Contact
Secretary General:
Zvonimir Lovrić, PhD, MD
Tel: ++385 98 281975
e-mail: cone@klovric.eu
Address of the Office:
10000 Zagreb, Croatia
Av. G. Suska 6
COLOMBO 2023
APIMSF - KDU MILITARY
SURGERY CONGRESS - COLOMBO
6th September 2023
University Hospital Kotelawala Defence University (KDU)Sri Lanka.
APIMSF - KDU Military Surgery Congress - september 2023
CONTENTS
Message from the Vice Chancellor .................................................... 05
Message from the Former Vice Chancellor ...................................... 06
Message from the President of APIMSF ......................................... . 07
Message from the Past President of APIMSF ................................... 09
Message from the Secretary of APIMSF ...................................... .. 11
Message from the Dean Faculty of Medicine KDU .................... ..... 12
Message from the Head of the Department of Surgery KDU ........ 13
Message from the ASSET coordinator - KDU .................................. 14
Congress Programme ......................................................................... 15
Pre Congress Workshop ..................................................................... 18
Resource persons ........................................................................ ....... 19
Abstracts of key note, plenary lectures and symposia ................... 31
VICE CHANCELLOR'S MESSAGE
It is my pleasure to issue this statement at the occasion of the APIMSF-KDU Military Surgery Congress.
The General Sir John Kotelawala Defence University (KDU) being the only defence university of the country, is very fortunate to join hands with the Ambroise Paré International Military Surgery Forum (APIMSF) since August 2022.
Since then, The APIMSF–KDU Military Surgery congress is one important milestone in our relationship. We hope to build upon to great heights in the future.
With great enthusiasm of Dr Kosala Somaratne, the President of APIMSF and the KDU staff, mainly the academics of the Faculty of Medicine, KDU we were able to organize this congress successfully. This event being a part of
the KDU International Research Conference (IRC) 2023, brings value to the KDU IRC and vice-versa.
While thanking the APIMSF and all at KDU in organizing this event, especially my predecessor, former Vice Chancellor of KDU, Major General Milinda Peiris, I wish all the success in the deliberations at the congress.
Rear Admiral HGU Dammika Kumara,
VSV, USP, psc, MMaritimePol, BSc (DS)
Vice Chancellor
General Sir John Kotelawala Defence University
FORMER VICE CHANCELLOR'S MESSAGE
It is heartening for me to have associated with Ambroise Paré International Military Surgery Forum (APIMSF) since August 2022 while I was the Vice Chancellor of the KDU. Dr. Kosala Somaratne, the President of APIMSF was instrumental in launching the collaboration with the KDU then. So, with pleasure, I issue this statement at the occasion of the APIMSF-KDU
Military Surgery Congress, which is the second activity in our collaboration. ASSET course which was the first activity in our collaboration was successfully conducted by APIMSF collaboration with KDU for the first time in Sri Lanka.
The role of military surgeons would be pivotal in this collaboration, and my wish is that it would provide a platform for surgeons and academics from around the world to share knowledge and enhance skills. I sincerely hope that the military surgeons taking part in this collaboration would take the leadership in its future endeavors, especially with a possible step forward to
establish a regional center for trauma care at UHKDU, which would expand knowledge sharing among militaries around the world.
With the expertise and the state-of-art facilities available at the Faculty of Medicine, General Sir John Kotelawala Defence University and the University Hospital of KDU supported by the extended faculty of military surgeons of the
tri-forces, we will certainly be able to reach greater heights.
I thank the APIMSF and all at KDU for organizing this event, and I wish all the success in the deliberations at the congress.
Major General Milinda Peiris (Retd)
RWP RSP VSV USP ndc psc MPhil (Ind)
PRESIDENT'S MESSAGE
Dear friends from Sri Lanka and abroad. In this time of serious troubles in the wider geopolitical arena, it take me absolute pleasure to welcome these experts in military surgery from different corners of the globe. I am proud as the
president of the APIMSF and as a Sri Lankan, for being able to make the platform for these top notch people from the NATO and the Russia, who are standing on either side of a wide and gaping geo-political fault line, to sit together as good friends, side by side.
