Ellis Dowes: Hello to everybody looking at the ISGE website, I am Dr. Ellis Downes from London. I am a gynecologist in London and I am speaking to you from a wonderful City of Osaka, Japan where we are holding our annual convention. It is a great pleasure to be talking with Dr. Shawki from Egypt. He has taken a few minutes from his busy schedule today to update us on some of the growing advances in operative laparoscopy.
Dr. Shawki what sort of instruments are new that we should be aware of?
Osama Shawki: Well, thank you Ellis for the nice introduction. First, I welcome all the ISGE members all over the world who are interested in endoscopic surgery or what you call the endo world. Well basically, we demonstrate that endoscopic surgery is a recent specialty. It exists since a couple of decades now, but in fact the instruments and technology invested in this new kind of surgery is still growing up and catching up. It is not like a standard surgery since the 1800s. Forceps to forceps, scissor to scissor, nothing new can be added now, but in endoscopic surgery more indications, more techniques necessitate new designs of instruments that can fulfill certain steps of surgery. So that is why allow many minds, innovatives to add more and more. Every month you hear about new instruments that allow new technique in an easier way.
Ellis Dowes: So, what are the sort of new instruments do the operative laparoscopists want to know about?
Osama Shawki: Well, you know that and everybody knows that operative laparoscopy is done from keyhole. You have only two holes followed by more to introduce the instruments, so in any procedure like laparoscopic hysterectomy whatsoever, sometimes you need a forceps and scissor and then you have to exchange instruments every now and then, and exchange of instruments consumes time to open the skin, for carbon dioxide and most importantly we need exchange instruments, you have to take the care of a little bit back, a little bit in, these three adjustments takes time and confuses you from focusing on the field of surgery, so my main concern was to find an instrument that can do many functions without the need to take it in and out. This is how you invent when you feel that you are in need, you think why not to turn this a little bit or to make this work, that is what happened to me. So during a step, for example you want to cut into tissue adhesions, so you want to cauterize, control the blood supply of this area, cauterization and then you remove the cautery portions and you go with the decision to cut and so on, so exchanging instruments was a little bit cumbersome to me, so what I did, I combined both jaws in one instrument. This part is a forceps, you can catch, you can dissect, and you can coordinate, okay, and this part of the blade is a very sharp titanium scissor. So, you coordinate and then you proceed to cut. While you are cutting, if you want to continue the next step you can catch. So you are doing two steps in one.
Ellis Dowes: Well, that sounds pretty exciting, a multi-functional instrument.
Osama Shawki: Cutting and coagulation process.
Ellis Dowes: Can you use it on laparoscopic hysterectomy?
Osama Shawki: I have a beautiful convincing video to show. I mean if you have a new product and you have to convince customers, you have to show them in reality not just diagrams, so I have many videos to show for LAVH, for cholecystectomy; my colleagues use it in the cholecystectomy cystic duct, cystic artery okay. In adhesiolysis, in ectopic pregnancy because the instruments give you the versatility you can use the tip like a laser blade, you can dissect, and you can catch, coagulate and cut. Okay, so all this allows you to focus on one step during the surgical procedures and if you have two of these in two ports, actually you have four blades, two forceps and two scissors.
Ellis Dowes: Well, I mean I think that sounds very exciting, but I am sure there might be some people watching our interview who personally feel quite unhappy about electrosurgical desication for larger blood vessels.
Osama Shawki: Yes.
Ellis Dowes: In your new instrument have you had any difficulties in this regard?
Osama Shawki: Well, I thank you very much for this question because you gave me the chance to answer it. We tested the coagulation of these instruments on the renal vessels on animals, where there are big renal vessels, okay, and then once coagulated then we tried to push water under pressure to see to extent it will withstand the pressure. We went double, triple, up to 700 mm Hg and then the vessel ceiling burst, so you can confidently press it up to 7 times the blood pressure that the power ceiling of this instrument is okay. I have to confess that there is only one disadvantage with this instrument for the moment, the model available on the market now. Can I say the name of it?
Ellis Dowes: Yeah
Osama Shawki: It is in Karl Storz, you open the catalogue you can find Shawki cutting forceps. It is a monopolar and I know that my fellow colleagues in the United States, they hate monopolar, I do not know why. Okay, so it is now that we know it is a monopolar, but we are developing a modified one with scrub heads with a bipolar that people will be happy very happy to use it safely.
Ellis Dowes: I mean, there is a big controversy about monopolar and bipolar. Some people say the monopolar is dangerous, I personally say monopolar is not dangerou, its the people who use it.
Osama Shawki: Perfectly, yes.
Ellis Dowes: If they do not know how to use it properly?
Osama Shawki: Exactly.
Ellis Dowes: I feel very comfortable using monopolar and I am sure lot of people would.
Osama Shawki: Exactly.
Ellis Dowes: Well, it has been great spending a few minute here in Osaka talking about the electrosurgical instrument.
Osama Shawki: Well, Osama.
Ellis Dowes: In Osaka
Osama Shawki: In Osaka with Osama… We better go back to the conference and see whats happening there.
Ellis Dowes: Thank you.
Osama Shawki: Wonderful few minutes. See you later folks.