Minimal Invasive Surgical Training (MIST)
Minimal invasive surgical training (MIST) was established to promote minimal invasive advanced surgical training. Minimally invasive surgery entail performing surgical procedures that limit the size of incisions needed resulting in reduced pain, quicker recovery times and fewer complications. There are various approaches to minimal invasive surgery. Most evolving approaches amongst these are laparoscopic and robotic surgery.
Minimal Invasive Surgery (MIS) is one of the most significant advances in history of surgery. The change has revolutionised the approach to surgical procedures. MIS role in cancer surgery has significant advantages over open approach for patients in terms of significantly reduced pain and early recovery without compromise in oncological safety. Introduction of laparoscopic surgery in 1990s was a phenomenal first step in newly evolving approach to surgery. The approach was adapted with hesitation in modern world as change is not easily accepted but the approach made its way because of significant advantages over open approach. Governments invested hugely in training the surgeons. Despite of massive investment current status of UK is that only 70% patients receive minimal invasive surgery in bowel cancer more than two decades since introduction of the surgical approach.
World has now recognised the minimal invasive surgery as a standard of care for cancer patients. Most of the world is still very far behind in this area.
Technique has evolved and now becoming a dominant approach in gastrointestinal and other visceral benign and oncologysurgical conditions with figures reaching approximately 70% all over UK. Gulf, some parts of Europe, South Asia and Africa are far behind in terms of adapting the approach to deal with surgically correctable conditions.
Who we are?
We are group of surgeons trained in minimal invasive surgery where technique was developing. We have not only adapted the technique but also trained to a very high level. We developed syllabus for minimal invasive surgery. We standardised the approach by simplifying it into various modules. We then decided to take this to rest of the world and transferred our skills. We developed our training program focussed to train full time consultant surgeons as well as the trainee surgeons. We developed curriculum, training modules for MIS and standardised our training program. We also developed assessment tools to assess post training competency. We developed training methods based on latest evidence. Training qualifications and fellowships were introduced. Training system was tested and validated.
We have developed an extensive portfolio in minimal invasive training. Our master trainer is one the pioneers in minimal invasive surgery training in United Kingdom. He contributed to skill the full-time consultants to help them adapt the modern era of minimal invasive surgery. He developed a team which then extended its portfolio beyond borders into Europe. We have laid foundation of minimal invasive surgery in Germany, HK and Czech Republic. We developed the training program for minimal invasive training in Serbia. We also developed the similar training program in Russia, Iran and south Asia. We founded European Academy of Robotic Colorectal Surgery (EARCS) which overseas advanced minimal invasive surgery all over the world.
MIST programme will improve the outcomes of oncology surgery internationally, thereby improving patient outcomes. This will also result in financial benefits resulting in savings from occupied bed days, intensive care and complications.
Training programme will impact the surgical practice in following ways:
Introduction of Multiple Disciplinary Team (MDT) approach to cancer surgery:
We understand and take every individual diagnosed with colon and rectal cancer as very important. The standard recommended method of providing specialist care to a newly diagnosed cancer patient is planned and individualised as per MDT discussion. This is the first principle of cancer treatment and we will implement this for every patient.
- MDT comprises of specialists from oncology, radiology, pathology and surgery. These are coordinated by specialist nurses and facilitated by cancer nurse practitioners. Hands on training will be given in workshops and emphasis will be given on adapting MDT approach which is considered as the best way to deal with cancer patients.
- Role of enhanced recovery and peri-operative care
- Demonstration and familiarization with operative techniques
In reach Training would involve:
- Up to 20 cases under direct supervision in the base hospital
- Teaching and training of the team with anaesthesiologists, radiologists and pathologists
- Training mapped with real time Global assessment Scores (GAS).
Research & Education
BMIST will become an integral part of surgical mainstream education, thereby raising standards on par with the western European standards.
The wealth of data gathered from MIST will translate to international presentations and publications, thereby impacting on translational research.
MIST will provide a streamlined, structured training programme, in association with EARCS. This will deliver a University diploma which is recognized around the world.
Pathway for training would include selection of centre and surgeons locally by the local stake holders. Some of the modules planned would encompass:
- Module 1 – Introduction to surgical oncology
- Module 2 – Surgical anatomy for Colo-rectal cancers
- Module 3 – Minimally invasive surgical principles
- Module 4 – Human factors: Decision making, risk communication, patient safety and health outcomes
The following tasks would need to be completed in consensus with all the stake holders:
- MCQ exams
- Video assessments
- 2 unedited videos for right and left colon performed by the trainees would be assessed blindly by the faculty using L-CAT forms
- Final certification and feedback
Infrastructure & resources required by each participating center
- Operative tables compatible with Laparoscopy
- High definition Laparoscopic stack – with a master and slave
- Laparoscopic instruments – Bowel graspers Johan’s long and short tip/ Endo Babcock / Laparoscopic needle holders
- Energy sources (Hormonic scalpel / Ligature – 5 mm device)
- Staplers – Laparoscopic Linear cutter / Echelon or endo GIA
- Circular stapling devices / CDH 28 – 30
- Hem-o-lock clips – various sizes
- Would protectors
- Patient immobilizers – Bean bag / Lloyd Davies boots
- Other consumables
Successful completion of the training programme will lead award of
“Diploma in Minimally invasive colorectal surgery” from EARCS
Medical Surgery Faculty | Minimal Invasive Surgical Training (MIST)
- Professor Dr Amjad Parvaiz (Master Trainer/Director)
- Dr Muhamad Tayyab (CEO/Director)
- Professor Dr Nuno Figueiredo
- Professor Dr Tahseen Qureshi
- Dr Jamil Ahmed
- Dr Najaf Siddiqui
- Dr Hassan Abbas
- Dr Hamid Reza Zamani
Professor Amjad Parvaiz
- MBBS, FRCS (Glasg), FRCS (Eng) FRCS (Gen & Colorectal Surgery)
- Professor of Surgery – University of Portsmouth, Portsmouth, UK
- Honorary Professor of Surgery – School of Medicine University of Berlgrade, Serbia
- Visiting Consultant Colorectal Surgeon -Poole Hospital NHS Foundation Trust, Poole, UK
- Head of Laparoscopic & Robotic Colorectal Unit – Department of Colorectal Surgery, Champalimaud Foundation, Lisbon, Portugal
- Director of the European Academy of Robotic Colorectal Surgery (EARCS) www.earcs.pt
- INTERNATIONAL FACULTY AND PROGRAMME LEAD
Professor Amjad Parvaiz is a visiting consultant surgeon at Poole NHS foundation trust in the UK and is Head of the Laparoscopic & Robotic Colorectal Unit at the Champalimaud Foundation in Lisbon, Portugal.