This is truly what APIMSF is all about, the vision of our founder president, the great American Surgeon Professor Norman Rich, APIMSF is a place where both friend and foe sits together as good friends with a single noble mission,
that is to protect the lives of those noblest of clans amongst us, those patriots, those soldiers in the frontlines who took up arms on our behalf.
The forum today which you are sitting in is the result of great story of collaboration, it’s the teamwork of many, who are in this forum and outside.
Everything started with a meeting that happened about a little more than one year ago at the office of the Chief of Defense Staff Colombo, where myself, General Shavendra Silva- the CDS, General Daya Ratnayake- former Army commander, Maj. General Milinda Peiris- then Vice Chancellor of the KDU and Eng. Prof. Prasanna Premadasa- International relations officer of
the KDU, sat together. There, the decisions were taken for the Kotelawala Defence University, the premier defense university in Sri Lanka to start a collaborative journey with the APIMSF, the premier global apparatus of the military surgeons worldwide. Then, on 16th of August,2022 during the World Congress of Surgery - Vienna Austria, the APIMSF sat in a virtual meeting
with the KDU hierarchy whereby a blueprint and a ground plan was laid down for further action.
Maj. General Milinda Peiris as the Vice Chancellor at that time, took a very keen interest in the matter and he was avidly supported by the Deputy Vice Chancellor, Director medical services, Dean Faculty of Medicine and all the Surgeons of the Department of Surgery.
The Head and the staff of the Department of Anatomy were particularly helpful in getting the groundwork arranged to conduct the ASSET course as the first in the region of South Asia and I profoundly thank Professor Mark Bowyer and his team for selecting the KDU as the venue for the ASSET. Taking over the hard work from Maj. General Milinda Peiris, the current Vice
Chancellor Vice Admiral Dhammika Kumara has done an excellent work in arranging everything in a flawless manner.
This great collaboration between the APIMSF and the KDU is something that should be preserved in the long haul and I am sure we all have the right will, vigor and the vision for that.
Let me again thank the all the international membership of the APIMSF for travelling all the way to Sri Lanka for this great moment and the excellent “team-KDU” for the fantastic works they have done.
Hail the collaboration…!
Dr. Kosala Somaratne MD,
Consultant Surgeon
President of the APIMSF
PAST PRESIDENT'S MESSAGE
Distinguished colleagues, esteemed guests, and fellow advocates of military medicine!
As we gather here for the exceptional conference on military surgery and collaboration between the Ambroise Paré International Military Surgery Forum and the esteemed Kotelawala Defence University, I am filled with a profound
sense of honor and excitement. This event marks a significant juncture where our shared commitment to advancing the frontiers of military medical knowledge converges with the spirit of collaboration and international partnership.
Our collective dedication to the well-being of those who selflessly serve their nations is what unites us, transcending geographical boundaries and differences. The journey we embark upon today is a testament to the power of
collaboration and the boundless potential that emerges when brilliant minds from diverse backgrounds come together.
Ambroise Paré International Military Surgery Forum's legacy of excellence in military medical research, practice, and education finds a perfect counterpart in the renowned Kotelawala Defence University. This partnership is a testament to our shared values, collective vision, and the understanding that by pooling our knowledge, expertise, and resources, we can elevate military medicine to unprecedented heights.
At the heart of this conference lies the profound importance of military surgery.
Our armed forces are often faced with challenges that demand the utmost skill, innovation, and precision to safeguard the lives of our brave servicemen and women. As we delve into discussions, share experiences, and present cuttingedge advancements in military surgery, let us remember that the outcomes of our deliberations can shape the future of healthcare for those who dedicate their lives to protecting our nations.
This gathering provides an unparalleled opportunity to learn from each other, to exchange insights, and to foster connections that can lead to groundbreaking collaborations. It is a forum where ideas can flourish, where expertise can be leveraged, and where friendships can be forged that extend beyond this event.
