Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 6th International Conference and Exhibition on Surgery London, UK.

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Scientific Program Day 1
Scientific Program Day 2
Scientific Program Day 3

Day 1 :

Keynote Forum

Harry S Goldsmith

University of California, USA

Keynote: New treatments for spinal cord injuries

Time : 10:00-10:30

Conference Series Surgery 2017 International Conference Keynote Speaker Harry S Goldsmith photo
Biography:

Harry S Goldsmith is Clinical Professor of Neurological Surgery at the University of California in Sacramento.  He has been a Full Professor of Surgery and Neurosurgery since 1970.  He has written 260 published papers, has edited four surgical texts, and was the Editor of Goldsmith's Practice of Surgery in twelve volumes from 1976-1988.  His main interest at present is in the treatment of Alzheimer's disease and in new treatment for acute and chronic spinal cord injuries using the omentum.

Abstract:

Background: In the late 1800's, Ramon y Cajal, Father of Neuropathology stated that the reason patients who suffered a spinal cord injury (SCI) do not improve is that a scar develops at the site of the SCI which prevents axons from penetrating through the scar barrier.  The aim of the study was to learn if a scar following an SCI could be surgically removed, followed by reconstruction of the spinal cord which could lead to functional improvement following the injury.
Method: Studies were carried out in the laboratory to learn a technique to see if a piece of a spinal cord could be removed followed by subsequent functional improvement.  It was found that when a section of the spinal cord in animals could be surgically excised with reconstruction of the spinal cord being successfully performed followed by functional success.
Results: It was learned in cats when a piece of spinal cord was removed, the spinal cord could be reconstructed by filling the spinal cord defect with collagen followed by the placement of an intact vascularized omentum directly on the underlying collagen connection.  Not only was this possible, but a patient underwent excision of 1.6" of her spinal cord with subsequent ability to walk which was confirmed by video.
Conclusion: It appears that chronic spinal cord injured patients may have in the future the ability to have the scar which is present in a chronic injury removed with expectations following a spinal cord reconstruction that functional return can occur.

Keynote Forum

Justus Gross

UKSH-Campus Kiel, Germany

Keynote: Complex hybrid procedure of a type 1 TAAA with retroperitoneal chimney approach for TEVAR and carotid-subclavian bypass

Time : 11:00-11:30

Conference Series Surgery 2017 International Conference Keynote Speaker Justus Gross photo
Biography:

Justus Gross is Head of the Department of Vascular Unit, Clinic for Cardio-Vascular Surgery, University Hospital Schleswig-Holstein, Germany. The main focus is set at aortic treatments, such as complete open, complete endovascular and complex hybrid procedures. Approximately 250 aortic cases are treated per year. The entire research group develops novel technologies according to stent-graft designs and finding solutions for endovascular treatment of the aortic arch. 

Abstract:

The 71-year-old patient with a symptomatic thoracic-abdominal aneurysm type 1 de Bakey (6.4 cm thoracic, 5.9 cm abdominal) and aneurysm of right iliac artery (4.2 cm) was admitted to our casualty department. Clinically she complained of chest as well as progressive back pain. The patient had an imperative will for treatment. A previously untreated pheochromocytoma and a mammary carcinoma (pT1 G2 pN0), also myocardial revascularization (LIMA/RIVA) are known as serious accompanying diagnoses. Furthermore, a pronounced PAD with bilateral subtotal occlusion of the external iliac artery existed, an interventional transfemoral approach was impossible. A supplemental blood supply of the liver by the superior mesentery artery was detected, which gave us a distal landing zone of 4 mm over stenting the coeliac trunk. We decided to perform a hybrid procedure including a left carotid-subclavian bypass essential according to the left mammarian bypass and a right aorto-profundal bypass with a side-to-side chimney functioning as sheath. Under rapid pacing the implantation of two TEVAR stent grafts with overstenting of the left subclavian artery as well as the coeliac trunk followed. Afterwards the trans-brachial subclavian plugs occlusion and controlling angiography showed successful treatment. At ICU initially stable circulatory conditions turned to increased lactic acidosis. Because of transfusion-dependent blood loss into the retroperitoneal drains, an angiography and a CT abdomen showed a pronounced retro peritoneal haematoma without an active bleeding. Only a small Type IIb endoleak was detected. In suspected of acute liver failure, due to the persistently compromised coagulation and strongly elevated liver values, upper abdomen sonography was immediately performed and showed a well perfused hepatic artery. A strongly reduced heart index of 1.5 l/m2 forced a highly dosed administration of inotropics. On the second postoperative day the patient underwent a ventricular fibrillation with maximum therapy, which rapidly degenerated into an asystole. Resuscitation measures were not enhanced because of actually limited prognosis.

