The CME was chaired by Dr. Mohan A Mathew- Senior Consultant, Director & Head Of Anaesthesiology & Critical Care, and Dr. K. M Mohammed Iqbal- Senior Consultant & HOD of Rheumatology.

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Apart from being an extraordinary  keyhole surgeon,  Dr. Padmakumar, who is  one of the unique surgeons  in the world performing all forms of  minimally invasive surgeries, is well  known for his caring and compassionate  attitude. He, who has dedicated  his entire life for hospitality, is  not only an asset to our state of Kerala,  but also a gem to the entire world.  He is at a time a student, who is always  eager to learn new techniques  in laparoscopy; as well as a teacher  who finds happiness in sharing what  he has learned, to others who are eager  to know about the topic.

After securing an MBBS degree  from Alappuzha Medical College, his  destiny was to be a part and a leader  of a medical revolution. As a surgeon  with around 23 years of experience,  he stands with a magical method  which offers a permanent solution to  painful surgeries. It is important to  remember that the doctor has contributed  immensely in developing  this surgical method and in passing  what he has learned to the next generation  for the benefit of the society.

It is the knowledge and experience  he has gained from New Delhi  AIIMS, Chennai Apollo and Mumbai  Tata Memorial, and his hard work,  accuracy and self-learning capability  is what makes Dr. Padmakumar one  of the finest Keyhole surgeons in the  world. He is a source of comfort not  only to patients in Kerala, but also to  patients in the GCC countries. He  is the fifth person in the world and  the first person in the Gulf countries  and Kerala to conduct a surgery to  surgically resolve the condition of  diabetes under the non-obesity category.  He is one of the rare doctors  who has expertise in endoscopic thyroidectomy, and is the first doctor  to successfully perform intestinal  surgery with just two grams of haemoglobin. He is the inventor of  Ileal Hybrid technology. It is a commendable achievement that he was  ranked twenty-eight when the 100  most powerful Indians were selected  in Gulf countries in the year 2012.  The doctor has a lot of golden feathers  in the crown of excellence such  as Global Achievers Award 2014,  Voice of Gulf Returnees Excellence Award 2016 and Icon of Laparoscopy 2017. In the year 2016, he was the  National President of the Indian  Hernia Society. Currently, he is the  Chairman of the Association of Surgeons  of India (Kerala Chapter) and  National Vice President of SELSI  (Society of Endoscopic and Laparoscopic  Surgeons of India). Let’s hear what the apostle of simplicity and  service has to say about the importance  of keyhole surgery and many  things related to that. 

The Importance of Endoscopic Neck Surgery

Endoscopic neck surgery is one  of the rare surgeries in the world.  This is mostly done in thyroid cases.  Nonetheless, this can be done in  cases of para-thyroid, thyro-glossal  cyst surgery and lymph node operation.

Specifically speaking, a three year-old Omani child with branchial  cyst condition was treated with the  help of keyhole surgery. Usually, this  surgery is not done in children. This  case is a world record.

Generally,  patients show disinterest to thyroid  surgeries as it may leave a mark on  the neck of patients. Today, using  the potential of keyhole surgery, this condition can be cured without the  fear of any permanent mark. The  publication about Endoscopic Neck  Surgery has appeared in the International  Journal. A special invitation  was made by the government  of Dubai to perform these surgeries  on their natives. What makes this  method attractive is it does not make  permanent mark and does not consume  too much time for recovery.  This surgery is of great importance  in the treatment of cancer.

Small Wound, Excellent  Results

Minimally invasive surgery  training needs lot of dedication and  hard work. Many complex surgeries  which required large cuts (20 to 30  cm) in abdomen or chest can now  be performed using one or two centimetre  cuts. This will bring down  pain very significantly and reduce  hospital stay. Patient will be in a position  to resume normal activities  in few days. In cases of cancer, as  the cuts are very smaller in laparoscopy,  patient can proceed with  additional treatments like chemotherapy  or radiation without much  delay. The need for blood transfusion  is reduced to one-hundredth as we  have precision, magnification by HD  camera and vessel sealing by use of  ultrasonic devices.