I would like to extend my heartfelt gratitude to the APIMSF President Dr. Kosala Somaratne for getting the international contingent together and initiating this remarkable journey of collaboration. Chief of Defense Staff General Shavendra Silva and former Vice Chancellor Major General Milinda Peiris for unwavering enthusiasm in getting all the pioneering groundwork
organized. Current Vice Chancellor, Rear-Admiral Dhammika Kumara for shouldering and going ahead with the hard work. Deputy Vice Chancellor, Director international relations, Director medical services, Dean faculty of medicine, All the great surgeons of the department of Surgery, Head department of Anatomy and all the KDU hierarchy, I know you are stars who put this magnificent event together. A huge thanks and an appreciation goes to you all, and also to the organizers, the participants, and the supporters who have made this conference possible. Your dedication to the advancement of military surgery and healthcare is truly inspiring, and I am confident that the outcomes of our discussions will resonate far beyond the confines of this venue.
In closing, let us approach these days of dialogue and exchange with a sense of enthusiasm and open-mindedness. Let us engage in conversations that challenge our perspectives, broaden our horizons, and spark new ideas. May
our collaborations continue to strengthen, and may the bonds we forge serve as a testament to the incredible potential that emerges when we work together for a common cause.
Thank you and I wish you all a productive, enlightening, and unforgettable conference ahead.
Prof. Dr. Kenan Yusif-zade
Past-President - APIMSF (2017-2019)
Honoured colleagues
Ambroise Paré International Military Surgery Forum (APIMSF) is a society of surgeons from all over the World who have experienced war surgery and are collaborating in establishing the platform for better understanding and unification
of war surgical determinants and settings.
The Forum is a tool for sharing experiences in war surgery for military surgeons, and aiming to help surgeons with no war experience to find the best way when confronted with war injuries.
The APIMSF is participating society of the International Society of Surgery (ISS).
There are quite a few colleagues from Sri Lanka members of our Forum, and above all, the actual president of the APIMSF is Dr. Kosala Somaratne.
Therefore, the members of the APIMSF are very pleased to have the opportunity to participate in this meeting and course with honoured colleagues from General Sir John Kotelawala Defense University.
Last decade APIMSF had autonomous meetings separate from ISS congresses:
Zagreb-Croatia (2012); Washington-USA (2014), Berlin-Germany (2016), Baku-Azerbaijan twice (2013, 2018) and now in Colombo joined with Sri Lanka defense university.
Hoping that all the best intentions of the APIMSF members will be continued and cherished here in Colombo and this beautiful country of Sri Lanka, I believe that this is not the end of our collaboration.
Prof. Zvonimir Lovrić, PhD, MD
General and trauma surgeon
Secretary - APIMSF
SECRETARY'S MESSAGE
It is with pleasure I issue this statement for the historic occasion of the KDU calendar. The KDU is proud to have been able to organise this APIMSF- KDU Military Surgery Congress as a pre-conference congress of the International Research Symposium – 2023 (IRC-2023).
Coincidently, the IRC-2023 Chair is also from the Faculty of Medicine.
On August 16, 2022, KDU and the Ambroise Paré International Military Surgery Forum (APIMSF) decided to join forces
to build a framework for bilateral cooperation in the field of international military surgery. The KDU being a defence university, we are suitably placed for the task. The KDU Faculty of Medicine has many surgeons, some veterans in the fields of accident, emergency and trauma and some of them are military surgeons. In addition, the surgeons in the Army, Navy and the Air Force are the extended faculty of the KDU.
As highlighted in the KDU website (https://kdu.ac.lk/international-relations/ kdu-and-ambroise-pare-international-military-surgery-forum-apimsf-tocollaborate/), we hope to achieve our objectives in time with the collaboration of APIMSF.
I wish to thank the former Vice Chancellor and the current Vice Chancellor of KDU and the Deputy Vice Chancellor-Defence and Administration, KDU who guided us in this exercise. My thank goes to the President, APIMSF, Dr. Kosala Somaratne and all the office bearers and the council of the APIMSF.
Also, to all those at the KDU, University Hospital-KDU, Faculty of Medicine – who supported this exercise, goes my gratitude. Especially to Dr. Chandana Karunathilake, Consultant Orthopedic Surgeon who is the Military Surgical Coordinator for the collaboration between the two organisations.
