It will be a boon for women when the diagnosis, treatment and management of gynaecological issues are taken to greater heights by the Colombo South (Kalubowila) Teaching Hospital, placing Sri Lanka at the top of this field, not only in the region but also the world. The good news in the New Year comes with [...]


Kalubowila Hospital & J’pura University on world map

Gynaecologists skilled in key-hole surgery ride high with SAMAGE Centre

It will be a boon for women when the diagnosis, treatment and management of gynaecological issues are taken to greater heights by the Colombo South (Kalubowila) Teaching Hospital, placing Sri Lanka at the top of this field, not only in the region but also the world.

The good news in the New Year comes with the setting up of the South Asian Minimal Access Gynaecology & Endometriosis (SAMAGE) Centre at the Kalubowila Hospital within the Professorial Unit on Obstetrics & Gynaecology, Sri Jayewardenepura University.
Tomorrow, amidst a distinguished gathering, the British Society for Gynaecological Endoscopy (BSGE) will formally bestow the SAMAGE Centre with provisional accreditation.

Minimal access or key-hole surgery (laparoscopy) in gynaecology is nothing new to this pioneering Obstetrics and Gynaecology Team, with Consultant Obstetrician and Gynaecologist Dr. Dhammike Silva, acting as the pivot. Before explaining to the Sunday Times what this honour of accreditation from the BSGE means, Dr. Silva says that the BSGE was founded in 1989 by a small group of consultant gynaecologists in the United Kingdom (UK), keen to promote the benefits of minimal-access surgery for their patients.

Nearly 30 years hence, it has grown from strength to strength with a membership of more than 1,000 drawn from consultants, trainees, specialist nurse practitioners, general practitioners and students, he says, quoting from its website that “the BSGE exists not only to serve its members, but also to promote knowledge and understanding of the endoscopic approach to diagnosis and treatment to a wider public, including patients and those responsible for the formulation of healthcare policy”. Thus the BSGE’s vision is to educate, train and encourage research. Being at the top of the field of minimal-access gynaecology, it initially set up a centre of excellence for endometriosis, as this disease is a major concern among women and the disease burden is very high but gradually spread its expertise to dealing with other gynaecological issues, the Sunday Times learns.

Dr. Silva says that earlier it was believed that a ‘frozen pelvis’ caused by severe endometriosis was inoperable. The thinking at that time was also that it was inoperable because it involved not only a woman’s reproductive organs such as the ovaries, fallopian tubes, womb (uterus) and vagina but also the bladder, the ureters (urinary tubes), the bowel (intestine) and the nerves in the area. As such, it required a multidisciplinary approach.

“Only a very skilled surgeon could negotiate and navigate the endometriosis-hit areas and resect or cut them out separately to deal with the disease,” he says, adding that “vena, venama resect karanna one”. In those days, only medical and not surgical treatment was offered to the patient who suffered throughout her life.

However, a skilled and experienced laparoscopic gynaecological surgeon, using minimal-access techniques, can skeletonize and isolate the bowel, the ureters, the womb, the ovaries, the vagina and the nerves and clear all these of endometriotic deposits. Citing examples, Dr. Silva says that the procedure may entail dissecting some parts of the affected ureters and re-implanting them or exposing and raising the nerve plexus (complex branching networks) for nerve-sparing.

All this and more are being performed at the Kalubowila Hospital, as the team guided by Dr. Silva has acquired strong laparoscopic skills.
Stressing that such minimal-access procedures which last many hours cannot be performed by a single doctor, he lists the multidisciplinary team required as: A Gynaecologist with special training in laparoscopy; a Colorectal Surgeon; a Urologist; a Pain Consultant; and a Specialist Nurse who would meticulously handle the nitty-gritty of pre, intra and post-operative periods, with the latter part lasting two years.
In the UK, according to Dr. Silva, there are accredited Endometriosis Centres of Excellence to which referrals are sent from all over the country. So far, the one-and-only such centre with provisional accreditation for Southeast Asia is the SAMAGE Centre at the Kalubowila Hospital.

