Seminar on visceral surgery

Hands-on medical technology: Visceral surgery

BDU seminar in Speyer

23-24.04.2016

Having been to a previous excellent medical seminar organised by Julia Berghaus on behalf of the BDÜ Rheinland-Pfalz two years ago (Medical technology – orthopaedic surgery: instruments, implants and their applications) and having unfortunately missed the boat last year (Cardiology at your fingertips), I was determined and fortunate to make it to this year’s event (Hands-on medical technology: Visceral surgery).

Dr Dirk Jentschura, senior consultant for visceral and vascular surgery at the Diakonissen-Stiftungs-Krankenhaus Speyer, welcomed us – 20 translators and interpreters from all over Germany, France, Spain and the UK – to what became a highly interesting, informative and intense two days. Our weekend whistle-stop tour covered a whole range of topics from the anatomy of the abdominal wall and suturing techniques to hernias and hernia treatment and management and from the anatomy and pathology of colorectal diseases and different techniques in surgery all the way to laparoscopic and open intestinal and rectal surgery including gall bladder and appendicitis. Dr Jentschura described visceral surgery as “alles, was weich und schlabberig ist” – everything soft and wobbly.

Dr Jentschura’s colleague, consultant Dr Helena Lochner, went on to explain open procedures versus laparoscopic (minimally invasive/keyhole) procedures which are the preferred method at the hospital in Speyer. To demonstrate and for us to try out a range of wound suturing and stapling techniques we were given a couple of raw chicken legs whose skin had already been cut to simulate a surgical wound. Even the most nimble-fingered among us agreed that it was easier said than done and that any needlework classes at school were of limited use. Still, an immensely enjoyable, satisfying experience!

After a well-deserved coffee break Dr Lochner handed over to her colleague, leading consultant Dr Willibald Renner, “leidender Oberarzt” as he calls himself, a play on words between “leitend” (leading) and “leidend” (suffering) before moving on to explain the different types of hernia, what causes them and how and when to treat them. His talk was supported by shockingly graphic photographs of patients with untreated hernias I would not have believed possible – including one case which went untreated for decades and ultimately reached to the patient’s knees.

Following lunch in the hospital’s canteen which we shared with what felt like half of Speyer’s children dressed up in surgeon’s scrub for a family open day we scrubbed up for our guided tour through the operating theatre where Dr Jentschura showed us the principles of keyhole surgery and letting us put our 3D awareness and steady hands to the test with a practice kit connected to the monitor. Using laparoscopic instruments such as the LigaSure^TM vessel sealing device we were asked to pick up jelly babies scattered about and put them in a pepper. Easier said than done!

Particularly fascinating to me was the innovative laparoscopic microwave ablation of liver tumours, which is essentially a probe inserted into the liver which accurately and relatively sparingly destroys individual tumours. The liver Dr Jentschura demonstrated this new technique on had belonged to a pig.

Later on that afternoon Richard Becker introduced us to the toolbox – various gadgets and gizmos that doctors new to laparoscopic procedures can use to improve and practice their surgery techniques on again by focussing on the monitor and not on their hands. We eventually got the hang of putting colour-coded plastic rings into their respective containers, but we were a long way off being accomplished keyhole surgeons! Still, it was fun experimenting and getting an idea of how it is done.

Sunday morning started with Dr Jentschura introducing us to colorectal diseases, anatomy, pathology and the principles of surgical procedures – of particular interest to me due to my own family history and having had two colonoscopies in the past. Seeing how physically close the liver is to the large intestines made me realise how easily colorectal tumours can infiltrate into neighbouring organs such as the liver and how vital it is for patients with a family history to have a colonoscopy to detect and resect any potentially cancerous polyps at an early stage.

Consultant Mathis Fußer took us through the open and laparoscopic intestinal and rectal surgical resection procedures and his colleague Dr Wilfried Müller through gall bladder diseases and appendicitis and their respective therapies. Both doctors explained the rapid development of laparoscopic procedures from their first introduction in the 70s for diagnostic purposes only to being the preferred method and in certain cases such as gall bladder removal the standard procedure in most hospitals and certainly in Speyer. The advantages speak for themselves: quicker organ recovery, shorter hospital stays, reduced post-operative pain, superior cosmetic results and a quicker return to normal activities.

This seminar did, judging from my previous experience, exceed my expectations in every respect. It was beautifully organised and presented and covered as much as would be possible over two days. Dr Müller congratulated us at the end for being such an inquisitive audience, giving me the impression that the entire visceral surgery department enjoyed the experience too. Nothing beats seeing the real thing and learning from the experts.