The title of the first session to kick-off ESCP’s 14th Annual Conference may have seemed unusual at first to some delegates shuffling into Hall A on Wednesday morning, but it was soon acknowledged by the symposium’s Co-Chair, Professor Des Winter, who explained its origin.
‘Mistakes are the portals of discovery’ is in fact taken from the words of renowned Irish novelist and poet James Joyce, who wrote in Ulysses:
"A man of genius makes no mistakes.
His errors are volitional and are the portals of discovery"
It was a fitting way for Des, Professor at St Vincent’s University Hospital in Dublin and Chair of ESCP's Programme Committee, who is also from Ireland, to open the symposium. It featured three expert speakers, with Co-chair Sara Kehlet Watt (Denmark) first introducing Professor Zoran Krivokapic (Serbia) to speak about surgical stapling. Zoran first presented the audience with a plotted history of its evolution. Modern surgical staplers, he explained, were initially designed for traditional, open surgery. However, with improved monitor technology and computer-managed imaging, laparoscopy became an increasingly viable and popular surgical option.
He went on to address the topic of surgical stapling by stating that anastomotic leakage (AL) is one of the most demanding issues in colorectal surgery. He pointed out the importance of the evolution of stapling in relation to the dangerous consequences of AL. This led to an analysis for the laparoscopic double-stapler technique and explaining that prior to choising a stapler, surgeons have to understand characteristics of tissue, as each tissue type presents unique challenges. Zoran then surmised that surgeons, together with patient, human and facility factors all contribute to the ultimate goal: positive patient outcomes. Finally, he left the audience with one final thought to ponder: is intelligent and robotic stapling the future?
Next, Yuri Shelygin who also referenced James Joyce’s fitting remarks (much to Des’ delight!!) and continued the theme of the session by discussing the role of pre-surgical investigation. He went on to explain the risk factors that lymph node involvement can cause. Traditionally, as Yuri pointed out, surgical treatment involves major abdominal surgery including total mesorectal excision and abdominoperineal resection. However, such radical surgery entails significant complications and impairment in quality of life. This has led to the development of local excision techniques, which include transanal endoscopic microsurgery and operation.
He rounded-up with some take-home messages, including the advice of embracing your pathologist, while he offered a special thanks to Dr. O. Maynovskaya and staff of the pathology lab at State Scientific Centre of Coloproctology in Moscow. He added that rigorous pathological examination after local excision is mandatory, and that the only effective way to fix TEM failure is immediate salvage surgery.
Our last speaker was Dr Tracy Hull (United States), from the Department of Colon and Rectal Surgery at the Cleveland Clinic Foundation, and President of the American Society of Colon and Rectal Surgeons (ASCRS). Tracey’s presentation focused on mistakes and error traps, and how to react in certain situations. She cited a case where a 49-year-old man who leaked after a difficult sigmoid resection for diverticulitis which was met with panicking, poor communication and ineffective support regarding presacral bleeding. Tracy impressed the need to "wait, wait, wait" before assessing the situation and making a suitable plan of action. She went on to discuss techniques and tips to control presacral bleeding such as using thumbtacks (sterilized after being taken from a bulletin board). Another technique put forward was a rectal muscle graft, with tips of waiting when it initially happens and taking your pulse before you move on to the next step. Referring back to her case study, Tracey informed the audience that a rectus muscle graft worked, the specimen was removed, and anastomosis was done, and the patient left happy with no infection and good bowel function.
Rounding-off the three fantastic presentations from our world-renowned speakers, Tracy posed a thought-provoking question: do surgeons always tell the truth to patients? Particularly when mistakes are made? Should they?
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