Obesity Treatment

Obesity in children is managed  by Intragastric balloon placement  with the help of endoscope. Women  suffering from infertility due to polycystic  ovarian disease also benefits  very well by this procedure, if they  have high levels of body fat. People  with morbid obesity will require Bariatric surgery. This keyhole procedure  helps them not only in fat  loss or weight loss but also helps to  resolve their medical conditions like  Diabetes, high BP, high cholesterol,  sleep disorders. The joint disease &  fatty liver also improves a lot once  the person loses weight. Risk of  cancer especially of colon, breast,  ovary – are reduced remarkably with  weight loss.

Diabetes cure through surgery

It is a big deal that diabetes can  be cured using laparoscopic surgery.  It is an undisputed reality that there  is no clear understanding about this  among people. This surgery is normally prescribed to type-2 diabetes patients,  and is very effective. This is called Hybrid  Ileal Interposition. It has been featured in  an International Journal as a surgical innovation.  This treatment is now very popular  around the world. I was an invitee in the first  IFSO conference held in Canada in 2014.  Hybrid Ileal Interposition has gained greater  recognition than Robotic Surgery when it has  been identified that the former consumes less  time and costs less compared to the latter.  If this surgery is done in a patient with diabetes  type-2, he/she can taste cure within a  timeframe of 24 hours itself. If one is obese  or overweight and under treatment for type-2  diabetes for long time, he/she can be treated  with this method – which helps to adjust the  intestine position and resume insulin production.  But, this type of surgery is not effective  in type-1 diabetes mellitus patients in which  insulin production is completely defective.

Laparoscopic Hernia Surgery

All kinds of hernias can be effectively  managed by minimally invasive technique. It  avoids large cuts especially on the area of hernia  which is already weak. Using a one centimetre  cut, the lap surgeon can place large  mesh – five times the size, possible in open  surgery. Mesh will be placed in the beginning  portion of hernia so as to get best strength  and least reaction with skin and fat. It gives  excellent results as recurrence chance is only  0.1 percent and infection chance is very negligible.  Patient can be active in few days’ time  compared to months of rest in cases done by  open techniques.

How did you get interested in  Laparoscopy

Laparoscopy was introduced in India while I was doing my post-graduation in New  Delhi. It was only few years since its inception  in the world. My training period gave me  the opportunity to observe and compare the  laparoscopy with open methods. The remarkable  advantage and comfort of laparoscopy  experienced by patients, generated interest  in me to pursue this speciality. I have trained  and developed a team of experts who are now  capable of performing these procedures and  surgeons from all across globe continue to  benefit from our training programmes.

Keyhole surgery: Further studies are underway

Right now, there are several surgical associations  across the world. Special live operative  sessions and conferences are arranged  for – the members of these associations – who  are interested in this specialty. In some cases,  only a week long session is required to get  an idea of this method. Sessions about this procedure also improve  the knowledge of both teachers as  well as students. I was a person who  learned this technique with my own  effort. Earlier, it needed at least one  year to learn this method. But, now,  it requires only weeks. What attracts  doctors is the fact that laparoscopy  require less time to perform.  This surgical procedure is taught  through several steps and methods.  Large pigs in animal labs at Yenopoya  Medical College are used for  training purpose. To get an opportunity  to try this method on human,  a surgeon has to get acquainted  with this technique by observing  several cases on a regular basis.  International Conference is organised  every year to discuss the latest  developments of this specialty, and  to promote this method. The main objectives of Verwandeln Institute in  Kochi are to promote Laparoscopic  training and conference. The institute  activity benefits learners, and  helps patients to be aware of this  surgical innovation. Only when  patients are aware, they seek such  procedures and give consent to  laparoscopic surgeries. There is an  outpatient section, named Keyhole  clinic in Kochi to educate patients  about this method. For those who  need the surgical service, it is done  at VPS Lakeshore hospital.  There is a general confusion  about whether there is any difference  between keyhole surgery and  laparoscopy. Actually, laparo means  abdomen and scope means watch.  That means when done in the abdomen  – it is laparoscopy; when done  in the chest -thoracoscopy; when at  the joints- arthroscopy; and when in  the neck- endoscopic neck surgery.  Laparoscopic method is helpful to  treat cancer – especially in cases  connected to intestine. It avoids  bringing out intestine – stoma.

