KPH Aiming for More Minimally Invasive Surgeries

The Kingston Public Hospital (KPH) is moving towards reducing overcrowding and having less inpatient days by improving access to minimally invasive surgery (MIS).

Senior Medical Officer (SMO) at the facility, Dr. Natalie Whylie, explains that the country will benefit more when persons are able to recuperate faster as a result of MIS.

“Surgical centres are moving away from inpatient services to ambulatory (out-patient) type care, so after having the procedure done, once a patient is assessed as being safe to go home, they leave and are usually up and about within a short period of time,” she says.

According to Dr. Whylie, the benefits of MIS add up, because within two to three days of surgery, patients are almost completely self-caring and back to doing all the basic things that they would normally do for themselves.

This, she notes, is in stark contrast to a patient who, when discharged from the hospital, after five to seven days following open surgery is still not fully functional, based on limitations from pain and fragility, and can be out of commission for up to six weeks. The SMO adds that one of the mandates of the Ministry of Health is for the hospital to move towards more ambulatory patient care.

MIS, or laparoscopic surgery, is a technique where procedures are done through small openings rather than the large cuts of open surgery.

Patients generally experience much less pain following the procedure. General and Advanced Laparoscopic Surgeon and Acting Chief of Surgery at KPH, Dr. Lindbergh Simpson, explains that surgeons are now focused on how they can decrease the initial insult or injury that is caused to the patient.

“Traditionally, we would first have to cut through the skin and muscle to get down inside to attend to a patient who has an inflamed appendix, which is going to burst and needs to come out,” he explains.

Based on the new technology and advancement in the discipline, the same outcome can be achieved with a small incision. He adds that for (MIS), surgeons try to decrease that original insult to the body because the evidence shows that it is better for patients.

He points out that some open surgical incisions never fully heal. “When we cause less damage at the beginning, patients do better, they feel less pain, they spend less time in hospital, they are more quickly able to return to their lives and return to their work, which is better for the nation,” he says.

Dr. Simpson explains that for minimally invasive surgery, small holes are made to put small instruments inside the body.

These include a light and a camera.

“The camera or scope may be a straight lens, or angled lens, which allows you to see over wider distances. You also have the camera, which connects to the lens so you don’t have to put your eye to the lens. When you attach the camera and connect it to the camera control unit, it produces the picture and then we output that picture to a screen. That is what we call the imaging chain. We use that to see what’s happening inside,” he says.

Meanwhile, Dr. Whylie points out that at KPH, there is a long waiting list for surgical procedures, and although some of the MIS procedures take longer, the benefit to the patient is greater.

“So, one of our strategies going forward is looking at how we can improve waiting time and recovery time and how we can provide more surgical procedures with what is now established as the standard of care for certain surgical disciplines,” she notes.

Dr. Whylie points out that the hospital is also looking at the efficiency of its operating theatres, as part of a strategic move to attend to patients more quickly. The SMO notes that the KPH does much more than general surgery, catering to other areas such as Ear, Nose and Throat (ENT); urology; neurosurgery; plastic surgery and orthopaedics.

According to her, all of these areas can utilise minimally invasive surgical techniques and each set of surgeons can take their equipment in and plug into the endoscopic tower once there is a standard set-up in the theatre.

“The equipment is largely compatible, and once you have that tower there, then it means that any surgical service that utilises minimally invasive surgical techniques can use the facility that is there. We have begun with the general surgery and ENT Departments,” she tells JIS News.

There are two laparoscopy towers, and the institution is hoping to acquire two additional towers for the other theatres, as the intention is to have each of the four main theatres equipped with the instruments and equipment that are needed to perform MIS.

“The laparoscopic equipment usually has the capacity to record, so you can review as a surgeon. Part of teaching and training is to review the techniques, so we are constantly auditing what we are doing as we try to improve the surgical-care delivery here at KPH,” she says.

The SMO points out that the KPH is also a major centre of training for undergraduate, postgraduate, nursing, pharmacy, physiotherapy, dietary, and radiography students and that recent acquisitions have allowed the facility to do surgery and send the live feed to a classroom where students can view what is being done in real time.

The new equipment recently helped to facilitate a first for the KPH, where a live surgery was viewed by a large group of surgeons and trainees, who were able to watch without compromising patient safety.

“Instead of having 20 people inside the operating room, those who wanted to learn from the procedure were safely away from the patient,” the SMO explains.