I wish all the success in the deliberations at the congress.
Thank you.
Col (Prof) Aindralal Balasuriya
Dean, Faculty of Medicine
Public Health Specialist
MESSAGE FROM THE DEAN, FACULTY OF MEDICINE, KDU
The Faculty of Medicine of the General Sir John Kotelawala Defence University is proud to be associated with Ambroise Pare International Military Surgery Forum to host this APIMSFKDU Military Surgery Congress as part of the International Research Conference 2023 of the General Sir John Kotelawala Defence University.
We are honoured to have with us several distinguished surgeons in the field of military surgery from around the world, and hope that these deliberations will serve as a focal point for continuing collaboration to share each other's knowledge and expertise. We are also extremely proud to facilitate the Advanced Surgical Skills for Exposure in Trauma (ASSET) course of the American College of Surgeons including its course Director Professor Mark Bowyer at the KDU. This skills and expertise gained from this highly regarded course will no doubt enhance the quality of trauma care that we provide in this country.
We welcome you all to these events.
Dr. Dulantha de Silva
Head, Department of Surgery
General Sir John Kotelawala Defence University
MESSAGE FROM THE HEAD OF THE DEPARTMENT OF SURGERY
On behalf of the organising committee, it gives me immense pleasure to welcome the distinguish invitees, international and local faculty members and participants to the APIMSF- KDU Military Surgery Congress, being held on the 6th of September
2023 at the University Hospital-KDU at Werahera.
This congress is organized with the pre congress workshop, the ASSET course which is an advanced trauma management course of the American College of Surgeons.
The APIMSF- KDU Military Surgery Congress, calls upon everyone to update knowledge, upgrade skill and upscale outcome. This is in keeping with our vision of developing the KDU as hub for trauma training in the region.
Dr. Chandana R. Karunathilaka
MBBS, MS(SL), MRCS(Eng),
MCh(Trauma & Orthopaedic)-Edin, FCSSL
Consultant Trauma & Orthopaedic Surgeon
Senior Lecturer, Faculty of Medicine
General Sir John Kotelawala Defence University
MESSAGE FROM THE ASSET COORDINATOR - KDU
APIMSF - KDU Military Surgery Congress - september 2023
| 0700 | Registration |
| 0730 | Arrival of Chief Guest and other dignitaries |
| 0740 | Lighting of oil lamp |
| 0745 |
Welcome address Dr Dulantha de Silva, Head, Surgery, KDU |
| 0750 |
Address by Chief Guest Rear Admiral HGU Dammika Kumara, Vice Chancellor, KDU |
| 0800 |
Address by Guest of Honour Maj Gen Milinda Peiris, Former Vice Chancellor, KDU |
| 0810 |
Address by Secretary of APIMSF Col (Prof) Zvonomir Lovric |
| 0815 |
Address by President, APIMSF Dr Kosala Somaratne |
| 0820 |
Address by Immediate Past President APIMSF Col (Prof) Kenan Yusif-zade |
| 0830 |
Keynote Address - Transforming Trauma Training with Technology- the next revolution Professor Mark Bowyer (USA) |
| 0915 |
Virtual Message Gen (Prof) Pavel Brusov (Russia) |
| 0935 |
Concluding Remarks Dr Chandana Karunathilaka, ASSET Coordinator KDU |
| 0940 | Conclusion of Inauguration and Tea |
APIMSF- KDU Military Surgery Congress,
Inauguration Ceremony
6th September 2023
|
1000- 1100 |
Symposium-01 Basics and latest in Military Surgery Latter-day advancements in Military Surgery (Prof. Kenan Yusif-zade - Azerbaijan) Profound therapeutic hypothermia to treat civilian and combat casualties with traumatic cardiac arrest (Prof. Viktor Reva- Russia) Abdominal gunshot injures (Prof Ari Leppanimi- Finland) The experience of US military surgeons in the deployed and garrison environment (Dr. Kirby gross- USA) (Chairpersons: Prof Jayantha Ariyaratne/Dr. Kosala Somaratne) ------------------------------------------------------------------------------------------------------------ |
|
1100- 1130 |
