Dr Elvis Japhlet doing first laparoscopic surgery at Sopas District.
This was an historic trip to Sopas District Hospital, being the first laparoscopic workshop conducted in the Highlands of PNG. Colorectal surgeon Dr Carina Chow from Royal Brisbane Women’s Hospital led the team bringing with her laparoscopic equipment donated by Wesley Hospital.
This one week trip was several months in the planning and organised by Sopas District Hospital General Surgeon Dr Elvis Japhleth and DAISI’s PNG program coordinator Mr Mark Taffa.
Dr Carina Chow and Dr Elvis Japhlet with the laparoscopic stack at Sopas District Hospital
It was the second DAISI visit to the PNG Highlands, on the request of the CEO for Enga Health Provincial Authority (EHPA) Mr Aron Luai.
The DAISI team consisted of Dr Carina Chow and her anaesthetist Dr Rajesh Brijball, and Mark Taffa.
Mark had been very active behind the scenes, this being his third trip to PNG. Working in collaboration with the Owen Miller Memmorial Foundation, Mr Taffa had secured sufficient funding to transport two shipping containers of necessary equipment to make laparoscopic surgery possible in the long-term.
It was a one week visit, beginning with a formal meeting with the Governor Hon. Peter Ipatas and CEO for Enga Province Mr Aron Luai, followed by three days of simulator laparoscopic training and anaesthetic education, (while waiting for carbon dioxide insufflation gas cylinders to arrive). The session was well attended, with local surgeons and Anaesthetic Scientific Officers (ASO’s) from nearby Wapendamanda and Enga Provincial Hospital also attending. Anaesthetist Dr Raj Brijball took the five ASO’s through the basics of paralysed anaesthesia.
This three day workshop was followed by three days of laparoscopic surgery.
Dr Elvis Japhlet and Dr Carina Chow practicing laparoscopic surgery with a home made simulator adapted from a cardboard box. Multiple re-useable ports and laparoscopic instruments were donated for the workshop and planned surgery.
Sustainability and environmental accountability were both the focus with the donation of re-usable ports and laparoscopic graspers rather than relying on single use disposables that would end up becoming landfill.
Dr Carina Chow and Mark Taffa putting together the laparoscopic stack at Sopas District Hospital with surgeons Dr Timothy Pyaku and Dr Elvis Japhlet assisting.
General Surgeon Dr Elvis Japhlet using the Applied laparoscopic trainer as scrub nurse Noreen John assists holding the camera.
The “rubber band-peg” test is particularly challenging, and teaches fine motor skills required for the real laparoscopic surgery.
Dr Carina Chow holds one of the many laparoscopes donated for the workshop, as Dr Elvis Japhlet does a practice run of port placement under vision.
General surgeon Dr Timothy Pyaku, Gynaecologist Grace Raira, General Surgeon Dr Elvis Japhlet, and surgical registrar Max Pangali, with Mark Taffa (rear) practice safe trochar insertion.
Registrars practicing with the standard triangulation technique, with laparoscope central, and two grasper ports either side.
Dr Max Pangali doing some laparoscopic training on the Applied simulator using a small 5mm fibreoptic camera.
Dr Carina Chows describes the insertion technique for port placement.
General surgeon from Enga Provincial Hospital Dr Timothy Pyaku holds the camera while the registrar practices using laparoscopic graspers.
This three day simulator workshop run by Dr Carina Chow allowed for practical learning of essential laparoscopic skills with hands on experience.
Dr Carina Chow discussed the principles of endoscopic (minimally invasive) surgery.
Dr Antonia Kombia (Gynaecologist) measuring port site placement.
Dr Max Pangali holding laparoscope while surgeon applies clip applicator.
Surgical registrar Dr Kalit Solomon doing the “rubber band- peg” exercise.
Back Row. From L-R: Dr Max Pangali, Dr Elvis Japhlet, Dr Carina Chow, Dr Raj Brijbal, Ronnie Kaum (ASO), Mark Taffa, Dr Timothy Pyaku, Scrub Nurse Noreen John, and ??
Front Row: ??
Dr Max Pangali holds camera, while general surgeon Dr Elvis Japhlet does simulator training on the “rubber band-peg” exercise where he must remove the rubber bands and re-apply with laparoscopic graspers.
Once sufficient skill set had been obtained by the surgeons, laparoscopic surgery was commenced puting into action those skills already learned.
First laparoscopic case at Sopas District Hospital, abdominoperineal resection for rectal cancer.
Dual monitors allow everyone in the room to see the surgery.
The operations went well without any issues.
The last day involved a Grand Rounds presentation at Wabag, followed by some smaller diagnostic laparoscopies. This is a particularly valuable skill, as the Highlands does not have a CT scanner with only ultrasound and X-ray available to assess abdominal complaints.
Diagnostic laparoscopy for undifferentiated abdominal pain in young woman.
Diagnostic laparoscopy and washout of pus in a woman with 4 days history of fevers and abdominal pain, where ultrasound and X-ray had been unhelpful.
The DAISI tram were given a tour of the local village and waterfall.
Dr Carina Chow, Dr Raj Brijbal & Mark Taffa visiting local village.
In the evening a final farewell dinner by the incredibly generous Sopas District Hospital hosts was provided to the DAISI team.
The visiting DAISI team were bestowed beautiful gifts as token of their appreciation.
Dr Carina Chow wearing the traditional PNG Bilum and holding traditional sand paintings unique to Enga Province given to her by Sopas District Hospital.
DAISI would like to give special thanks the Operating Theatre Nurse Manager Sister Rose Philip and to the Sopas District nursing staff who worked tirelessly making this inaugural laparoscopic surgery workshop possible.
VIDEOS
1 minor (Laparoscopic)
1 major (Laparoscopic)
4 minors (open)
6 Total Cases
