Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 4th International Conference and Exhibition on Surgery Crowne Plaza, Dubai, UAE.

Day 2 :

Keynote Forum

P Thamilselvam

Perdana University, Malaysia

Keynote: Quality of life after colostomy

Time : 10.00-10.25

OMICS International Surgery-2015 International Conference Keynote Speaker P Thamilselvam photo
Biography:

P. Thamilselvam M.s., Working as associate professor, Perdana university –royal college of surgeons in Ireland), Malaysia. He completed his UG and PG in India.rnHe is having 30 yrs of surgical experience in general and laparoscopic surgery. He also worked in Chennai Apollo Hospitals , Maldives and various universitiesrnin Malaysia .he participated in international education forum 2015 in, Malaysia he also invited as speaker to deliver medical topics in various hospitals andrnuniversities - Malaysia and chairperson for CMEs. He is visiting lecturer for surgery in johns Hopkins university school of medicine- Perdana University , Malaysia.

Abstract:

Purpose: To assess and improve the quality of life in colostomy patients who underwent colostomy due to various causes.rnMaterials & Methods: 112 patients with colostomy were identifi ed and subjected for this study for past 4 years in the HospitalrnSultanah Nora Ismail, Batu Pahat, Johor. Some patients were identifi ed from ward, some from surgical clinic and few patientsrnwere identifi ed through hospital record. Th e questionnaires were prepared by us and the study was conducted. Th e patients,rnwho were identifi ed from the record, were interviewed through telephone.rnResults: Following this study, we identifi ed that most of the patients were depressed and stressed. Th ey were also found tornbe isolated in the family and facing multiple problems. Some patients avoided certain type of food since the smell from therncolostomy bag created most of social problems. Th is study also identifi ed some family members and some people in therncommunity who were also later counseled regarding the responsibility of giving care to the colostomy patients.rnConclusion: Th is study fi nally identifi ed some good solutions which will help others and new colostomy patients to improverntheir quality of life and minimize their mental stress and social problems.

Keynote Forum

Shyam Parashar

Dammam University, KSA

Keynote: Flash Back; Surgery, then and now

Time : 09:20-09:40

OMICS International Surgery-2015 International Conference Keynote Speaker Shyam Parashar photo
Biography:

Shyam Parashar completed his Masters in Surgery from Vikram University, India in 1962. He has fi fty years of extensive experience as an active general surgeonrnand medical teacher. He is a recipient of awards in Goa as Best Clinical Teacher, 1973 and Doctor of the Year, 1975. In 1981, he joined King Faisal University inrnSaudi Arabia as professor of surgery and as Consultant Surgeon at King Fahd teaching hospital of the University. He has also held the addition appointments asrnDirector, Internship training program and later as Director, post-graduate training program in surgery. After thirty three years, retired and recognized as EmeritusrnProfessor. He played active role in establishing new colleges for Medicine, Nursing, and Pharmacy in the kingdom; and in developing undergraduate medicalrncurriculum and postgraduate training programs; and constantly reviewing them. He has seventy scientifi c publications in Indian, Saudi and International Journals.rnHe is an international editor for Journal of Medicine and Medical Sciences, and for Journal of Family and Community Medicine, of University of Dammam, SaudirnArabia. He is the recipient of many Awards like Hind Rattan Award, Bharat Gaurav Award, Medical Excellence Award and Life Time Achievement Award, Glory ofrnIndia Gold Medal and Global Indian Achievers Award at Indo-British Friendship banquet in London. Has published two books on surgery by Scientifi c PublishingrnGroup and are available on their website as E-Books, Surgery: the way I teach and Atlas of Surgery. He has also published three books on Philosophy; Twists andrnTurns of Destiny, Scattered Gems and Bikhre Moti.