Keynote Forum

John S Jarstad

University of Missouri, USA

Keynote: Pearls from 1000 robotic femtosecond bladeless laser-assisted cataract procedures

Time : 11:30-12:00

Conference Series Surgery 2017 International Conference Keynote Speaker John S Jarstad photo
Biography:

John S Jarstad is an Associate Professor and Director of Cataract and Refractive (LASIK) surgery at University of Missouri School of Medicine Department of Ophthalmology. He is a Graduate of Brigham Young University (Provo, Utah), MD from University of Washington (Seattle), and completed his Internship, Residency and Clinical Fellowship in Ophthalmology at Mayo Clinic (Rochester, Minnesota). He was a Medical Student Research Fellow at National Institutes of Health (Bethesda, Maryland). He has lectured and taught cataract surgery at University of Washington in Seattle and as visiting professor in Indonesia, Austria, the Philippines, North Korea, Vietnam, Cambodia, Zimbabwe, Egypt, Angola, Nigeria, Madagascar and England, where he was elected to the Royal Society of Medicine in 2006. He was named by Consumer Research Council one of “America’s Top Ophthalmologists” and by Newsweek magazine as one of 15 Top Laser Eye Surgeons in the USA.  He has performed over 1000 robotic femtosecond bladeless laser cataract procedures since 2012.  He is the author of 60 publications or presentations and one book.

Abstract:

Statement of the Problem: Robotic Femtosecond Bladeless Laser Cataract Surgery is the newest and most controversial procedure in the world’s most common surgical procedure cataract surgery with intraocular lens implantation.  First performed in England in 1949 by Sir Harold Ridley, the technology for both removing the cataractous lens and implanting a corrective intraocular replacement lens has reached new heights of precision and success with the introduction of the femtosecond laser, approved by the FDA for use in patients (2011). The purpose of this study is to describe the experience of one surgeon who has performed over 1000 robotic femtosecond bladeless laser-assisted cataract procedures and review common pearls that have led to excellent outcomes.
Methodology & Theoretical Orientation: 1000 patient procedures were reviewed to determine common complications and findings that would improve outcomes compared to early Femtosecond Laser-assisted Cataract Surgeries (FLACS). 
Findings:  Common complications included: difficulty docking the laser on Asian patients and those with small eyelid fissures, incomplete anterior capsulotomy with early interface attachments, posterior capsule blow-out, decentered Lens capsulotomy and small pupil and Floppy Iris Syndrome.
Conclusion & Significance: Whilst some conservative ophthalmologists have criticized Femtosecond Laser-assisted Cataract Surgery (FLACS) as an overhyped gimmick, its usefulness in patients with dense, mature and hyper- mature (Morgagnian) cataracts and in assuring the accurate centration of newer multi-focal intraocular lens implants is unquestioned in the authors opinion.  Robotic Femtosecond Bladeless Laser-assisted Cataract Surgery is here to stay and will be the future of the most common surgical procedure performed throughout the world.

  • Orthopaedic Surgery | Oral & Maxillofacial surgery | Perioperative Care and Anaesthesiology| Otorhinolaryngology Surgery | Advancements in Surgery | Plastic Surgery
Location: London
Speaker

Chair

John S Jarstad

University of Missouri School of Medicine, USA

Session Introduction

Marcus Vinicius Danieli

Botucatu Medical School, Brazil

Title: The chondral tissue and PRP: Theory to support the use

Time : 12:00-12:25

Speaker
Biography:

Marcus Vinicius Danieli completed his Graduation in Medicine and Residence in Orthopedics at Botucatu Medical School. He focuses on Knee Surgery. He is an active member of the Brazilian Society of Knee Surgery (SBCJ); International Society of Arthroscopy, Knee Surgery and Sports Medicine (ISAKOS); and the International Cartilage Repair Society (ICRS).

Abstract:

The hyaline cartilage structure is very complex with few cells and without blood and lymphatic vessels or nerves. This makes the healing potential very limited. Knee cartilage injuries are very common, and its treatment is a major challenge. Surgical options available nowadays like chondroplasty, microfractures, mosaicplasty and autologous chondrocyte transplantation still doesn’t have satisfactory results, mainly in long term. Platelet-Rich Plasma (PRP) has been used in orthopedics since 90’s in order to stimulate tissue healing, because of its potential to concentrate platelet derived growth factors in the target place. The goal of the PRP application is to stimulate a better healing environment. PRP has been used in cartilage to treat steoarthritis and to support treatment techniques for chondral injuries. However, the literature is still doubtful regarding the surgical results with PRP application in chondral injuries.

