The 19th annual meeting of Egyptian Society of Laparoscopic Surgeons (ESLS) congress report

The 19th annual meeting of Egyptian Society of Laparoscopic Surgeons (ESLS) was held on 16-17 February 2023 at 5 Stars Semiramis intercontinental hotel, Cairo, Egypt. The president of the Congress is Prof. Faheem Bassiony, Honorary President Prof. Raouf Sallam, Vice President Prof. Kais A. Dayem Abulata, Secretary General Prof. Hassan Shaker, Congress Secretary Prof. Mohamed Hakky and Treasurer Prof. Ahmed Lofty. It was preceded by pre-congress hiatus hernia training course at the learning center (LRC) at Cairo University.

The meeting is CME accredited and accumulates 30 points. It is a wonderful national and international meeting which brings together a constellation of excellent experts nationally and internationally and discusses state of the art in surgery.

This year, however, the program was two days only, not three days as usual, excluding pediatric surgery session.

There were 14 sessions divided into 2 halls, with 7 sessions in each. Hall A hosted GIT, bariatric and metabolic I, the Italian job session, which is an annual gold standard session in this meeting led by Prof. Gianluigi Melotti, the eminent Italian surgeon and Godfather of minimally invasive surgery (MIS) in Egypt, and the 2 keynote lectures on the first day.

Hall B hosted General I and hepatobiliary I and colorectal I on the first day.

On the second day, Hall A hosted hepatobiliary surgery II and bariatric and metabolic II, the Turkish session and Italy on the Nile; the Italian presence is quite evident because with the help of Italian MIS pioneers such as Gianluigi Melotti, MIS adoption was made possible after a period of resistance in the early 90’s.

Hall B on the second day hosted General II and made in Italy, the robotic, GIT and Colorectal II.

The congress was remarkable for a unique collection of surgeons’ videos describing their experiences, and what was noticeable was the high quality of videos and the advancement of surgical techniques. Beyond that, there were some very interesting topics raised on surgical education and artificial intelligence.

Highlights of the sessions on day one.

The meeting started with a very interesting presentation by Heba Taher, Associate Professor of Pediatric Surgery, who works at Cairo University. Her presentation received positive feedback from the audience and the President of ESLS meeting, Prof. Faheem Bassiony. It was about new perspectives on surgical education after highlighting the fact that 5 billion people in the world do not receive adequate surgical care, especially in low- and middle-income countries and added that death from surgical mistakes is the 3rd leading cause of death in the world, emphasizing the importance of developing surgical training and adoption of new training models, not relying completely on the old fashioned Halstedian training model.

She stressed the importance of visualization and virtual reality in training and even lucid dreaming as a way of training, stressing that the surgical field should be as safe as the aviation industry (link to presentation). She also grasped the opportunity to announce her book Intuitive Surgeon, which is published on Kindle Unlimited (link to book).

Following her presentation, Prof. Jan F. Kukleta gave a series of presentations about the management of different types of hernias. Prof. Kukleta from Switzerland is one of the world-renowned surgeons in hernia surgery. He gave a talk about the role of botulinum neurotoxin A (BTA) prehabilitation in complex hernias (link to presentation), as well as a couple of interesting rarely addressed yet frequently encountered topics in hernia, which are the management of cord lipoma in groin hernia repair (the missing chapter of hernia surgery guidelines), as well as rectus diastasis -update in 2023, a finally recognized surgical problem especially in multiparous women, shedding interesting perspective of human anatomy (link to presentation).

Prof. Andrew Gumbs, an eminent professor of hepato-biliary surgery, presented a survival study titled: International multi-centric minimally invasive liver resection for colorectal metastasis. He highlighted the importance of randomized controlled trials and good data, as well as the necessity of having a data scientist at each center (link to his first presentation here)[Figure 1]. Prof. Gumbs is also the Editor-in-Chief of Artificial Intelligence Surgery journal (AIS journal) and a leader in artificial intelligence surgery, trying to spread the word about and adoption of artificial intelligence in every country he visits. He also gave a second presentation about the topic of AIS on the second day, titled Artificial intelligence surgery: how do we get autonomous actions in surgery; a link to his presentation introducing the audience to AIS is (here). An important point to mention is that artificial intelligence surgery is unlike artificial intelligence in surgery. Without the preposition, it refers to automation in surgery and autonomy is comprised of 5 levels. Currently, most devices, even robots, are not beyond level 1 autonomy.

Figure 1. Photos of international guests and conference hosts: (A) Prof. Faheem Bassiony and Mohamed Hakky; (B) Dr. Heba Taher Intuitive Surgeon Presentation; (C) Prof. Hassan Shaker; (D) Prof. Mohamed Hakky and his bright son Mr. Sherif Hakky; (E) Prof. Andrew Gumbs; (F) Prof. Adrian Park; (G) Group Photo; (H) Dr. Heba Taher: author of intuitive surgeon. Revolutionizing surgical training.

Another remarkable presence at the meeting was Prof. Adrian Park, who was visiting from Washington DC and was the head of Surgical Department at John Hopkins University. At this meeting, he shared a breakthrough in the surgical field, which is the laser speckle contrast imaging (LSCI) in achalasia surgery, which was the first time used in this kind of surgery in his center and first announced in our meeting. LSCI provides real-time imaging as the surgeon operates, providing real-time vision of the vasculature and the mucosa status. This was mentioned in his presentation on an approach to achalasia treatment failures; also a link to his presentation is (here). Prof. Adrian Park gave two presentations on the second day, one of which is always a highlight of his talk, which is an update on surgeon ergonomics (link here). Many surgeons suffer from musculoskeletal problems due to faulty posture while operating, and he describes ideal ways to overcome this problem using ways thoroughly studied in his research lab. He also gave a talk about the management of sports hernia.