Abstract:

History of medicine dates back to origin of Humans, either by Creation or Evolution, whichever one believes in. Basically rnthe primary medical needs of humans were related to just three; Relief from pain, healing of wounds and fixing of rninfirmities. Delivery and Child birth were considered as ‘Natural’, and not as medical need.rnModalities to support healing of wounds may be considered as the beginning of ‘Surgery’. Th ese modalities included mostrnprimitive remedies drawn from nature, to time tested treatments prescribed by grandmas, to scientifi cally developed adjunctsrnand now to most recent advances like stem cell research and skin banks. Job of a surgeon is to ‘Surge-on’; and to manage allrntypes of wounds, of all tissues, in all locations on the body, infl icted by external or internal and natural or iatrogenic agents.rnAn ‘Operation’ is the most essential arena of surgical practice. Operation theatre is the only theatre where there are no prior rnrehearsals; and every case is an individual test of competence of surgeon.rnI started my surgery training in 1959. More than half a century has passed since then. I have seen changes in surgical practicernin developing countries like India and Gulf countries as well as in UK and USA. What I saw and performed, as a ‘General surgeon’rnin the interiors of India can only be termed as ‘Handicap surgery’ by today’s standards. Moreover a general surgeon has to managerns urgical problems from head to foot, since even the concept of ‘Specialists’ was beyond reach. In addition, surgical problems inrntropical climates were quite diff erent and were not usually part of any surgical training program.rnFor today’s generation, it may not even be comprehensible to imagine performing surgery without disposables, clips andrnstaples, endoscopes, haemostatic glues, hot, cold and ultrasonic knives and of course, lasers. Preoperative preparations andrnpostoperative managements were primitive, to say the least. ATLS was unheard of and Critical care had no standard protocol;rnit was left to individual judgment. In spite of all this, there is always a humorous side to surgical practice, and ‘Surgeon’s jokes’rnare well known. I may touch on some. It will be my pleasure to speak about Handicap surgery in a philosophical way as a flashback of my surgical experience.

  • Cardiovascular and Thoracic Surgery
Location: Dubai
Speaker
Biography:

Simone Battibugli is an Assistant professor in the Department of cardiothoracic surgery Hospital Santa Marcelina, Brazil. His research interests include General surgery, Cardiovascular surgery, Thoracic surgery.

Abstract:

Introduction: Anterior tibial tendon transfer is a common procedure used to treat a residual forefoot dynamic supination in children with idiopathic clubfoot. Several anterior tibial tendon transfer techniques have been described however; currently there is no general agreement as to the best method of transferred tendon fixation. Th is prospective study of consecutive cases was proposed to assess and compare the results of two techniques pullout or anchor suture fi xation. Methods: Between 2001 and 2009, 78 relapsed clubfoot deformities were initially treated by one of the authors (AFL) with repeating serial casting (Ponseti's method). From those, 25 patients (34 feet) with exclusive residual dynamic forefoot supination were selected and underwent to anterior tibial tendon transfer. Patients were allocated consecutively in two groups discriminating the method of transferred tendon fi xation, as follows: Group I (anchor) which enrolled 13 patients (18 feet) average age 5.1 years (4.2–5.6 years) and Group II (pull-out) which enrolled 12 patients (16 feet) average age 5.54 years (4.3–7.2 years). Surgical procedure was performed similarly to all patients (n=25) by the same author (ALF) using the modifi ed Ponseti and Smoley technique with two dorsal foot incisions; over the anterior tibialis tendon and the other over the third cuneiform. Th e tendon was passed subcutaneously and secured in the third cuneiform. Th e pull-out fi xation involved passing the tendon through a drill hole to the bone with attachment of the tendon fi xation suture on the plantar aspect of the foot which was tensioned while the foot was dorsi-fl exed. Th e anchor fixation technique utilized a metallic suture anchor that was fi xed to the dorsal aspect of third cuneiform in the usual described fashion. Average follow-up Group I was 2.98 years (2–5.2). Group II was 2.37 years (1.2–4.2). Results: Average surgery duration was similar between the two groups; Group I average 32 minutes (24–42). Group II 28 minutes (23–37). Th e clinical results was based on the restoration of muscle balance and correction of dynamic forefoot supination as follows; Group I, there were 15 good (83.4%), 03 regular (16.6%) and no poor results. In group II, there were 14 good (87.5%), 02 regular (12.5%) and no poor results. Th e groups had statistically similar results (p=0.732). No patient in either group had subsequent relapse, failed fixation of the tendon transferred or required additional operative intervention associated with clubfoot deformity during the follow-up period. No major complications were found in both groups. Group I, one patient developed fi brous adhesion dorsal skin, which haven’t required any subsequent intervention. Group II, one patient developed a plantar pressure sore, which improved and healed aft er removing the plantar plastic button. Average procedure cost; anchor fixation U$ 1,400 and pull-out U$ 600. Conclusions: Our study results show that the amount of correction obtained and complications rate were similar between the two methods of fixation (anterior tibial tendon transfer) being the pool-out technique less expensive compared with anchor fixation.

