Articles
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October
2000
Volume 5, Issue 5
Editor: James E. Carter, M.D., Ph.D., F.A.C.O.G |
ISGE
Training Committee Report
Alan Gordon, M.D.
John Newton, M.D.
ISGE, in May 1999, took over the training
program in endoscopic surgery initially set up
by Alan Gordon under the auspices of the WHO.
The ISGE set up a committee consisting of a
chairman, Alan Gordon, vice-chairman John
Newton, and the following members – Ivo
Brosens (regional coordinator, Europe), Yap
Lip Kee (regional coordinator, Asia), Raphael
Valle (regional coordinator, The Americas),
and Johan van der Wat (regional coordinator,
Africa).
Initially, it was proposed that one or two
training centers be established in China, to
be followed by one center each in Hungary,
South Africa and South America. A local
coordinator was chosen at each of the training
centers who had to be a senior physician in a
training hospital and would then select
suitable clinical material for training. Case
selection was on the ability and needs of the
trainee, not the trainers.
Teams of two trainers would then go to run a
course for five days in each center,
approximately four times a year. As the
process evolved, it became clear that the
needs of the centers were different and
therefore a structured program of addressing
these needs, e.g. initial course in
urogynecology, initial course in advanced
laparoscopic surgery or other endoscopic
needs, was developed in collaboration with the
regional coordinator and the local coordinator
at the training center.
Funding for the travel of the trainers and the
hotel accommodations was from the instrument
company Storz for the first three years, as a
feasibility system (see paper prepared by Alan
Gordon for ISGE, May 199)
A list of trainers was developed by Alan
Gordon from members of the ISGE. This list
specifies their particular skills and
interests, e.g. advanced laparoscopic surgery,
urogynecology and their base hospital address
and contact details. This list is to be added
to by the committee from time to time, in
order to maintain an active list of trainers.
The concept being that those in the Far East
should basically cover training centers in the
Far East, i.e. move within their own
geographic zone rather than crossing time
zones to reach training courses.
A report from the ISGE training committee will
be provided after the programs have been
reviewed by John Newton.
A Needle Puncture that Helped to Change the World of Surgery
An Homage to János Veres
By Prof. István Rákóczi
Budapest Hungary
endomed@mail.matav.hu
The creation of a pneumoperitoneum is the first step that offers space for us to see and work inside the abdominal cavity. Thus all over the world surgeons and gynaecologists every days say to nurses: “the Veres-needle, please.” There are only a few who know who was the ingenious inventor of the pneumoperitoneum-needle and the reason he used this device for originally.
János Veres was born at the beginning of the past century, in 1903, in Hungary, Kismajtény, where his father was the stationmaster of the Royal Hungarian Railways Company. He started to study medicine at the University Medical School of Debrecen, where he got his M.D. degrees in 1927. After a year spent at the Department of Forensic Medicine at the same University, he moved to Szombathely in the western part of Hungary. While working at the department of internal medicine in the county hospital, he gained the title of Specialist in Internal Medicine in 1932. In the same year, he was appointed to the head of the Department of Internal Medicine at the hospital at Kapuvár.
At that time there were a lot of patients suffering from tuberculosis in Hungary (the disease was often called “Morbus Hungaricus”), and a special and useful treatment was the pneumothorax creation. To prevent injuries of the lung while getting through the thoracic wall, but none of them was safe. Veres used his own special, spring-loaded needle to create an artificial pneumothorax even in 1932, and after 950 successful interventions he reported his experiences first in 1936 in the Hungarian language (3). He had to bear those critical remarks that are characteristic of important inventions. Immediately after his original report there was a comment published by another Hungarian internist who claimed the priority for himself as the inventor of the needle and at the same time declared his opinion that “this needle was not suitable for everyday practice.” Veres explained in his answer why his needle was an original one and emphasized its usefulness based on his own experience. The international medical world became acquainted with the Veres-needle in 1938 through his article written in German.
In 1955, Veres moved to Budapest for family reasons. After the death of his wife, he married again and his daughter, Andrea, is still working as a psychiatrist in Budapest.
In Budapest, Dr. Veres was working at different medical departments. Meanwhile he got his Ph.D. in 1958 for his study entitled “Clinical Course and Therapy of Tularaemia.”
During the years in Budapest he continued his pioneer work in the field carbon dioxide snow (cardice) treatment of patients with peripheral occlusion and other circulatory disorders.
In different scientific papers he wrote his name in sometimes with a double “s.” Other times he used only a single “s” so today if we cite him we can use both variations.
The question is, who used the Veres needle for the first time, not to get through the chest wall, but to puncture the abdominal cavity? “We have further evidence in 1952 that he published a case report of a “successful treatment of severe hiccups by performing a pneumoperitoneum.” (5)
His patient had pleural fluid collection because of pleuritis and the fluid was suctioned. Shortly after treatment severe hiccups started which didn’t stop for 11 days. The patient couldn’t eat or sleep, in spite of sedatives, morphium, atropine, etc., medications, even local anesthesia of the phrenic nerve was ineffective. Pneumoperitoneum was performed and the hiccups ceased immediately and didn’t come back again. The success was probably due to the elevation of the diaphragm as a consequence of pneumoperitoneum.
For laparoscopic surgery, probably R. Witsomer, R. Palmer or K. Semm was the first doctor who introduced the Veres-needle. Frequency of injuries and complications during laparoscopic surgical procedures caused by this needle are extremely low provided it is used in the proper way. Although there are some who prefer open laparoscopic surgery or in gasless procedure, the importance of the Veres-needle is obvious. There are a lot of variations and modifications of the needle, but its original idea and technique remain.
Reprinted with permission of the author from The Hungarian Society of Gynaecological Endoscopists Newsletter, Vol. 6, Issue 2, August, 2000.