Plenary 01- Prof Ari Leppanimi (Finland) Duodeno-pancreatic trauma and duodenal fistulas; a surgeon’s nightmare Chairperson: Dr Wasantha Wijenayake/Dr. Hiroya Goto ----------------------------------------------------------------------------------------------------------- |
|
1130- 1200 |
Plenary 02- Dr. Kosala Somaratne (Sri Lanka) Progress of Surgery through war; managing battle field liver injuries to civilian liver resections Chairperson Dr Ranga Perera/Prof. Viktor Reva) ----------------------------------------------------------------------------------------------------------- |
|
200- 1230 |
Plenary 03- Gen. Prof. Horst Peter Becker (Germany) Leadership in Surgery; a personnel perception and a German perspective (Chairperson: Dr. Chandana Karunathilaka/Prof. Kenan Yusif-zade) ------------------------------------------------------------------------------------------------------------- |
|
1230- 1330 |
LUNCH ------------------------------------------------------------------------------------------------------------ |
|
1330- 1400 |
Plenary 04 (virtual)- Prof Kenneth Boffard (South Africa) Blast Injuries Chairperson: Dr. Kamal Jayasuriya/Dr. Tanya Egodage) ----------------------------------------------------------------------------------------------------------- |
|
1400- 1500 |
Symposium-02 Training, simulation and military-civilian partnerships Trauma training, the global scenario and where to place the KDU- (Prof. Ken Boffard- South Africa) NTMC and the trauma training in Sri Lanka (Dr. Kamal Jayasooriya Sri Lanka) US civilian hospitals improve US military trauma care by partnerships. (Dr. Tanya Egodage- USA) Simulation in medical education. (Dr. Thilanka Seneviratne- Sri Lanka) Chairperson: Dr Ranjith Ellawala/Prof. Horst Peter Becker) -------------------------------------------------------------------------------------------------------------- |
|
1500- 1530 |
Plenary 05- Prof Viktor Reva (Russia) Selective aortic arch perfusion and other extra-corporeal life support techniques in severe combat trauma (Chairperson: Dr Dulantha de Silva/Prof. Zvonimir Lovric) ------------------------------------------------------------------------------------------------------------ |
|
1530- 1545 |
TEA -------------------------------------------------------------------------------------------------------------- |
|
1545- 1700 |
Panel discussion Ways and means to make KDU a global center and hub in Military and Trauma Surgery -Rear Admiral Dhammika Kumara-Vice Chancellor KDU -Dr. Kosala Somaratne- President APIMSF -Prof. Kenan Yusif-zada (Azerbaijan) -Prof Mark Bowyer (USA) -Prof. Victor Reva (Russia) -Dr. Hiroya Goto (Japan) -Prof. Horst Peter Becker (Germany) -Prof. Zvonimir Lovric (Croatia) -Prof. Ari Leppanimi (Finland) --------------------------------------------------------------------------------------------------------------- |
|
1700- 1815 |
Launching of the RSMSF Closing Ceremony -------------------------------------------------------------------------------------------------------------- |
|
1815- 1900 |
Interim General Assembly of the APIMSF Presidential speech Welcoming of new membership Further plans for Sri Lanka Plan for the ISW-2024 Kualalumpur |
APIMSF- KDU Military Surgery Congress,
PRE CONGRESS WORKSHOP
RESOURCE PERSONS
Gen. (Prof.) Horst Peter Becker
Germany
Col. (Prof.) Kenan Yusif-zade
Azerbaijan
Col. (Prof.) Zvonimir Lovric
Croatia
Col. (Prof.) Mark Bowyer
USA
Dr.Thilanka Seneviratne
Sri Lanka
Dr.Kosala Somaratne
Sri Lanka
Dr. Tanya Egodage
USA
Dr. Hiroya Goto
Japan
Col. (Dr.) Kirby R. Gross
USA
Col. (Prof.) Viktor Reva
Russia
Prof. Ari Leppanimi
Finland
Pavel Georgievich Brusov
Russia
Prof. Kenneth Boffard
South Africa
Dr.kamal Jayasooriya
Sri Lanka
Prof. Dr. med. Horst Peter Becker, MBA
Brigadier General (ret)
Born 07.11.1956
• General Surgeon
• Executive MBA of Health Care Management
• Chief Editor “Wehrmedizinische Monatsschrift”
Mobil +49 171 215 0901
E-Mail: horstpeter.becker@t-online.de
hpbecker@beta-publishing.com
Actual Occupation Military CV
