Medical Education Programmes
Pelvic Laparoscopy in Leipzig
Developing new skills to improve patient care
by Krishna Patil, Consultant Urologist
Recognising the advantages of minimally invasive surgery in the year 2000, I took personal responsibility for developing this facility in our hospitals in Middlesex and Surrey. I therefore completed the BAUS-recommended dry-lab courses (practising on simulators to acquire laparoscopic skills) and then performed operations on anaesthetized animals to gain proficiency. Laparoscopy is a demanding skill that requires dedication and hard work to learn, and I am delighted that, with time and dedication, it is a skill that I have been able to acquire.
Following structured training and appropriate mentorship, I have now been doing laparoscopic kidney operations since 2003 in Ashford and St Peter’s hospitals, near London, and I have successfully performed more than 150 operations for kidney cancers, obstructed kidneys and ureter stones.
In 2003, with generous support from my NSH Trust, I had 6 months sabbatical leave to take a fellowship at the worldrenowned robotic centre in Detroit, USA. I now have vast experience in robotic surgery, I have mentored urologists in the UK and USA, and I am a member of a leading robotics team in London, where we have performed more than 600 robotic prostatectomies with excellent results.
Earlier this year I identified that, where robotics facilities are not available, the next best option is laparoscopic radical prostatectomy, which provides an equally good patient experience and comparable outcomes. I therefore decided to learn this very demanding procedure for the benefit of my patients. Research led me to a high-volume laparoscopic prostatectomy centre in Leipzig, Germany, where hands-on training is available for overseas doctors. The Urology Foundation readily sponsored me for this training and I am very grateful to The Foundation for its support.
Military efficiency and rapid progression
I spent one freezing cold month in January 2009 learning advanced laparoscopic skills under the supervision of Professor Stolzenberg in the University of Leipzig. Although the training was gruelling, with my experience in kidney laparoscopy and robotic surgery I was able to master the skills of laparoscopic radical prostatectomy in 1 month, whereas many learners take more than 3 months.
The training at the University of Leipzig is a modular programme, run with military efficiency. The modules were graded from simple to difficult and the professor would decide to upgrade to the next module according to the ability of the trainee. We had to report to the dry lab to practise suturing at 7.30am and spent 1 hour learning to suture gloves, mimicking anastomosis.
At 8.30am sharp, the patient would be on the operation table ready to start his operation; from the first day, I was allowed to start an operation. With my extra time in dry lab (I spent an extra hour practising suturing), I was able to progress to the next modules in rapid succession. By the end of 1 month I had managed to perform five complete procedures to the satisfaction of Professor Stolzenberg.
The atmosphere in the operating theatres was very friendly. Laparoscopy is a real example of teamwork. The theatre team was very co-operative which helped me to learn the difficult steps with minimum stress. I am very grateful to my professor and his team for giving me this opportunity. I would highly recommend this centre for learning this technique.
Excellent benefits for patients
After returning to the UK I sought the mentorship of Mr Winkler at Charing Cross Hospital, who had also trained in Leipzig with Professor Stolzenberg. I performed eight cases under his close supervision with very good results.
Since April 2009 to date I have performed 22 prostatectomies with excellent patient outcomes.
The patient benefits are blood loss of less than 500ml, less pain, early discharge from hospital (average stay 2.4 days) and early return to normal activities. Patient satisfaction is tremendous, which is obvious from patient feedback, and the hospital management is happy because hospital beds are used more efficiently.
Although it was hard work I am very satisfied as patient benefits are gratifying. I cannot thank The Urology Foundation enough for its support and encouragement in this venture.
