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Hope amid doom and gloom
View(s):- First-ever academic sessions of cardiothoracic & thoracic surgeons
By Kumudini Hettiarachchi
Under the able leadership of ACTSSL Dr. Rajeeva Peiris the inauguration ceremony on Friday evening at the Galadari Hotel, Colombo, set the stage for the two-day sessions on ‘Advancing cardiothoracic surgical care’ on Saturday and Sunday.
The head table (from left) ACTSSL Treasurer Dr. Kanchana Singappuli; Chief Guest Dr. Nihal Kulathilake; ACTSSL President Dr. Rajeeva Peiris; Orator Dr. Chandima Amarasena; and ACTSSL Secretary Dr. Malik de Soysa
Dr. Peiris was appreciative of the immense support he has been able to garner for the sessions. The reasonably priced registration has been over-subscribed and the free five satellite meetings, two of which are yet to be held, in coordination with a few private hospitals and some institutions, have also been houseful with eager interest by nurses, perfusionists and trainee surgeons.
ACTSSL President Dr. Rajeeva Peiris
Ten foreign specialists from eight countries and 18 local specialists are part of the sessions which comprise plenaries and symposia.
Renowned Senior Consultant Cardiothoracic Surgery, University of Wales, Cardiff, Dr. Nihal Kulathilake, who has helped many Sri Lankans to train in the United Kingdom (UK), was the chief guest at the inauguration.
With the description that “he is the best and one needs to see him operate”, Dr. Kulathilake now retired, had been the first Sri Lankan Consultant to be appointed to the UK’s National Health Service (NHS). In Sri Lanka, he had pioneered cardiac surgery in the private sector by setting up units in two private hospitals.
Dr. Kulathilake’s comments that cardiac and thoracic surgery are “very specialized” fields and to see so many here was very encouraging for its future, was like music to many ears as Sri Lanka is facing unprecedented challenges. Among them are the escalation in the cost of medical consumables, instruments and equipment and the brain-drain of specialists. Another challenge is the slow pace of infrastructure development which is creating a shortfall, with the demand exceeding supply in terms of the number of surgeries performed, leading to long waiting lists and complications, severe disability and loss of life in some instances.
Dr. Nihal Kulathilake
Delving into the origins of cardiac and thoracic surgery worldwide, this distinguished surgeon moved onto the present day and also the future. He questioned whether cardiac and thoracic surgeons are a “vanishing” tribe? Is it all doom and gloom?
“Hope not,” he said, but red-flagged a “hidden” danger where cardiac surgeons are involved only in complex operations. Then, how would they train future generations – how could they teach the basics when there were no more simple cases, as innovation and research were bringing about new procedures without the need of a surgeon.
Dr. Kulathilake urged the surgeons to innovate, keep up with new developments and adapt to changing circumstances. Maybe they could become “hybrid” surgeons, with a knowledge of both operative and interventional techniques.
“To help us innovate and adapt to changing circumstances, we need one very powerful tool – data and the information they provide,” he said, requesting the ACTSSL to set up a Cardiac Surgical Registry for Sri Lanka with national activity and outcome data from the cardiac and thoracic units across the country.
“Start it now and you can have a very powerful tool to help raise the quality of care. Regard this as a challenge – you can do it,” added Dr. Kulathilake.
In Sri Lanka, cardiothoracic and thoracic surgery, the finer surgical sub-specialties involving surgeries of the heart, lung and chest cavity, had humble beginnings dating back to the 1950s. They involved operations in the lung and chest cavity for complications of tuberculosis (TB) and closed heart surgeries for narrowing of heart valves.
This field has now come a long way, with six major centres across the country performing cardiothoracic surgery in the state sector – the National Hospital of Sri Lanka (NHSL); the Kandy National Hospital; the Karapitiya and Jaffna Teaching Hospitals; the Sri Jayewardenepura General Hospital, Colombo; and the Lady Ridgeway Hospital (LRH) for Children, Colombo. This is while most of the thoracic surgeries are performed at the National Hospital for Respiratory Diseases, Welisara.
The wife of Dr. Ravi Pillai, Ms. Shanti Jayewardene-Pillai (at centre) in the audience, listening to the oration.Pix by M.A. Pushpa Kumara
“Cardiac surgery has made steady progress in the last two decades, from Coronary Artery Bypass Grafting (CABG) performed as on pump and off pump (beating heart) to minimally invasive (keyhole) surgery. The milestone of the first heart transplant was achieved in 2017,”states the ACTSSL, adding that the thoracoscope has done wonders in the hands of thoracic surgeons with most work being through keyhole surgical techniques.
Referring to services at the LRH since 2007, it states that paediatric cardiothoracic surgery has advanced to accommodate more and more complex operations for congenital malformations. The Tissue Bank provides necessary homografts for such operations, while cardiothoracic anaesthesia and intensive care have improved significantly, lowering the mortality and morbidity of otherwise high-risk operations. Extra Corporeal Membrane Oxygenator (ECMO) facilities, though limited, are also available.