Chief Editor “Wehrmedizinische Monatsschrift”
Professor for Health Care Management, Leadership and Project Management
| 2019-2022 | Commander Military Hospital Berlin |
| 2014-2019 | Deputy Commander Military Hospital |
| Berlin Ulm | |
| 2011-2014 | Department Director Hospital |
|
Management Medical Command Koblenz Chief of Surgery Military Hospital Koblenz |
1999-2011 |
| 1984-1999 | Surgical Ecucation Military Hospital Ulm |
| 1977-1984 | Medical Studies University of Cologne |
Mark W. Bowyer,
MD, FACS, DMCC, FRCS (Glasg), FRCSThai (Hon)
Col (retired), USAF, MC
Ben Eiseman Professor of Surgery
Surgical Director of Simulation
The Department of Surgery at the
Uniformed Services University and
Walter Reed National Military Medical Center
Bethesda, Maryland USA
Retiring after 22 years of active-duty military service as a Trauma and Combat Surgeon,
Dr. Bowyer remains the Ben Eiseman Professor of Surgery at the Uniformed Services
University of the Health Sciences (the military medical school) in Bethesda, MD.
In this role, he is responsible for the training of current and future military doctors
learning to care for those in harm’s way. As a faculty member of Advanced Trauma
Life Support, Definitive Surgical Trauma Care, Definitive Surgical Trauma Skills,
Emergency War Surgery, Advanced Trauma Operative Management, and Founder
of the Advanced Surgical Skills for Exposures in Trauma courses, Dr. Bowyer is an
international force in trauma education. His active practice of trauma surgery in busy
civilian trauma centers and experiences as “Trauma Czar” in Iraq, provide him with
credible real-life experiences that he enthusiastically brings to the classroom. As an
acknowledged expert in the fields of trauma and medical simulation he is in great
demand as a speaker having presented in many national and international forums.
Dr. Bowyer has published widely on a diverse range of critical care, trauma, and
simulation topics.
Dr. Kosala Somaratne,
MBBS, MD, MRCS, Diploma in Minimal Access Surgery,
Fellowship in Minimal Access Surgery
Ex-Surgeon to the Sri Lanka Army
President of the Ambroise Pare International Military Surgery Forum (The APIMSF)
He was surgeon to the Sri Lanka Army during the anti-terrorist operations of 2006-
2009. With this war time surgical experience he produced a number of papers dealing
with high velocity projectile injuries to the liver, emergency vascular repairs in
frontline hospitals, specialized vascular repair techniques for 48hr re-exploratory
laparotomy for war injuries and specialized wound debridement techniques for
facial and extremity war injuries which were presented in the international surgical
week, 2011 in Yokohama. Having listened to these papers, Prof Zvonimir Lovric,
then president of the Ambroise Pare International Military Surgery Forum (APIMSF),
invited this young surgeon to the organization.
Being an avid active member of the organization since the younger days, he was a
consistent active member of the APIMSF through Yokohama in 2011, Baku in 2013,
Helsinki in 2013, Bangkok in 2015, Berlin in 2016, Basel in 2017, again Baku in
2018, Krakow in 2019, Vienna in 2022 and today in Ratmalana 2023..!
He was inducted as the president of the APIMSF in 2019 in Krakow,Poland. This
surgeon from Sri Lanka always maintained a tricky balance of power in this unique
organization where the military surgeons from the NATO and Russia sits together.
During his presidency the Ukrainian crisis broke out making the situation more
problematic and acute. After this geo-political volcano erupted, the international
membership entrusted him the difficult balancing of power to be carried out till
2024…! With General Horst Peter Becker sharing the burden as the co-president.
Today, on this 6th day of September 2023, he has been able to bring the military
surgeons from the US and NATO powers and the Russia to a single forum sitting side
by side as good friends, in a hotly divided world on geo-political fault lines.