Rajneesh Kumar

Punjab Institute of Medical Sciences, India

Title: Retained foreign bodies - A rare case of removal of surgical blade as retained foreign body from abdomen 5 years after surgery

Time : 12:25-12:50

Speaker
Biography:

Dr.Rajneesh Kumar M.S; FAIS; FLCS; FMAS; FIAGES; FICS. is an Associate Professor in the Punjab Institute of Medical Sciences [PIMS], India.

Abstract:

Foreign bodies forgotten or missed in abdomen include cotton sponges, artery forceps or other instruments, pieces of broken instruments or irrigation sets and rare tubes. Presence of retained surgical blade as foreign body is uncommon and significant patient safety challenge. Most common etiologies for presence of such foreign bodies are accidental, traumatic or iatrogenic. Most common surgically retained foreign body is the laparotomy sponge. We report the management of a case with a rare foreign body in the abdomen i.e. surgical blade and repair of congenital diaphragmatic hernia. A 38 years female reported to us with X-ray lumbo-sacral spine showing radio-opaque object in abdomen. We further investigated the patient and CT scan abdomen revealed–A metallic foreign body in the left hypochondrium just beneath the left lobe of liver; it was seen in close proximity to the transverse colon gut loops and left diaphragmatic eventration hernia–herniation of stomach, large bowel loop and omental fat into left hemithorax. Traditionally, diaphragmatic hernia was repaired by laparotomy and foreign body was removed after exact localization on C-arm.

Nikitha Rajaraman

University of Glasgow, Scotland

Title: Tongue-- tied: Management in pierre robin sequence, a case report

Time : 12:50-13:15

Speaker
Biography:

Nikitha Rajaraman is a 4th year medical student from the University of Glasgow. She is a highly motivated in pursuing her career in the surgical specialities. She has completed modules and electives in General,Plastic, Upper GI and Vascular Surgeries, and has completed various audit projects in the process. She has also contributed to national audits. She was recently awarded the top poster prize at the 8th Surgical Undergraduate Conference 2017 conducted in the Royal College of Physicians and Surgeons of Glasgow. She was also awarded Senior Elective award by the university as a recognition for her efforts towards a surgical career.

Abstract:

Pierre Robin Sequence (PRS) is a rare congenital condition of facial abnormalities, defined by a triad of micrognathia, retroglossoptosis and airway obstruction. PRS may have varied presentations due to associations with syndromes. Hence, the consensus in management remains elusive, with no definitive treatment protocols. We describe a case from a resource-‐ scarce setting that highlights the use of a less commonly performed surgical procedure which is simpler and cheaper than the gold-‐ standard surgery in PRS. An 18-‐ month-‐ old boy with PRS presented to A&E with airway obstruction and hypoxia due to retroglossoptosis. He was resuscitated immediately and intubated. Gold-‐ standard treatment was surgery: Mandibular Distraction Osteogenesis (MDO). However, as the patient was unable to afford the surgery, a cheaper procedure called tongue-‐ lip adhesion (TLA) was performed. The procedure involved pulling the base of the tongue anteriorly and tying to the hyoid bone. This maintained airway patency and patient was extubated. Mother was given feeding and child positioning advice. It is expected that the mandibular growth will eventually catch up with the tongue growth. The surgical procedures used to relieve airway obstruction in PRS include TLA, MDO and tracheostomy. In this case, TLA was chosen due to affordability issues. Three different TLA techniques, previously described in the literature for PRS, were discussed. Given the nutritional status of the patient, we decided to avoid extensive dissection. We required a technique that would not restrict mobile segments of the tongue, to allow for normal speech development and feeding. In addition, sutures on the tongue should not be damaged by biting, in the teething child. Lapidot and Ben-‐ Hur technique (briefly described in the case) satisfied above-‐ mentioned requirements and was hence chosen. Overall, this case is of great value in exploring different surgical techniques for PRS management, not widely explained in the literature.

Yaacov Gozal

Hebrew University of Jerusalem, Israel

Title: Anesthesia and neurodevelopment in children

Time : 14:00-14:25

Speaker
Biography:

Yaacov Gozal is an Associate Professor of Anesthesiology at the Hebrew University, Jerusalem. He is the Chair of the Department of Anesthesiology, Perioperative Medicine and Pain Treatment and Director of the operating rooms at Shaare Zedek Medical Center, Jerusalem, Israel. He has published more than 100 peer reviewed papers and serves as an Editorial Board Member of the Journal of Pharmacology and Toxicology.