The ACTSSL, meanwhile, had been convened in 2014 to support the development of this specialty with emphasis on improving patient care.
| Oxford surgeon who touched numerous lives rememberedHe is no more but his memory and work will be etched forever not only in the hearts but also the minds of numerous doctors as well as patients. He is none other than eminent Cardiothoracic Surgeon, the late Dr. Ravi Pillai, and the honour of delivering the inaugural ‘Ravi Pillai Memorial Oration’ aptly fell on senior-most Consultant in the field at the NHSL, Dr. Chandima Amarasena. Dr. Pillai had facilitated the training of many at the Oxford Heart Centre, United Kingdom, where he worked for over 25 years and Dr. Amarasena had been one of them.
For Dr. Amarasena, Dr. Pillai had not only been his teacher and mentor, but also his friend. It was with much emotion that he looked at Dr. Pillai’s contribution to cardiac surgery in Sri Lanka, while giving a brief history of cardiac and thoracic surgery here, as well as some facets of Dr. Pillai’s professional and private life. He recalled how in 2011, Dr. Pillai took early retirement from the UK’s National Health Service (NHS) to settle down in Sri Lanka and try his hand at farming aloe vera in Jaffna for export, after joining an agricultural cooperative. A business journal had stated: ‘The Oxford Surgeon who became a Jaffna Farmer’. Moving onto Dr. Pillai’s contribution to cardiac surgery in Sri Lanka through which he touched numerous lives, Dr. Amarasena says he personally trained five Sri Lankan post-graduate trainees at Oxford, the largest number by one surgeon. All five returned to Sri Lanka to serve their motherland and make important contributions such as launching the paediatric cardiac surgery programme; the Coronary Artery Bypass Graft (CABG) surgery in the private sector and then the state sector and also the off-pump CABG; performing the first successful arterial switch operation; an aortic surgery programme to treat thoracic aortic aneurysms and aortic dissections and complex paediatric cardiac surgeries and valve repairs. “Dr. Pillai’s last trainee was a leading member of the team which performed Sri Lanka’s first heart transplant at the Kandy Hospital and was directly involved in restarting heart surgery in Jaffna, assisting Dr. Pillai and performing surgeries himself,” he said, explaining that Dr. Pillai also helped in the foreign training of two others. They included a thoracic surgeon who, on his return, performed the first rib fixation surgeries for multiple fracture of ribs and introduced advanced video-assisted thoracoscopic surgery (VATS) techniques. Dr. Amarasena details how even amidst a flurry of lectures, training programmes and contributions to prestigious medical journals, Dr. Pillai also brought down three teams to perform complex adult and paediatric surgeries both at the National Hospital of Sri Lanka (NHSL) and the Sri Jayewardenepura General Hospital, personally funding most of the cost of these teams. He was also the first surgeon to perform homograft valve implants in Sri Lanka, four successful aortic valve repair (AVR) procedures after obtaining the valves from Oxford, meeting the cost himself. He touched on Dr. Pillai’s “dream” to start cardiac surgery in Jaffna and how to this end he launched the charity, Oxonian Heart Foundation (OHF), with funds from the Pillai family, friends and the corporate sector, while actively doing the fund-raising.
“With the wheels of bureaucracy turning slowly with regard to establishing cardiac surgery at the Jaffna Teaching Hospital, Dr. Pillai, never a man to let the grass grow under his feet, negotiated an agreement with the private Northern Central Hospital (NCH) to provide the building and staff, promising training and equipment through the OHF,” he said, adding that surgeries were performed at a subsidized cost. It had been a proud moment for Ravi when the first open heart surgery was performed at the NCH, followed soon after by the first valve replacements and first CABGs. This unit continues to function today. He says Dr. Pillai’s work in the north extended beyond the operating theatre and the hospital to many free medical clinics for impoverished heart patients, while his pioneering efforts paid off elsewhere too when the Jaffna Teaching Hospital started its cardiac surgeries in 2017. To honour his contributions, the College of Surgeons of Sri Lanka awarded him an honorary fellowship. Dr. Amarasena recalls the shock when Dr. Pillai passed away after a brief illness in 2018. But he has not been forgotten and the OHF – UK has decided to award fellowships for Sri Lankan cardiac surgical trainees, continuing his legacy. Quoting the Elizabethan playwright Christopher Marlowe who famously said, “Honour is purchased by the deeds we do,” Dr. Amarasena winds up that “Dr. Pillai has done more than that”.
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Renaissance man of cardiothoracic surgery felicitated
Dubbed as the ‘Renaissance man of cardiothoracic surgery, with a healing pair of hands and compassionate heart that restored and repaired other hearts’, the ACTSSL’s first Lifetime Achievement Award went to Dr. Panini Arinda Gooneratne. In his “impressive” career, among the firsts to Dr. Gooneratne’s credit are performing the first arterial switch operation for the Transposition of the Great Arteries (TGA); introducing and establishing paediatric and neonatal open heart surgery; and carrying out procedures such as Rastelli and Sennings operations, aortic arch replacement, aortic root replacement and elephant trunk procedure for aortic aneurysms. He has also trained the next generation to wield the scalpels, across the country. |
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