Speaker
Biography:

DWS is hydrocephalus associated with a posterior fossa cyst and dysgenesis of the cerebellum. In USA the incidence of DWS is thought to be between 1 in 25000 – 35000, live births. Th is is a case of middle aged male patient with large head since birth, which was asymptomatic till 57 yrs of age. Aft er LOC and CT scan he was diagnosed to have DWS. Th is case was successfully managed with conservative management plan.

Abstract:

Muhammad Ishaq Khan

Department of Urology, Postgraduate Medical Institution Lady Reading Hospital, Peshawar

Title: Management of structure urethra by internal optical urethrotomy
Speaker
Biography:

Muhammad Ishaq is the fellow of College of physicians and surgeons of Pakistan, Royal College of Surgeons of Ireland, Royal College of Physicians & surgeons of Glasgow and Royal college of Surgeons of England. He is the examiner to the Royal College of Surgeons in UK. Moreover, he is the Founder Chairman of Jinnah Medical College Peshawar Pakistan. He is a general Surgeon and Head of the Department of surgery of DHQ Hospital and Naseerullah Khan Baber Memorial Hospital. He is also the founder Chairman of Ghulam Yousaf Education System (Pvt. Ltd.) which promotes medical education and allied education in the province in collaboration with the Khyber Medical University and University of Peshawar, Government of Khyberpukhtunkhwa Pakistan. He is also the chairman of Jinnah institute of paramedical sciences and Fatimah Jinnah institute of public health under the auspices of Pakistan nursing council. He is a busy surgeon and has more than 20 publications to his credit in the reputed Journals of the country.

Abstract:

Transuretheral urethrotomy under vision with the Sachse urethrotome is a relatively new surgical procedure for the treatment of urethral strictures. Th e main advantage of the urethrotome is the fact that the surgeon can cut strictures selectively and accurately under clear vision. the procedure is less painful than blind internal urethrotomy. We report on 105 cases with at least 12 months of follow up. In 47(45%) cases the strictures were in membranous and prostatic urethra, in 39(37%) in bulbar urethra and in 19(18%) in penile urethra. the results were considered good in 79(75%) improved in 21(20%) and a failure in 5(5%). Th e-Technique for urethral strictures in described and postoperative treatment is emphasized and discussed. We have found this technique a further improvement in the management of urethral strictures.

  • Neurosurgery, Urology and Transplant Surgery
Location: Dubai
Speaker
Biography:

Ziad Al-Naieb has completed his MB ChB at the age of 24 years from College of medicine at University of Baghdad and postdoctoral studies from Johannes Gutenberg, Mainz Germany MD at urology clinic and Poly-Clinic Mainz Germany and Finished his PhD at the university of Mainz Germany and then completed his Fellowship of the Royal college of Physicians and Surgeons of Glasgow, United Kingdom. He became Full Professor in urology in 1994. Currently, he is the Vice Dean for clinical affairs and Chairman of Surgery at the Arabian Gulf University since 2008 director of Urology Clinics at King Abdulla medical Center and Consultant urologist at Royal Bahrain and Bahrain Specialist Hospital in the Kingdom of Bahrain. He has published more than 33 papers in reputed journals and serving as an editorial board in many national and international medical journals including our reputed journal. His main researches are directed to Stem cell therapy in urology,early detection of Bladder malignancies and photo dynamic therapy of Bladder Cancers.

Abstract:

Background: Th e early detection of carcinoma is very essential for the diagnosis and prognosis of a bladder cancer patient. 5-aminolevulinic acid induced fluorescence cystoscopy can detect more tumour lesions comparing to standard cystoscopy is a well-documented fact. Th e goal of our study is to assess the infl uence of fl uorescence cystoscopy using 5-AlA as a natural amino acid oral powder with the conventional delta-aminolevulinic acid (ALA) or its derivative, hexaminolevulinate (HAL, Hexvix), installation. Th e oral form of 5- ALA in clearance of other urological malignancies was evaluated. Th e possible apoptotic activities of this substance in the treatment of bladder cancer as a new option and the benefi t of oral form in detecting other urological malignancies during surgery will be outlined. Methods and results: In retrospective and prospective study, 74 patients with primary or recurrent stage Ta Tl bladder transitional cell carcinoma treated with transurethral resection were enrolled. In 15 patients (group A) the oral form of 5-ALA (5-Aminolevulinic acid (SBI-Pharma-Japan). 20 patients (Group B), we used hexaminolevulinate (HAL, Hexvix). Th irty nine patients (Group C) were taken from records as the medic Germany is not producing the 5 ALA Delta from for intravesical installation any more. Th e patients were followed using standard cystoscopy and urinary cytology. In both groups, white light and blue light were used for comparison. Th e white light DATA was categorized as C I and blue light (visible blue light with wavelength of 420 nm) as C II, Recurrence free interval was evaluated in whole groups and also for single and multiple and for primary and recurrent tumours separately. Th e median time to recurrence was 8.05 months in group A and was signifi cantly shorter than 13.54 months in group B (p=0.04, log-rank test). Conclusions: 5-Aminolevulinic acid induced fl uorescence cystoscopy used during transurethral resection reduces the early recurrence rate in stage Ta Tl bladder transitional cell carcinoma. Th is fl uorescent oral form of 5-ALA, substance can be a useful tool in the treatment of Bladder cancer by inducing apoptosis when exposing the 5-ALA loaded tumour cell to external source of energy. Th is is a new research going on in our centre to study the possible use of external energy source aft er loading the cells with 5- Aminolevulinic acid. Th e patient will take the tablet 4 hours prior to surgery and the bladder will be inspected using white/blue light to stimulate the cell to produce the Protoporphyrin IX from the loaded cells and to explore the hidden or fl at cancer cellssocancer cell will be visible up to 1 mm with this method. Th e oral form opened to us new advantages in using this technology indetecting not only bladder cancers but ureteral renal and even prostatic malignancies in open, laparoscopic or robotic surgeries.

Speaker
Biography:

Maram Nasser Al Awad is a Professor in the Department of Physiology at Hail university, Saudi Arabia. His research interests include General surgery, Abdominal surgery, Urology and Transplant surgery.

Abstract:

Objective: Cholestasis is one of the most common gastrointestinal disorders requiring hospitalization. While diff erent factors infl uence gallstone formation, these factors are not the same in diff erent cultures or geographical locations. We determined the prevalence of gallbladder disease as assessed by ultrasonography and its complications in Hail City, Saudi Arabia. Methods: Patients who underwent emergency or elective abdominal ultrasonography at King Khalid Hospital, the largest tertiary hospital in the Hail region of Saudi Arabia, between January 2013 and December 2013 were retrospectively analyzed. Results: Of the 4552 patients analyzed, 494 (10.9%) had gallstones. Of these 494 patients, 173 (35%) were male, 321 (65%) were female and 337 (68.2%) were aged >35 years. Th ree hundred twenty-six patients (66%) had multiple stones, whereas 168 patients (34%) had a single stone. Marked and mild wall thickening were found in 180 patients (36.4%) and 155 patients (31.4%), respectively. Common bile duct dilatation was present in 36 patients (7.3%), fatty liver in 106 patients (21.5%), hepatomegaly in 36 patients (7.3%), cirrhosis in 20 patients (4%) and ascites in 21 patients (4.3%). Of the 494 patients, 335 (67.8%) were symptomatic. Saudi females had the highest prevalence of gallbladder disease (60.1%) followed by Saudi males (31.6%), non-Saudi females (4.9%), and non-Saudi males (3.8%). Conclusion: Th e prevalence of gallbladder disease was higher in Hail City compared with other cities in Saudi Arabia.

Speaker
Biography:

Sibel Akyol and Murat Hanci is an assistant Professor in the Departments of Physiology, at Istanbul University, Istanbul, Turkey. Her research interests include General surgery, Neurosurgery and Transplant surgery.