He holds a personal chair at the University of Portsmouth affiliated with the Faculty of Health Science in Portsmouth, UK. He is also Director and Founding Member of the European Academy of Robotic Colorectal Surgery (EARCS) since 2014.
He has vast experience in laparoscopic and robotic colorectal surgery with particular interest in training in minimally invasive techniques worldwide. He became the leading trainer in UK for delivering largest number of training procedures within the National Training Programme (Lapco). He has performed and supervised more than 2500 laparoscopic colorectal resections & more than 1000 robotic colorectal resections. His clinical results are quoted as one of the best in the world for short term hospital outcomes and long -term cancer survival. 5 year local recurrence rate of 1.4%.
He has a keen interest in research and teaching with over 150 publications in International peer reviewed journals and book chapters. He is on Editorial boards on number of International peer review journals. He has supervised various research projects leading to award of MSc and MD degrees. He has successfully pioneered and established epicenters for minimally invasive surgery including laparoscopic and robotic colorectal surgery at Portsmouth, Poole in UK and at the Champalimaud Foundation in Lisbon, Portugal. Under his leadership, these centres have gained National and International reputation for teaching and training.
His interest in teaching and training of minimal access surgery, Led him to develope and designed the robotic rectal training programme for European colorectal surgeons and led the creation of the European Academy of Robotic Colorectal Surgery (EARCS). He has also established International centers of excellence for laparoscopic and robotic colorectal surgery throughout Europe, Russia, East Africa, Turkey, Iran, Pakistan and China.
In recognition of his work, he was elected as a Fellow of the Royal College of Surgeons of England, Fellow of Portuguese Society of Surgery in Portugal and Honorary chair for professor of surgery at Belgrade University of Medicine, Belgrade, Serbia. He also has won numerous awards and honors worldwide.
- First prize in video presentation on effects of standardization on laparoscopic and robotic TME surgery for rectal cancer. Turkish Colorectal surgery conference, Antalya, Turkey, May 2015
- Best Video prize for European surgeons in EAES meeting Brussels June2012.
- David Dunn Medal Best paper on Clinical Outcomes in NTP, ALSGBI, Nov2010.
- Best Paper Prize Winner on Impact of NTP on training opportunities for HSTs at the 5thInternational Congress of Laparoscopic Colorectal Surgery, Florida 11-12, Feb2010.
- Best Paper Prize Winner on Feasibility and safety of Laparoscopic resections in High Risk patients at the 4thInternational Congress of Laparoscopic Colorectal Surgery, Florida 10-11, February2009.
- Best paper prize winner on Feasibility and early outcomes following Laparoscopic Liver resections – regional SpR meeting, March2004.
- Best Clinical paper award for Long Term Outcomes following IVC filter insertions at the European Society of Vascular Surgeons’ meeting, Istanbul, Turkey2002.
- Travelling Fellowship award to visit Washington Cancer Centre, Washington,USA.
Major Research Interests
- Technological advances in minimal access & robotic surgery
- Teaching and training laparoscopic and robotic colorectal surgery
- Development of laparoscopic and robotic Total Mesorectal Excision (TME) for rectalcancer
- Impact of laparoscopic surgery on long term oncological outcomes following colorectal cancerresection
International Teaching & Training: Laparoscopic Surgery
Professor Amjad Parvaiz was advisor and master trainer for the development of Laparoscopic Colorectal Surgery in the following countries:
• Iran • Morocco • Tunisia • Pakistan • Poland • Turkey • Kenya • Russia • Serbia
It is a project to develop laparoscopic colorectal surgery in Eastern Europe, North and East Africa. A hub and spoke model was employed with the aim to develop central unit and thereafter to expand training to regional centres in the respective countries. Professor Amjad Parvaiz trained number of local consultant surgeons in the laparoscopic colorectal surgical techniques in various centres in these countries. It involved personal commitment and various travels to these countries. The program was successfully delivered in Russia, Kenya, Iran and Turkey.
International Teaching & Training: Robotic Surgery
Professor Amjad Parvaiz is a Director and Founding Member of the European Academy of Robotic Colorectal Surgery (EARCS). He was instrumental in establishing EARCS as an assessment based training academy to introduce robotic technology to surgeons without incurring a risk to the patient. To date, EARCS has successfully trained over 150 delegates of which 80 have now completed the assessments and been certified as competent to perform robotic colorectal surgery. Since the start of EARCS in 2015, professor has personally performed and supervised more than 1000 robotic training operations with EARCS delegates in 15 countries:
• Austria • Denmark • Ireland • Netherlands • Sweden • Belgium • Finland • Italy • Portugal • Switzerland • Czech Republic • France • Germany • Qatar • United Kingdom