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| Pregnant woman undergoes successful laparoscopic surgery |
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Saturday, October 25, 2008
Shahina Maqbool
Islamabad
The General Surgical Department of the Pakistan Institute of Medical Sciences (PIMS) added another laparoscopic procedure to its repertoire by successfully performing laparoscopic appendectomy on a 23 weeks pregnant woman here the other day.
The procedure was the first of its kind in the history of PIMS. The patient was discharged the day after the operation with no signs of foetal complications. In Pakistan, only one or two surgeons, those too in Karachi, have performed laparoscopic surgery during pregnancy, although it is now an established safe procedure in the developed world.
Laparoscopic appendectomy during pregnancy is a challenging procedure requiring high level of expertise by the surgeon. This is because surgical access is difficult due to enlarged uterus, resulting in tight packing of the intestines in the abdomen and hence, reduced working space for the surgeon.
The advantages of this procedure, when performed by an expert laparoscopic surgeon is diagnostic accuracy, less operative injury (markedly reduced incision length) resulting in less pain, better cosmesis, shortened operative time, decreased wound infection and early recovery as compared to conventional open surgery. Laparoscopic appendectomy during pregnancy, especially in second trimester, is superior to conventional open surgery.
Appendectomy is a common emergency procedure for acute appendicitis, which can easily be done laparoscopically. Appendicitis can affect all ages and its incidence in pregnancy is quoted as 1 in 50,000 to 65,000 pregnancies. Lack of treatment or delayed surgical intervention can lead to complications including high risk of fetal death and even maternal death. The risk of abortion after surgery for appendicitis used to be high but improvement in anesthesia and obstetric care has reduced this risk significantly. Appendectomy, when performed in time during pregnancy, is a safe procedure and saves the life of mother and fetus (child).
From the last one year, many procedures which were previously done by conventional methods are now being done laparoscopically at the general surgery department of PIMS. The faculty of the department consists of eminent specialists who are experienced enough to undertake any complex procedure.
“Surgeons working at PIMS can perform advanced laparoscopic operations at par with the developed countries, provided they are supported by the government as advanced laparoscopic surgical procedures require specialized training and technically advanced equipment,” assistant professor Dr. Aatif Inam pointed out. Dr. Atif’s special field of interest is laparoscopic hernia repair and colorectal surgery. He is also actively involved in laparoscopic training of young surgeons.
Dr. Atif holds weekly interactive tutorials with video presentations in laparoscopic surgery for surgical residents and has developed a dry lab facility for laparoscopic training of postgraduate trainees in his office in Surgical Ward 5 .He is also working on a project to establish an online video library of PIMS. This library will provide universal access to young surgeons and be informative to general public about the operations performed at PIMS.
Dr. Atif’s assertion about the need for enhanced government support for specialized training and equipment was seconded by the executive director of PIMS, Dr. Abdul Majid Rajput. “Such facilities should be available in all peripheral hospitals so that state-of-the-art technology can be used to benefit maximum number of patients in Pakistan,” he suggested.
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ISSN 1563-9479 