Some experience

Jehovah’s Witness belief group  will not accept blood transfusion.  Once such a patient, with an intestine  bleeding condition, consulted  me. For him, his belief was much  higher than his life. To save him  and his belief, for the first time in  the modern medical history, surgery  was performed on him with just 2  gmHb; without the support of any  blood administration. He was given  oxygen assistance for at least four  weeks. An injection to improve haemoglobin  level –was administered.  He successfully recovered from his  disease. That story was featured in  several global journals.  For a doctor, what is important is  the health and satisfaction of his patients.  He should be willing to go to  any extend to help his patients. Had  I not taken that risk, the aforesaid  patient would not have survived his  disease condition.

Likewise, a surgery performed  on a cancer patient who was turned  away by almost all major hospitals  across India is also noteworthy. She  was struggling with the pain caused  by the disease condition. The tumour  that had developed in her pelvis  had spread to almost all nearby  organs. Through surgery, the size of  the tumour was reduced to around  1/20. It is very satisfying to see her  moving around happily.  A surgery done on a woman who  suffered a stab injury from a guest  worker is similar to those mentioned  above. She was bleeding to death. In  that case also, the patient was successfully  saved by an emergency  chest surgery within minutes of her  arrival to hospital.

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Training was conducted on Endotrainers, Suturing, Knotting, Videos, Energy Source, Video Sessions, Demonstration, Updates on Mesh, Fixation devices, Hernia Surgeries (TEP, TAPP, Ventral hernia), Bariatric Surgery, Endoscopic Thyroidectomy.

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Bariatric surgery is performed to restrict the intake of food or to reduce absorption of food from stomach and intestine. Thus this procedure results in overall body weight reduction and helps improve associated medical disorders that result from excess body weight.

Before Bariatric Surgery

After Bariatric Surgery

Video Testimonials

Videos Related to Bariatric Surgery

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KASICON 2019 was conducted at MES Medical College Perinthalmanna from 26 to 28 April 2019. More than 400 Surgeons from all across Kerala participated in this Continuing Medical Education Programme.

Related Links

• Kasicon 2019 – Diabetes Surgery Faculty
• Dr. Padmakumar – Professional Excellence Awards
• Dr. Padmakumar – National President Indian Hernia Society – March 2016

Video Talks by Dr. R. Padmakumar

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The annual state conference of Association of Surgeons of India Kerala Chapter (KASICON 2019) was conducted at MES Medical College Perinthalmanna from 26 to 28 April 2019. More than 400 Surgeons from all across Kerala participated in this Continuing Medical Education Programme.

Diabetes Surgery Medical Publications & Articles

Effectiveness of Minimally Invasive Hybrid Surgery for Ileal Interposition (MIHSII) for the Resolution of Type 2 Diabetes.

MIHSII is an innovative technique in which sleeve gastrectomy is performed laparoscopically, followed by extracorporeal ileal interposition performed through a 5-cm midline incision. The procedure was performed on 31 T2DM ( type 2 diabetes) patients, 17 males and 14 females.

Efficacy of Laparoscopic Sleeve Gastrectomy in Type 2 Diabetes even with BMI less than 35: A Retrospective Study.

To evaluate the effectiveness of Laparoscopic Sleeve Gastrectomy (LSG) for resolving type 2 diabetes in obese patients even with BMI<35

Keyhole Surgery for Diabetes – Malayalam

Diabetes Surgery – Keyhole Surgery for Type 2 Diabetes Resolution

Type 2 diabetes mellitus (T2DM) is a common disease associated with numerous complications. Obesity is the leading cause of the increased incidence of type 2 diabetes mellitus in both developed and developing countries. 

Related Links

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