Abstract:

Each year, millions of infants and children undergo surgery, diagnostic and interventional procedures under anesthesia and sedation. Concern has been raised about the effect of anesthetic drugs on brain development. It has been shown that these medications affect the developing brain of different non-human species. It usually results in behavior, learning and memory abnormalities. The different human studies suggest that similar problems may occur in young children exposed to these drugs. However, recent large scale prospective studies did not find correlation between anesthesia exposure and poor neurodevelopmental outcome. Future research may clarify this important issue.

Turgut Donmez

Lutfiye Nuri Burat State Hospital, Turkey

Title: Thyroid surgery, IONM and sugammadex sodium relationships: Benefits in sugammadex Sodium using for IONM

Time : 14:25-14:50

Speaker
Biography:

Turgut Donmez was graduated from Istanbul University Cerrahpasa Medical Faculty in 1997 and completed his Residency in General Surgery in 2003 in the same faculty hospital. He has been working at Lutfiye Nuri Burat State Hospital. He has expertise in laparoscopic and thyroid surgery.

Abstract:

Statement of the Problem: One of the most important complications in thyroid surgery is vocal cord paralysis as a result of recurrent laryngeal nerve (RLN) injury. While unilateral injury of the nerve can be tolerated by the patients, bilateral nerve paralysis might results in as severe complications as death. The surgeon must use a strictly standardized intra operative neuro monitoring technique (IONM) to succeed a good, well-quality monitoring and safe-surgery in order to prevent injury to RLN and save its functions. But, the half-life of general anesthetic drugs with neuromuscular blockade effect which are used during operation are closely related to affectivity and reliability of IONM. We aimed to detect nerve conduction by using TOF-Guard neuromuscular transmission monitor and provide a more reliable IONM after administering sugammadex sodium (bridion) which antagonizes neuromuscular blockade of the anesthetic drug.
Methodology & Theoretical Orientation: 20 patients who underwent total thyroidectomy operation in our surgery department between January 2017 and March 2017 were involved into the study. All the patients were intubated following anesthesia induction with propofol 1.5 mg/kg; rocuronium 0.6 mg/kg; remifentanil 0.25 microgram/kg/min and mechanically ventilated at Vc mode. Anesthesia maintenance was provided with remifentanil of 0.25 microgram/min, sevoflurane of 0.8 mac, and air-o2 combination of 4 lt/min. Following the intubation, the TOF-Guard neuromuscular transmission monitor
was placed on left hand and TOF was measured and recorded. 100 mg of bridion was administered intravenously just before the surgeon start thyroid gland resection. Following bridion injection, TOF response at 1st, 2nd, 3rd and 4th minutes were measured and recorded. If the response was over 90%, then the surgeon was let to use neuromuscular monitoring device. Vocal cord examinations were done in all the patients by an ear-nose-throat specialist on the 1st post-operative day. Age, gender, recurrent laryngeal nerve conduction speed before and after excision, BMI, surgery time, hospital stay duration, nerve conduction response duration following drug injection and complications were analyzed.
Findings: None of the patients developed nerve-related complications. The mean age was 47.6±11.82 years and mean BMI was 28.745±3.20. The mean operation time was 52.65±5.51 min. There wasn’t any significant difference in neither right nor left RLN monitoring values before and after surgery. Following the drug injection, the TOF guard nerve conduction response values were found 23.5±4.90; 69.5±6.86; 88±4.1 and 100, on 1st, 2nd, 3rd and 4th minutes, respectively.
Conclusion: The use of an anti-muscle relaxant drug and detecting the presence of nerve conduction with TOF-guard nerve monitor can provide a more reliable IONM and more safe surgery.

 

Emilio Vicente

San Pablo University, Spain

Title: The role of robotic-Assisted pancreatic surgery: Lessons learned from our initial experience

Time : 14:50-15:15

Speaker
Biography:

Emilio Vicente has completed his Residency in General Surgery. He is currently the Director of the General and Digestive Surgery Service at Sanchinarro University Hospital and Clara Campal Oncological Center and; Chairman of the Surgery Section at Faculty of Medicine, San Pablo University. His other professional positions include: Digestive Viscera Transplant Program Director at Ramón y Cajal Hospital (Madrid, Spain); Chief of the General Surgery Section at Ramón y Cajal Generalb Hospital, Spain and; Professor of surgery at Alcalá Uni-versity, Spain.

