American surgeons are being urged to adopt a keyhole surgery technique developed and named after a doctor in the Cayman Islands.
Dr. Sarath de Alwis, a consultant/specialist of obstetrics and gynaecology attached to Chrissie Tomlinson Memorial Hospital, has been using the innovative laparoscopic entry technique in Cayman for more than two decades.
Now, doctors at Harvard Medical School are using this method and an article on the technique, called the ‘Modified Alwis Method’, has appeared in the latest edition of the medical journal Reviews in Obstetrics & Gynecology.
The article stated: ‘Although we acknowledge that no entry method is foolproof, we have yet to experience an entry-related injury using this method, with the lead author [Dr. Jon Einarsson] performing 450-500 advanced laparoscopic cases per year.’
It continued: ‘We encourage surgeons to standardise entry techniques as much as possible and to seek guidance from other surgeons if they are encountering frequent complications during laparoscopic entry.’
Dr. de Alwis introduced his surgical method to Dr. Einarsson, director of Minimally Invasive Gynaecologic Surgery at Brigham and Women’s Hospital and assistant professor of Obstetrics, Gynaecology, and Reproductive Biology at Harvard Medical School in Boston, more than two years ago.
Laparoscopic surgery is a non-invasive method of entering the abdomen though a small incision to enable a scope to be inserted to view the internal organs.
The entry of the scope, through the bellybutton, however accounts for 40-50 per cent of complications arising out of the procedure.
‘We developed a technique to minimise that type of injury,’ Dr. de Alwis said. ‘We showed it to Harvard medical professors; they accepted it and have published it in this journal under the ‘Modified de Alwis Method’.
‘I’ve been using this technique for decades. I started this a long time ago because of the fear of bowel injury,’ he explained.
Using the method, Dr. Alwis said he had removed 47 fibroids from the uterus of one patient and 41 fibroids from the uterus of another last month.
He performed his first laparoscopy in Cayman in 1995 and has worked with Chrissie Tomlinson Memorial Hospital since 1996.
His method relies as much on his ears as on his surgical skill because he is guided by the sound of negative pressure being made in the abdomen of the patient to determine exactly where to insert his surgical instruments.
Dr. de Alwis explained the method in layman’s terms, at his office in the Chrissie Tomlinson Hospital surrounded by members of the team he said were instrumental in the success of the procedure.
‘It’s a simple technique. If you stand on your head, the bowels don’t drop because [of] surface tension that holds things together,’ he said, licking his finger and touching a piece of paper which he then lifts off the table, attached to his finger. ‘That’s surface tension,’ he explained.
‘The bowels do the same thing. They hold onto each other because of surface tension… In the abdominal cavity, that surface tension prevents bowels from dropping and changing position. Using that principle, we put a little gas in and test to hear the response to that negative pressure inside the abdomen.
‘With that technique, we are able to say that we are definitely in the abdominal correct place or not, so we don’t have to put trocars in the wrong place,’ he said.
Trocars are metal tubes that are inserted in the abdominal cavity during laparoscopic surgery.
‘It is similar to the mouth. If you suck in the lips, when you let them go you hear a noise. That’s the movement from high pressure to low pressure,’ he said.
Being able to listen to and identify the exact noise made in the abdomen during this surgery has enabled him to carry out about 10,000 of the procedures. The modified version entails surgeon using monitors and machinery to detect the negative pressure, rather than relying merely on the sound.
With the modified version, a warning alarm will sound and a negative pressure warning will appear on a monitor
‘It is important that in a small country like Cayman, we have a procedure that has been accepted in a leading medical school,’ Dr. de Alwis said.