Abstract:

Aim: Th is study aims to provide the infl uence of anesthesia on the expression of natural killer cells and major histo-compatibility complex (MHC) molecules patients who had cerebral digital subtraction angiography (DSA) for either the diagnosis or treatment of intracranial vascular pathologies. Material & Methods: Forty-one male patients who admitted for cerebral DSA were included in this study. Patients were divided into two groups: Group I (n=7) included patients who did not receive anesthesia and group II (n=34) received anesthesia. For the molecules, a venous blood samples from every patient was collected before and aft er cerebral DSA. Results: In the group I, NK cells, NKG2D, MICA/MICB, CD3 and CD8 cytokines were increased signifi cantly aft er the DSA but CD16+56+ and MHC-class I showed no statistical signifi cant diff erence. In the group, NK cells, CD16+56+ and MICA/ MICB levels did not show signifi cant diff erence. On the other hand NKG2D, MHC-class I, CD8+ and CD3+ levels increased signifi cantly aft er the DSA. Comparing the group I and II aft er the DSA showed no signifi cant diff erence regarding CD16+56+ and NKG2D. NK (CD56+), MICA/MICB decreased and MHC-class I, CD8+, and CD3+ levels increased signifi cantly in the group II. Conclusion: Anesthesia combined with surgical stress DSA causes some alterations in the immune status of the patients. More data will lead us to give appropriate agents to the patients in order to strengthen the immune status during the preoperative period for decreasing the morbidity and/or mortality rate.

Speaker
Biography:

Adam H Hamawy is board certifi ed by the American Board of Plastic Surgery, specializing in both aesthetic and reconstructive procedures. He is trained in General Surgery at New York Presbyterian Hospital in New York City and in Plastic Surgery at the University of Texas’ Southwestern Medical Center in Dallas. He subsequently served in the US Army. He left the military after achieving the rank of Lieutenant Colonel and currently works in private practice in Princeton, NJ. He is currently the Chief of Microsurgery at St. Joseph’s Regional Medical Center. He has authored peer reviewed journal articles and book chapters. He is an Editorial Reviewer for the Journal of Plastic and Reconstructive Surgery. His clinical interests are migraine reduction surgeries, aesthetic facial restoration and aesthetic breast reconstruction.

Abstract:

There are many variables that must be considered when making decisions for breast reconstruction. Consideration of the patient and oncologic variables is becoming increasingly appreciated when selecting the surgical team and technique as a predictor of good outcomes following mastectomy and reconstruction. Th is discussion is structured to review the variables that are relevant when deciding upon a particular reconstructive option for a particular patient.

Speaker
Biography:

Robert Ryu is a Professor of Radiology and Director of Interventional Radiology at the University of Colorado Anschutz Medical Campus in Denver, CO. He is a Fellow of the Society of Interventional Radiology. He was the Radiology Residency program Director at Northwestern University from 2005-2014, where he was Cofounder of the IVC Filter clinic. He has authored over 100 peer reviewed publications. His areas of clinical and research interests include venous thrombo-embolic disease, interventional oncology and hepatobiliary intervention.

Abstract:

Purpose: Decreased successful retrieval rates have been reported in conjunction with prolonged dwell time of retrievable IVC fi lters (rIVCF). Th e use of adjunctive techniques has improved overall retrieval rates of these devices. Th is study compares the technical successful retrieval rate of rIVCF with prolonged dwell time (defi ned as >6 months), with rIVCF implanted for <6 months. We hypothesize that the technical success rate of rIVCF retrieval is equivalent. We aim to determine and compare technical and clinical factors that impact retrieval success in both cohorts. Materials: All rIVCF retrieval procedures from Jan 2009 to Dec 2014 were identifi ed from a prospectively acquired database. We assessed the technical success of rIVCF retrieval; we recorded fi lter dwell time as <6 months or >6 months for all cases. Th e use of adjunctive retrieval techniques was also recorded. Adjunctive techniques included loop wire, directional sheath use, balloon disruption, endo-bronchial forceps and excimer laser assistance. Statistics were analyzed using the Chi square test, with signifi cance accepted at p<0.05. Results: During the study period, 648 rIVCF retrieval procedures were performed. Th e technical success rate for retrieval procedures performed with rIVCFs in place <6 months was 97.7% (n=596); retrieval technical success rate for rIVCFs in place >6 months was 94.2% (n=52) (p=0.14). Adjunctive techniques were necessary to remove rIVCFs with <6 months dwell time 11% of the time (n=62), and 67% of the time (n=33) for rIVCFs with >6 months dwell time (p<0.001). Overall, complications occurred in 3% (3 major, 15 minor). Conclusions: Th ere is no signifi cant diff erence in the technical success rate for removal of rIVCFs that were implanted >6 months vs. <6 months ago. Retrieval rates for both cohorts exceeded 94%. In patients with prolonged IVC fi lter dwell time, adjunctive techniques are used more frequently to achieve these results.