Abstract:

Minimally invasive surgery (MIS) has achieved worldwide acceptance in various fields, however, pancreatic surgery remains one of the most challenging abdominal procedures. Laparoscopic pancreatic surgery has not gained broad acceptance due to the complexity of the procedure, the accuracy required to perform the operation, and the steep learning curve involved. Indeed, the procedure has only achieved widespread consensus for distal pancreatectomy. In the field of major pan-creaticoduodenectomies, the laparoscopic approach is still considered to be an ex-tremely demanding method due to the challenge of reconstruction. The develop-ment of the robotic platform has overcome many of the disadvantages of traditional laparoscopy. Robotic surgery (RS) gives the surgeon a three-dimensional stereo-scopic view of the operating field and restores hand-eye coordination that is often lost in traditional laparoscopy when the camera is offset to the plane of dissection. Given the limitations of current laparo-scopic technology and the need for meticu-lous vascular control as well as complex reconstruction in pancreatic surgery, we hypothesized that RS would be particular-ly a good option for these procedures. We now report our experience with 50 consec-utive robotic-assisted pancreatic resections. We evaluate the safety, feasibility and versatility of this platform in the hands of dedicated, high volume hepato-pancreato-biliary (HPB) surgeons.

 

Tanja Anguseva

The Special Hospital for Surgical Diseases “Filip Vtori”, Macedonia

Title: Surgery in septic patient with acute aortic endocarditis - Case report

Time : 15:15-15:40

Speaker
Biography:

Tanja Anguseva is Subspecialist cardiologist in Special Hospital for surgical diseases ZanMitrev. Scientific work titled “SyScheechan”, Clinic of Obstetrics, Faculty of Medicine, Skopje. Graduation at the Faculty of Medicine within Ss. Cyril and Methodius Skopje, Macedonia. Doctor – general practitioner, Military Outpatient Clinic, Veles. Specialization in internal medicine at the University Ss. Cyril and Methodius.Assistant at the Department of Hemodialysis - Department for Internal diseases, Military Hospital,Skopje. Postgraduate studies at the Clinic of Cardiology, Faculty of Medicine, Skopje. Topic: Immunoactivity of patients in end-stage ischemic heart failure. Intensive Care Unit – Department of Internal Diseases, Military Hospital, Skopje. Coronary (cardiac) stress test, Echocardiography, 24-hour ECG and ABP Holter monitoring – Department of Internal Diseases, Military Hospital, Skopje. Doctor in charge at the Intensive Care Unit, PHI FILIP VTORI, Skopje.

Abstract:

Objective: Despite antibiotic treatment, active infective endocarditis continues to be a devastating and often fatal condition, which needs to be treat with urgent life threatening , high-risk surgery.Essential adequate debridement of the infective material is followed by repairmen (excisement of the vegetations) or replacement of the valve . The postoperative intensive care treatment usually is faced with septic shock patient with predicted high mortality rate.
Case Report: A 37years old patient was admitted to our unit with an acute endocarditis of the aortic valve, diagnosed by transoesophageal echo (TEE) with a great vegetations on the right and non- coronarial cusp with a aortic regurgitation +2 as well as left ventricle failure.Biochemistry was positive for infection (neutrophilia in blood, increased CRP and procalcitonin) and positive blood culture for staphulococcusepidermidis MR. Patient had been treated with Linezolid according to antiniogram. After 10 days he developed pulmonary edema, due to high grade aortic regurgitation due to rupture of the non-coronarial cusp (confirmed on 3D TEE) and in a septic shock under catecholamine he was operated. Intraoperativelly his aortic valve was completely destroyed with a lot of vegetations and rupture of the non coronarial cusp. Patient got a mechanical prosthesisSorin 25mm. After surgery he was high fevered, on high dosage of catecholamine and positive biomarkers for infections. On a first postoperative day he was put on antibiotics according to antibiogram and on CRRT treatment with Oxiris filter on Prisma-flex machine. After forth hour hemodynamic stabilization was notified, due to which catecholamine had been excluded second postopoperative day, and patient dieresis had been normalized. Patient had been extubated after 7 days. After 2o days he had been discharged at home.
Conclusions: Surgery in acute endocarditis is a high risk procedure which can be performed with a better haemodynamic stability and less postoperative complications, if patient is treated with adequate antibiotics as well as CRRT- Oxiris filter to remove the endotoxins.

  • Are our health care systems “patient-centered”? How to run a quality improvement study of the health care system?
Location: London
Speaker

Chair

Nahla Gomaa

University of Alberta, Canada