and hospital stay. Italso avoids the delay and morbidity of post-operative ERCP, and preserves the Sphincter ofOddi.

The approach is often defined by theavailability of choledochoscopes. In their absence,

stones in the common bile duct may be accessedwith a basket under fluoroscopic control,although it is necessary to have the ability toflush with contrast medium at the same time.Nathanson’s Transcystic Common Bile DuctExploration Pack is an option, including a 5.5 Frradiopaque catheter and a stainless steel flat wirebasket.

A transcystic approach is possible with a 3mmcholedochoscope, whilst a 5mm scope requires acholedochotomy. A basket and a drain may be allthe accessories required for the CBD route. Foraccess through the cystic duct, you may need anintroduction sheath, hydrophilic guide wire,dilatation balloon and tipless basket. If youcannot achieve total stone clearance and thepatient is to be send for endoscopic extraction,it might be useful to maintain post-operativedrainage with a temporary stent.

To learn more, please visitwww.cookmedical.com and search for commonbile duct exploration.

INDUSTRY NEWS

18

Lawmed is delighted to begin their sponsorshipof the ALS by formally announcing an exclusivepartnership with the leading, US based, surgicaltechnology company, SurgiQuest®. Surgiquest’sproprietary technology, Airseal®, is the world’sonly intelligent and integrated insufflation andaccess system.

SurgiQuest set out to develop a radicallydifferent laparoscopic trocar design thateliminated the circular seals and duckbill valvesthat had plagued conventional trocars sincethe early 1990’s. They immediately recognizedthat the technology had the capability totransform laparoscopic surgery not only byeliminating the problems associated withconventional trocars such as scope fogging,fragmented specimen removal, and sealdisintegration but by enabling the use ofmultiple instruments down a single port.

The development process quickly identifiedadditional benefits that went well beyondeliminating these problems. They found thatconventional insufflators lacked the capabilitiesto operate the new valve-free trocars, so thecompany developed their own insufflator thatwas able to create and maintain an invisible airbarrier within the trocar cannula’s housing. Thenew unit utilised a revolutionary, re-circulatoryflow design that created a surgicalpneumoperitoneum that was far more stable thananything surgeons had previously experienced.They also discovered that it automaticallyevacuated surgical smoke and plume from thefield of vision. The combination of this valve-free

trocar and re-circulatory insufflation unit becamethe foundation of AirSeal®, the world’s first andonly integrated access system for laparoscopicand robotic surgery.

The arrival of Airseal means that surgeons cannow operate without fear of losingpneumoperitoneum even in the most challengingsituations, including colpotomy in totallaparoscopic or robotic hysterectomy or the

continuous use of suction to remove blood orirrigation fluid. In addition to these operativebenefits, anesthesia teams reported that patientsseemed more stable and are easier to ventilateduring procedures where the AirSeal system isused. Based on these early reports, the companyis now studying key anesthesia metrics includingPeak Pressures and End Tidal CO2 to assess thetechnology’s impact on pulmonary compliance.

An initial prospective comparison betweenthe AirSeal System and a conventionallaparoscopic trocar/insufflation system identifiedthat the use of AirSeal reduced both overallprocedure time by approximately 15% andcarbon dioxide (CO2) absorption by the patient(urology 2011;77:1126-1132), believed to be asignificant contributor to post-operativeshoulder pain. The company is now researchingthese and other metrics in prospective,randomized studies in a number of surgicalprocedures.

As a company, SurgiQuest is focused on howits technology can improve not only how surgicaloperations are performed but by how patientsrespond to surgery itself, both during and afterthe procedure.

For further information about the Airsealsystem please visit www.surgiquest.com orcontact John Black john@lawmed.co.uk

Mr John BlackLawmed

Stable Pneumoperitoneum, Automatic Smoke Evacuation Valveless Access

INDUSTRY NEWS

Membership Application FormI wish to apply for membership of the Association of Laparoscopic Surgeons of Great Britain & Ireland (ALSGBI) & the Association of Laparoscopic Theatre Staff (ALTS). Please complete in BLOCK CAPITALS

Name (please print)

Proposed by (Name of Consultant)

Consultant’s telephone number

My preferred mailing address

Postcode

Hospital

Specialty Grade

Telephone (home) Telephone (work)

Mobile Date of Birth

Email address

Full Member with EAES membership and journal £215

Full Member without EAES membership or journal £145

Overseas Member with EAES membership and journal £190

Overseas Member without EAES membership or journal £115

Trainee Member with EAES membership and journal £125

Trainee Member without EAES membership or journal £88

Senior Member with EAES membership and journal £73

Senior Member without EAES membership or journal £33

Auxiliary Member (ALTS) £33

MEMBERSHIP FEES • PLEASE TICK PREFERRED BOX

Signature Date

Cheques should be made payable to ‘The Association of Surgeons & Sub Specialties’. Please note that the ALSGBI can obtain a proposer’s signature on your behalf. This form, when completed, should be returned to:

The Honorary Secretary of the Association of Laparoscopic Surgeons of Great Britain & Ireland @ The Royal College of Surgeons of England, Room 505, 5th Floor, 35–43 Lincoln’s Inn Fields, London WC2A 3PE Enquiries +44(0)20 7869 6941

Alternatively visit www.alsgbi.org and join online which is quick and easy!

The ALSGBI is a registered charity (1058455)

A Small But Fine

Difference!

The new Minilaparoscopic Instruments fromKARL STORZ

KARL STORZ GmbH & Co. KG, Mittelstraße 8, D-78532 Tuttlingen/Germany,Phone: +49 (0)7461 708-0, Fax: +49 (0)7461 708-105, E-Mail: info@karlstorz.de

KARL STORZ Endoscopy (UK) Limited, 392 Edinburgh Avenue, Slough, Berkshire SL1 4UF,Phone: +44 (0)1753 503500, Fax: +44 (0)1753 578124, E-Mail: customerservice@karlstorz-uk.com

www.karlstorz.com

20