NIKI 2009 REPORT
Pari-Naz Mohanna and Asif Haq
Again it was a great privilege for us to be invited by Dr Alireza Haghighi to participate in the NIKI trip to Iran for the second year running. It was wonderful to meet up with the NIKI faculty who had become such good friends the previous year. The academic trip was very well organised and during this time we visited three university Hospitals; Khashan, Zahehdan and Kermanshah University of Medical Sciences. This year the NIKI faculty was smaller and consisted of 15 delegates from the UK and USA. On arrival at each University we attended a welcoming conference which allowed us to introduce ourselves, explain the work that we do and meet our counterparts at the University. We were very impressed with the expertise, enthusiasm and dedication of the Doctors and Ancillary staff at all three units. All three hospitals were very well organised and had preselected suitable patients for us based on the CVs they had received. We undertook consultations with these patients and swiftly moved on to perform surgical procedures.
Khashan University of Medical Sciences was opened in 1986 with an intake of 150 students and now houses over 600 students. The Chancellor of the University Dr Nickbacht and his team were wonderful hosts. We linked up with Dr Behrooz Kelidari a very well established and enthusiastic General Surgeon with a special interest in laparoscopic surgery. He presented us with a 45 year old man with a low rectal carcinoma who required an abdominoperineal excision (APE) and adjuvant radiotherapy. At first the patient was very reluctant to proceed as he did not want to have a stoma, but after many consultations he understood that this procedure would have the best prognosis. In order to accelerate wound healing and minimise post operative complications we advocated that he should also undergo an immediate perineal reconstruction using bilateral inferior gluteal artery perforator flaps (IGAPs). The latter is a novel procedure which we have developed at St Thomas’ Hospital in London and over the last year has revolutionised the management of these patients. In view of Dr Kelidari’s interest in laparoscopic surgery and ambition to develop and establish a unit in Khashan Asif suggested that the procedure should be performed laparoscopically. Unfortunately the equipment in stock was not adequate for the procedure but Asif was fortunate enough to be put in touch with the Ethicon representative Shervine, who was extremely helpful and travelled from Tehran to Khashan with all the equipment that was required. As the procedure of a laparoscopic APE and bilateral IGAP reconstruction was the first to be performed in Iran it generated a lot of interest with over 25 Doctors in attendance in the operating room. The buzz of excitement in the operating theatre filled was elating. Asif and Dr Kelidari performed the colorectal part of the procedure and I carried out the perineal reconstruction.
Despite operating in a foreign environment the procedure went very smoothly thanks to the professionalism and expertise of the theatre staff and the Shervine. The patient made an uneventful post operative recovery and was discharged at 5 days with clear resection margins and was due to start a course of adjuvant radiotherapy. This case was followed on by 4 other laparoscopic procedures which were also very successful. It was a very exhausting day as we started at 0730 and did not finish until midnight but the sense of camaraderie and moral satisfaction energised us throughout the day.
Zahehdan University of Medical Sciences is situated in Zahehdan, a relatively new city only 70-80 years old. The University is 22 years old with over 2,000 students. Dr Zeratian and Dr Eskandari took us under their wings and looked after us during our stay. They had a very well established unit with an immense workload owing to the large volume of trauma cases they received. It was amazing to see the meaning of true General Surgeons who had to be a Jack of all Trades. Nonetheless the trainees had had minimal exposure to aesthetic plastic surgery and were very keen to be taken through some cases. They had organised for a 26 year old lady to see me regarding a bilateral breast reduction, a procedure which was not undertaken at this hospital. This case was televised to the lecture theatre and allowed me to take the trainees through the procedure step by step whilst fielding questions live. Subsequently the trainees have informed me that they have performed bilateral breast reductions after following the instructional DVD that was made on the day of surgery. In addition I was privileged to perform an abdominoplasty on the wife of the Professor of Surgery Dr Abazary.
Finally at Kermanshah University of Medical Sciences we were involved in a very well organised Academic Program which gave us an opportunity to deliver our key lectures in the areas of breast reconstructive surgery and advances in colorectal surgery. Again at this University there was no established Plastic Surgery training program and I set the wheels in motion to establish an observership program with Guy’s and St Thomas’ Hospitals where I am based. A frequent request is again for bilateral breast reductions and as a result the Consultants and Trainees were very keen that I perform this procedure so that it could be filmed and used as training material.
The 2009 NIKI trip to Iran has again been a fabulous experience on so many levels for us. It provided us with an opportunity to meet new colleagues in Iran and for us to benefit bilaterally from each others knowledge and expertise and build collaborations. We would like to sincerely thank Mr Alireza Haghighi, Dr and Mrs Farivar for organising such a wonderful trip, our 3 hosting Universities for their generous hospitality, kindness and care.