This surgeon from the central hinterlands of Sri Lanka humbly considers this is NOT
his personnel achievement, yet a collective achievement of everybody sitting in this
August forum today and many outside this forum as well…!
Prof. Dr. Kenan Yusif-zade (Col), MD, PhD, MBA, FACS
General and Military Surgery | Gastroenterology and Surgical Endoscopy | Breast &
Endocrine Surgery
Hepatopancreatobiliary Surgery | Colorectal Surgery
Leyla Medical Center | Department of Surgery
19, Y.Safarov, AZ1025, Baku, Azerbaijan
UNEC School of Business | Healthcare Management
yusifzadekr@yahoo.com
Baku Higher Oil School
Fundamentals of Civil Defense and Medical Aid
AZERBAIJAN SOCIETY of MILITARY SURGEONS, Founder and Chair
2013-2016 ADA University, School of Business, Executive MBA, Baku,
Azerbaijan 2013-2015
Maastricht School of Management, MBA, Maastricht, Nederland
01.11/03.12.2008-05.12.2008 Research Fellow in Department of Colorectal Surgery
in Cleveland Clinic, Cleveland, Ohio
Work experience:
From 10.2022 up to now
Lecturer at the Azerbaijan State University of Economics (UNEC), Healthcare
Management (www.unec.edu.az)
From 11.2021 up to now
General Surgeon and Gastroenterologist at Leyla Medical Center
https://leylamc.az/
2010-2020-Head of Military Hospital of State Border Service of Azerbaijan Republic,
Baku
07.2020-09.2021 Chief of the Military Medical Department of the State Border
Service of the Azerbaijan republic, Baku
Dr. Thilanka Seneviratne,
MBBS (Peradeniya),
Diploma in Child Health (Colombo),
MD- Paediatrics (Colombo),
MRCPCH (UK)
Consultant Paediatrician and specialist in Allergy.
Head, Department of Pharmacology, Faculty of Medicine, University of Peradeniya,
Sri Lanka.
Vice president of the Sri Lanka Association for Simulation in Health Care (SLASH)
Dr. Seneviratne is keenly utilising simulation in medical education. She has published
and presented widely in simulation, medical education, Clinical pharmacology and
Allergy and Immunology in National and International forums as the first author and
has Presented award winning papers.
As the founder Vice President of the Sri Lanka Association for Simulation in Healthcare
(SLASH) she organised the first ever international conference on Simulation in Sri
Lanka. She is a Founder member of the Asia Pacific Biomedical Science Educators
Association (APBSEA). A consistent contributor for Asia Pacific Medical Education
Conference (APMEC) as a resource person and as an invited speaker.
Her special interests are in Allergy and Immunology and has published widely on the
subject. She is a Member of the American College of Allergy, Asthma and Immunology
(ACAAI), Asia Pacific Academy of Paediatric Allergy, Respirology and Immunology
(APAPARI), and European Academy of Allergy and Clinical Immunology (EAACI).
Zvonimir Lovrić,
PhD, M.D. surgeon
Primarius, Professor
Since the beginning of war against Croatia, May 2. 1991 working at Department
of Surgery Osijek General Hospital, where during the 15 months period more than
4500 wounded Croatian soldiers and civilians have been surgically managed. Since
November 21. 1991. Chief of War division "A" at Department of Surgery Osijek
General Hospital. During 15 months of war in eastern part of Croatia and northern
Bosnia made about 400 various operations of wounded, especially acute vascular
injuries, explosive bone fractures, management of skin defects etc.
From January 1993. member of Mobile Surgical Teams in Maslenica region during
war activities, and commander of Mobile Surgical Teams of Special Units of
Croatian Police in rank of higher inspector in reserve (colonel). Commander-in-chief
of Mobile Surgical Teams of Special Police Forces of Croatian Police during the
Croatian “Storm 95 action”.
Honored with five medals for war merits by President of the Republic of Croatia
Tudjman.
He was the president of the Ambroise Pare International Military Surgery Forum (the
APIMSF) from 2011-2013 and the General Secretary since 2013.
