A recent article in The Times (March 22) focused on the illustrious career of our compatriot Professor Sir Alfred Cuschieri. It was stated that "although he left Malta in the 1960s, soon after graduating from the University, Sir Alfred still feels Maltese". This is an understatement. Not only does Sir Alfred "feel" Maltese but he has also actively supported Maltese surgery and Maltese surgeons for many years from his professorial unit in Dundee, and continues to do so now that he has moved to Pisa in his mature years. On a personal note I have known Alfred since we were neighbours in Sliema and we have remained close friends ever since.
The article rightly focuses on Sir Alfred's pioneer work in promoting minimal access surgery (popularly referred to as keyhole surgery). Although these techniques are now standard it needed the endeavour and years of research by Sir Alfred and a few other pioneers to establish the feasibility and efficacy of these novel techniques and to introduce them, in the mid-1980s, to a largely sceptical surgical fraternity.
Interestingly, we had in 1986 introduced the first "keyhole" surgery in my speciality dedicated to urology when we introduced percutaneous nephrolithotomy which essentially involved the removal of large stones from the kidney through a small skin incision and using dedicated telescopic equipment and novel stone shattering systems, thus avoiding the large flank incisions which were the routine access to the kidney in those days. This technology had the full support of the Department of Health and quickly gained wide acceptance. The recently established Urology Department at St Luke's Hospital was thus quickly projected into the mainstream of European urology where these techniques were at the time only available in a few centres.
The next year, in May 1987, Prof. Cuschieri performed the first intra-abdominal keyhole procedures at Ninewells Hospital in Dundee. Although the concept of these minimal access surgical procedures was essentially the same as those for kidney access, they were more complex and sophisticated and required new armamentarium and surgical training. This new technology was based on the availability of dedicated scopes to which miniature video cameras were attached and the images viewed on TV monitors. The surgeon works from outside the patient's body by using dedicated tissue manipulators and controlling the whole process by looking at the monitors. This obviously created a new dimension to surgery which threatened to displace classical surgical procedures. These new minimal access procedures quickly gained acceptance particularly by patients who could leave hospital after a few hours with minimal scarring on their body. Prof. Cuschieri became known throughout the international surgical fraternity. We were privileged to be among the first to become aware of this breakthrough in surgery when in 1989, during the First Maltese Medical School conference, Prof. Cuschieri showed a video of this procedure to a captive Maltese medical audience.
In 1991, when I was appointed Director of Surgery, I made the introduction of keyhole surgery as one of my objectives. However, I was conscious of Sir Alfred's sage warning not to rush into these new procedures unless we had the right equipment and, more important, surgeons who were well trained in these procedures.
I initially invited a Greek team to teach us the technique by operating on pigs. This initiative was successful and we soon had a second British team to help us start the programme in our operating theatres at St Luke's Hospital.
To ensure patient safety we followed strict guidelines and limited operating privileges in this technique to two surgeons. The rest is history. At present the surgical department at Mater Dei Hospital boasts of a number of well trained "keyhole" surgeons and the number and breath of procedures is continually expanding.
Maltese surgery continued to benefit from Sir Alfred's regular visits to these islands and we owe him a great deal of gratitude for his continual interest in the development of our young surgeons. Prof. Cuschieri was knighted by Her Majesty Queen Elizabeth II for his contribution to British and world surgery. Malta cannot but feel proud of such a worthy son.
Prof. Cutajar was formerly Director of Surgery at St Luke's Hospital.
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