Colorectal and bariatric talks were impressive in this meeting, with top experts sharing their remarkable experiences; some of them really deserved more than 15 minutes to cover their talks and mention all tips and tricks. The UK had a strong presence in colorectal surgery led by Mr. Ken Campbell, director of Lower GIT Training University of Dundee. His presentation was about minimally invasive complete mesocolic excision: Evidence and technique, highlighting the importance of understanding of open book concept, understanding vasculature, variations in vascular anatomy, CT road mapping efficacy and safety (link to Mr. Ken Campbell here). Majid Bassuni, a professor at Sheffield University, presented about combined laparoscopic and endoscopic resection for early colonic cancer: propensity prospective study and review of literature. His second talk was about the prevention of abdominal wall hernias and perineal hernias after laparoscopic colorectal resections: pros and cons of mesh. His third talk was about the uses of ICG in laparoscopic surgery: anatomy, safety and feasibility, and his fourth talk was on laparoscopic, robotic, open or TaTME for rectal cancer: questions more than answers (some of his talks will be available on the channel under the ESLS playlist on Intuitive surgeon YouTube channel).

Another guest from the UK was Prof. Nader Francis, Honorary Professor at UCL at Division of Surgery and Interventional Science. He gave a talk about the oncological outcomes of TaTME in England and his second talk was about the role of MIS in colorectal elderly patients, which marked the end of the conference on the second day.

Other honorable mentions in colorectal surgical talks on the first day were those by Prof. Soliman El Shakhs. He gave an interesting talk about the role of laparoscopy for ultra-low rectal cancer and introduced PET MRI to the audience, showing very informative radiological images. A presentation about restorative total proctolectomy for familial adenomatous polyposis: indications and technical steps by Dr. Islam Hany, as well as minimally invasive suture proctopexy by Ahmed Aly Khalil.

The keynote lectures were on day one and were given by Prof. Faheem el Bassiony, who gave a very important presentation about going green in surgery, discussing measures to save energy, which is a hot global topic and very important to implement (link to his presentation) [Figure 2]. Prof. Gianluigi Melotti talked about the strong Italian-Egyptian relations and a keynote lecture by eminent female surgeon Micaela Piccoli, who is an expert robotic surgeon and very influential in her field. She gave a talk about the robotic repair of giant hiatal hernia with biological prosthesis: a single institution experience matching the theme of the pre-congress training course (link to her presentation). The Italian team gave various presentations about their experience with robotic surgery in the oncological field, sharing their tips and tricks, as well as their vision for future development of the role of robotic surgery in esophagogastric junction by Mario Annecchiarico, endoscopic gastric plication for obesity: our experience by Alessandro Balani, robotic D2 lymphadenectomy for gastric cancer, mini-invasive adrenal surgery: moving from adenoma to carcinoma on the first day. On the second day, they extended their talk about the role of robotic surgery in colorectal cancer, focusing on the use of robotic surgery in different ages, such as robotic colorectal surgery in the elderly: is it worthwhile? By Antonio Crucitti, Da Vinci: a new playmate for paediatric surgeon by Ceccarelli Pierluca, robotic prostatectomy with three robotic platforms by Bernardo Rocco, advantages of minimally invasive robot-assisted abdominal wall surgery by Davide Gozzo, robotic Ivor-Lewis resection by Graniano Perazza.

Figure 2. (A) Left: Prof. Gianluigi Melotti, among the first experts who helped the Egyptian Society of Surgeons to adopt MIS and implement it in Egypt (the Godfather); Right: Prof. Micaela Piccoli, chief surgeon at Azienda Unità Sanitaria Locale Modena; (B) Prof. Micaela Piccoli; (C) Prof. Micaela Piccoli and Prof. Gianluigi Melotti.

One particular presentation, which stood out but was unfortunately interrupted by some technical difficulties, was by Dr. Serena Langella, who is a radiologist, about ultrasound-guided laparoscopic liver resection.

The Tunisian team also make great contributions to this meeting, especially in hepatobiliary surgery, with several contributions to the management of hydatid disease.

Metabolic and bariatric sessions were very informative as mentioned earlier and surgeons shared very informative videos, which were extensive and will require a booklet to describe, but the honorable mentions are presentations by Prof. Mousa Khorsheed from Kuwait about observations and comments: adiposity-based chronic disease: understanding the disease and therapeutic spectrum, and his second presentation, BP limb length in MGBOAGB: how much is too much?

Moataz Basha from Qatar reported about the restoration of normal anatomy after gastric bypass and Abdel Rahman Salem from Saudi Arabia presented the laparoscopic D-sleeve gastrectomy preliminary report.

Mr. Sherif Hakky, who is a graduate of Cairo University and trained at Cairo University and the UK, gave an interesting presentation about redo surgery revisions, the challenges of unknown and unorthodox primary surgeries, and a video presentation and discussed with the floor on what could have been done differently.

All of the above were the conference highlights.

The meeting is usually held in February each year, and for future announcements, please visit Egyptian Society of Laparoscopic Surgeons Congress website.