Speaker
Biography:

Muslim Mustaev is a Professor in the Department of General Surgery at Caboolture Hospital, Queensland, Australia. His research interests include General surgery, Neurosurgery, Transplant surgery, Urology. He is the author of many reputed articles.

Abstract:

Purpose: Cytomegalovirus (CMV) is predominantly an opportunistic infection in immunocompromised patients. CMV infection, in otherwise immunocompetent individuals, is a rare phenomenon. Amongst CMV’s systemic manifestations, colitis is the most common presentation. CMV enteritis in the immunocompetent is rare and has not been reported in association with small bowel ischemia. Methodology: A 78-year old male presented with diarrhoea and abdominal pain for four days. No immunosuppressive risk factors (HIV, transplant procedures or steroid therapy) were noted. Haematological investigations showed leucocytosis with neutrophilia. Initial CT scan indicated enteritis with thickening of terminal ileum. Diagnostic laparoscopy revealed thickened small bowel which was however viable. Persistent clinical features led to laparotomy, and thickened congested segment of ileum was resected with caecum. Histology showed isolated small bowel ischemia, ulcerative changes with CMV inclusions. Ganciclovir therapy was commenced and the patient had subsequent uneventful recovery. Results: CMV enteritis was the least suspected cause of this presentation. Literature has reported limited number of cases of CMV colitis and its association with enteritis is even rarer. Th is is perhaps the fi rst case reported where the virus has caused ischemia of the small bowel without evidence of colonic involvement. Even in the elderly patients, small bowel is resilient to ischemic changes because of good blood supply. Isolated ischemic changes sparing colon are unusual and rare especially due to CMV infection. Conclusion: Segmental ileal ischemia caused by CMV in immunocompetent individuals is another facet of this disease. It needs to be investigated further for better understanding to aide timely diagnosis.

Ahmed abdel monem

alsalama one day surgery center ,Saudi Arabia

Title: Laparoscopic Evaluation of Chronic Abdominal Pain
Speaker
Biography:

Ahmed abdel monem is a Professor in the Department of General surgery at alsalama one day surgery center ,Saudi Arabia. His Research interests include General surgery, Abdominal surgery, Transplant surgery.

Abstract:

Background ; Chronic abdominal pain is a troublesome dilemma confronting both the medical and surgical care professionals. These patients are submitted to a lot of diagnostic investigations but, regretfully, no precise aetiology of their problem could be elicited. Diagnostic laparoscopy, apart from visualizing a large part of the abdominal cavity , a precise targeted biopsy can be done. Laparoscopy offers also a theraputic solution for a lot of cause of chronic abdominal pain. Patient and Methods: Patient with the inclusion criteria underwent diagnostic laparoscopy for chronic abdominal pain over last two years from January 2012 to December 2013. The patient’s demographic data, length of time with pain, diagnostic studies, intra-operative findings, interventions and follow-up were determined. Statistical methods:descriptive statistics of included patients were summarized graphically and by tabulation . Analytical statistics including associations between qualitative and quantitative variables was done by chi-squared test (for qualitative variables) and Kruskal-Wallis test (for qualitative/quantitative data associations ) . Asignificance level of P<0.05 was set. Results: in this study, 66 patients (45 female and 21male) with an average age of 25 years underwent diagnostic laparoscopy for the evaluation and treatment of chronic abdominal pain. The average duration of pain was 19,5 weeks. Findings included intra-abdominal tuberculousis in 4 patients, internal herniation in 2 patients, significant intra-abdominal adhesions in 12 patients, secondary intessusception in two patients, small intestinal stone in one patients, intestinal lymphoma in one patients, abdominal lymphadenopathy due to lymphoma in 2 patients, ceacal diverticulum in 2 patients and subacute appendicitis in 20 patients. Conclusion: Diagnostic laparoscopy seems to be a simple, rapid and an effective diagnostic tool in evaluating patients with chronic abdominal pain, in whom conventional methods of investigations have failed to elicit a certain cause with the advantages that it is an effective therapeutic tool and accurate and easy tissue sampling.