Now that provisional accreditation has been granted, the SAMAGE Centre will be under rigorous scrutiny and stringent evaluation by two international collaborators of BSGE along with two local collaborators. Data and videos sent by the SAMAGE Centre of pre-operation procedures and minimal-access surgeries will be studied scrupulously and a final audit conducted at the end of the year, to decide whether it has lived up to the high standards required, to get full accreditation.

The Kalubowila Gynaecological Team comprises Consultant Obstetricians and Gynaecologists Dr. Dhammike Silva and Dr. Madura Jayawardane; Consultant Genito-Urinary Surgeon Prof. Srinath Chandrasekera; Consultant Colorectal Surgeon Dr. Bawantha Gamage; Consultant Anaesthetist Dr. Nilangani Lamahewage with a special interest in pain management; and Specialist Nurse Himali Malawiarachchi.
It is with humility that Dr. Silva says that they have been performing minimal-access gynaecological procedures for nearly 10 years and thought the time was right to reach out for international accreditation.

“Minimal-access surgeries have been used not only for endometriosis and that too the really-bad Grade 4 stage but also for everything else,” he says, ticking off on his fingers some of the others, all ureter work including re-implantation and end-to-end anastomosis (surgical joining), rectal shaving, bladder procedures, fistula, pelvic abscesses and any operable gynaecological cancers including ovarian cancer.
“Nokarana ekak ne,” he says simply. (“There’s nothing we don’t do.”)

Underscoring that the best form or optimal treatment for endometriosis is minimal-access surgery delivered by a multidisciplinary team, Dr. Silva says that due to lack of expertise and skill, many a patient regrettably gets sub-optimal treatment going from one open surgery to another, getting more and more adhesions within her body. This needs to change.

Therefore, the Kalubowila team has also been holding exposure training and outreach clinics with the blessings of the Sri Lanka College of Obstetricians and Gynaecologists in Embilipitiya, Kahawatte, Homagama and Nawalapitiya.

Come January 2019, the Kalubowila team is hoping to stand before the patients they serve with full accreditation for the SAMAGE Centre from the BSGE in hand, offering undeniable proof that they are world-class.

Formal honouring by BSGE tomorrow

Kalubowila Director Dr. Asela Gunawardena

The South Asian Minimal Access Gynaecology & Endometriosis (SAMAGE) Centre within the Professorial Unit at the Kalubowila Hospital will be given formal provisional accreditation by the British Society for Gynaecological Endoscopy (BSGE) tomorrow (January 15) at 3 p.m.
The small but distinguished gathering will include Health Minister Dr. Rajitha Senaratne; Health Services Director-General Dr. Anil Jasinghe; University Grants Commission Chairman Prof. Mohan Silva; Sri Jayewardenepura University Vice Chancellor Sampath Amaratunge, its Dean of the Faculty of Medical Sciences Prof. Surangi Yasawardene and its Emeritus Professor of Obstetrics and Gynaecology Prof. Jayantha Jayawardena; Kalubowila Hospital Director Dr. Asela Gunawardena; and SLCOG President Prof. Prasantha Wijesinghe.

The BSGE’s international facilitators, Dr. Kirana Arambage and Dr. Dilip Visvanathan, will also participate in the event.
Dr. Dhammike Silva is quick to appreciate the invaluable support that Kalubowila Hospital Director Dr. Gunawardena has extended to them with regard to minimal-access procedures.
The aims of obtaining BSGE accreditation are:

  • To take the medical image of Sri Lanka to a different level with such international collaborations.
  • To become a training centre not only for local but also regional medical and nursing teams.
  • To become a centre of excellence for research dissemination and contribute to the International Guidelines for Endometriosis as there are a lot of unexplored areas.
  • As the disease burden of endometriosis is huge and having just one centre in Sri Lanka is inadequate to train medical and nursing teams across the country.
  • In the long-term, to establish a centre of excellence per district in the country with the ‘mother’ centre at the Kalubowila Hospital.
  • To give all obstetrics and gynaecology post-graduate trainees sound knowledge in minimal-access treatment for endometriosis and other gynaecological issues.

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