Laparoscopic surgery takes off in Solomon Islands

registrars using applied laparoscopic simulator

by Dr Sepehr Lajevardi

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Image: Surgical Registrar Dr Clay Siosi and other surgical registrars practicing laparoscopic surgery on the Applied® simulator at National Referral Hospital (NRH) Laparoscopic Workshop in Honiara, January 2017.

National Referral Hospital (NRH), the main referral hospital for the Solomon Islands, located in the country’s capital city Honiara, performed its first laparoscopic surgery in January 2017.

Although more than fifty years since laparoscopic surgery first began worldwide, surgeons in the Solomon Islands have made up for lost time, rapidly acquiring these skills thanks to a team of DAISI volunteer surgeons and anaesthetists, with the second DAISI laparoscopic workshop at NRH conducted in April 2017 and led by Sydney hepatobiliary surgeon a/Prof Charbel Sandroussi.

Dr Scott Siota, a general surgeon from NRH, is now doing laparoscopic appendicectomy and diagnostic laparoscopy independently, and hoping to further develop his laparoscopic cholecystectomy skills with the next visiting DAISI workshop scheduled for June/July 2017 and led by Sydney hepatobiliary surgeon Dr Anubhav Mittal.

“We are so excited to be able to offer something to our people that for many years just was not available due to lack of resources” said local Honiara surgeon Dr Scott Siota.

The acquisition of laparoscopic equipment was due to the generosity of Olympus, who donated their second stack in late 2016.  This and other equipment donated by MedEarth, Ramsay and Rotary was shipped over thanks to the support of DAISI.  With only five local surgeons serving the entire population of 580,000 of the Solomon Islands, the surgical caseload is often overwhelming.  This represents an hundred fold difference to Australia which would have 580 surgeons for the same case-load.

Dr Douglas Pikacha doing key hole surgery

Image: Honiara surgeon Dr Douglas Pikacha performs the first laparoscopic cholecystectomy at National Referral Hospital (NRH) in January 2017.

National Referral Hospital (NRH) in the capital city Honiara, is the only tertiary hospital in the country, receiving transfers and admissions from almost one thousand islands across the nine provinces that make up the Solomon Islands.  With no CT scanner in the country, diagnostic laparoscopy, now available at NRH, makes sorting out the “undifferentiated abdomen” much easier, allowing quicker diagnosis and treatment, and discharge from what is already an overly burdened hospital.

Although laparoscopic surgery only became available this year at the country’s main referral hospital, laparoscopic surgery first arrived at Gizo Hospital, in the far Western Province of the Solomon Islands, in April 2013, when Bathurst volunteer surgeon Dr Neil Meulman performed the first successful laparoscopic appendicectomy & cholecystectomy in April 2013.  This was possible due to the donation by Olympus of a laparoscopic stack and equipment organised by Bathurst general surgeons Dr Neil Meulman and Dr Fred Boseto.  Getting all this equipment in working order to such a remote province was quite a challenge.  In fact, during this first laparoscopic visit, the cooling fan broke down, with improvisation required with a small pedestal fan bought from the local shops.

Laparoscopic surgery has a difficult learning curve, and typically in the West involves the use of disposable equipment.  Therefore a systematic approach is required for teaching safe laparoscopic surgical skills, with ongoing teaching sessions scheduled to occur on a regular basis, and organise totally by volunteers.  The introduction of new technology and procedures also needs to be culturally appropriate, and one of the main objectives of DAISI, is to promote sustainability and provide re-usable instruments to avoid a reliance on expensive disposables, that end up becoming ugly land-fill.

Prof Charbel Sandroussi

Image: DAISI volunteer a/Prof Charbel Sandroussi & local surgeon Dr Scott Siota doing laparoscopic cholecystectomy at National Referral Hospital (NRH) in April 2017.

Fortunately, due to the incredible generosity of so many individuals and organisations, DAISI has been able to send three shipping containers in the past 2 years with much needed medical equipment.  This year alone over 83 specialists have volunteered in the Solomon Islands with DAISI, which is an incredible act of generosity as all volunteers pay their own way.

With a huge number of recent medical graduates just returning from medical training in Cuba, the Solomon Islands is at a pivotal point in its history, with the per capita number of trained doctors likely to dramatically improve.  But these doctors still require post graduate specialist training, and up until now this has only been available overseas either in Fiji, Papua New Guinea, or Australia.  Although the Australian Government through the Pacific Islands Project (PIP) has invested a large amount in sending specialist surgeons to teach subspecialty surgery, there is a huge need for equipment and medical training for our humble Commonwealth neighbours who are still doing it very tough, with a per capita income and supply of local surgeons one hundredth that of Australia’s.

Article written by Dr Sepehr Lajevardi (Treasurer of DAISI).