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FROM PHILLY TO THE PHILIPPINES: TEMPLE SURGEON SHARES HIS TALENT IN HIS NATIVE COUNTRY
January 2011 (from Temple Talk magazine)
CONTACT: Christopher Guadagnino firstname.lastname@example.org
Ian Soriano (wearing Storz OR cap) showing the Open Hasson Technique for abdominal access.
Ian Soriano, MD, Assistant Professor of Surgery at Temple University School of Medicine and laparoscopic and bariatric surgeon at Temple University Hospital, grew up in the Philippines and went to medical school there. This past August, he had the honor of being invited to return there by the Global Affairs Committee of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) with a special mission: to share his talent and experience with local surgeons so that their patients needing a very common operation—surgical removal of the gallbladder (cholecystectomy)—would no longer have to undergo conventional open surgery.
Soriano is skilled in performing minimally invasive or laparoscopic surgery—in which small tubes with cameras and instruments are inserted through tiny incisions in the patient's abdomen and are guided with the help of a video monitor. The laparoscopic procedure typically allows the patient to go home quicker on minimal pain medications and return to work within a week, whereas the traditional open surgery procedure requires a 6- to 8-inch incision under the right rib cage, a longer hospital recovery, and two to four weeks recuperation before returning to work, says Soriano.
Patients at Temple University Hospital and other U.S. hospitals for years have had the benefit of skilled surgeons such as Soriano who are proficient in laparoscopic surgery. But surgeons in some countries still don't have the training or resources to offer it to their patients. Soriano was invited to participate in the SAGES International Proctoring Course by Mayo Clinic surgeon Horacio Asbun, MD, who also chairs the SAGES Global Affairs Committee.
Their mission was different from traditional ones in which U.S. surgeons share their good works by visiting third-world countries to perform surgery on as many needy patients as they can during their visit. Instead, Soriano and Asbun taught local surgeons how to perform a procedure they had not done before on their patients. "A transfer of skill and competence to local physicians makes a lasting impact by reaching far more patients," says Soriano.
SAGES team after the 19th and last case (from left): Dr. Akalal (trainee), Dr. Soriano, Dr. Horacio Asbun (SAGES team leader), Denise Stines, RN (SAGES coordinator), Dr. Cerillo (trainee).
Soriano and Asbun, joined by SAGES coordinator Denise Stines, RN, trained two surgeons at the Zamboanga City Medical Center, Zamboanga City, Philippines. Nineteen patients, all indigents who could not afford to pay for their own surgery, were chosen and underwent successful laparoscopic cholecystectomy over a period of four days, with Soriano and Asbun proctoring the local surgeons in the finer points of performing the surgery safely and proficiently, and how to avoid complications. "We did the operation on one patient, and they did the other 18 patients with us talking them through the case," says Soriano. He and Asbun were right there to step in, if needed.
During the trip, Soriano and Asbun adapted the technique to limitations of locally-available technology so that the procedure would be sustainable and not dependent on donations. "This meant things such as using first-generation video monitors instead of the more advanced ones we have at TUHS, and using locally available specimen retrieval bags and non-disposable instruments," Soriano notes. "We also focused on teaching the surgeons, nurses and residents about equipment maintenance and trouble-shooting, assisting tips, and pre-op and post-op care," he adds.
When laparoscopic cholecystectomies were first performed in the U.S. in the early 1990s, complication rates were initially high, then dropped as surgeons gained more experience with the procedure. "Our goal, in places that are just learning the procedure, is to teach local surgeons to avoid those complications right away and leap quickly over their learning curve," says Soriano.
"In the end, it was a very rewarding trip. We felt that we made a difference in the community in bringing a technique that we have been doing in the U.S. for over 20 years now, and the two surgeons we trained will now also be training other surgeons in the area, multiplying the benefits to the community of Zamboanga City," Soriano notes.
Soriano's trip embodies an important element of Temple's health mission. "Temple is one of the most diverse groups of faculty/student bodies of any academic medical center in the northeast. Part of our faculty's mission is to provide excellent education to instill an ethic of human service and lifelong learning. We're fulfilling that mission beyond our local Temple community and making it global," Soriano adds.