In 2013 he was awarded the Michael E. Debakey International Military Surgeons
Award for Excellence by the Department of Surgery at Uniformed Services University
of the Health Sciences (USUHS), Bethesda, Maryland USA.
Hiroya Goto, MD
Ministry of Foreign Affairs of Japan
Hiroya GOTO, MD, graduated from National Defense Medical College, Saitama,
Japan in 1996. Upon graduation, he joined the Japan Ground Self Defense Force
(JGSDF). He started an ophthalmology residency program at Osaka University
Hospital in 2000 then was certified ophthalmologist in 2003. He conducted research
on refractive surgery and night vision goggles at Naval Medical Center San Diego,
United States Navy in 2004 to 2006. Then he was assigned to the Military Medicine
Research Unit, JGSDF, developing combat wound models. He was sent to the Office
of Surgeon General of the United States Army, Washington D.C. in 2008 to2010. He
supported the JGSDF medical team of urgent medical assistance to Haiti Earthquake
in 2010. In 2011, he was a member of the US-Japan bilateral coordination team
of Operation Tomodachi against Eastern Japan Earthquake and Tsunami. Then he
became an instructor on combat casualty care at JGSDF Medical Service School to
teach junior physicians and medics. In 2018 he was dispatched to the Japan-China
frontline at Yonagunijima Island, the westernmost island of Japan. After serving at
JSDF Central Hospital as an ophthalmologist, he left JGSDF and joined the Ministry
of Foreign Affairs in 2022. His current assignment is the medical attache at the
Embassy of Japan in Djibouti.
Dr. Kirby R. Gross
M.D., F.A.C.S., COL(Retired) U.S. Army
Dr. Kirby Gross is currently practicing Trauma and Surgical Critical Care at Cooper
University Hospital in Camden, New Jersey. Dr. Gross retired from the U.S. Army
in July 2023 after twenty-one years in uniform. During his military career, Dr. Gross
had deployed ten times for a total of five years. He had served as Commander of
a Forward Surgical Team and Deputy Command of a Combat Support Hospital.
Dr. Gross also served as Director of the Joint Trauma System. Dr. Gross trained in
General Surgery at Indiana University Medical Center and trained in Trauma and
Surgical Critical Care at Vanderbilt University Medical Center. His specific interests
are trauma systems and trauma education.
Prof. Viktor Reva
MD, PhD
Deputy Chief of War Surgery Department
Kirov Military Medical Academy St.Petersburg,
Consultant Surgeon at Dzhanelidze Research Institute of Emergency Medicine
Associate Professor of Trauma Surgery, Moscow Medical Institute of Continuous
Education Board of Directors: World Society of Emergency Surgery, EVTM Society
His interests are in, Trauma surgery, Vascular trauma, Polytrauma, Shock, Damage
control Resuscitation and Surgery, Endovascular Bleeding and Trauma Management
Invited faculty at Trauma Workshops and EVTM Workshops at Orebro University
(Sweden) Director of the Russian SMART platform for trauma education.
Ken Boffard
BSc (Hons) (Aerospace Medicine), MB.BCh, FRCS., FRCS(Edin), FRCPS(Glasg),
FCS(SA), FISS, FACS (Hon), MAMSE.
Professor Ken Boffard is a Sub-specialist in Trauma Surgery and Trauma Critical Care. He is Trauma Director and Academic Head at Milpark Hospital Academic Trauma Center, and Professor Emeritus in the
Department of Surgery of the University of the Witwatersrand, Johannesburg. He has been awarded Honorary Fellowship of the American College of Surgeons, and Membership of the ACS Academy of Master Surgical Educators.
He is Secretary General and Past President of the International Society of Surgery
(ISS) in Switzerland, and a Past President of the International Association for Trauma
Surgery and Intensive Care (IATSIC).
He is a Colonel (Res) in the South African Military Health Service.
His interests include surgical education, Military medicine, blast and ballistic injury,
trauma resuscitation and intensive care, coagulation and haemostasis, and Aviation
Medicine (he is a licensed fixed wing and helicopter pilot) and scuba diving.
Professor Ari Leppäniemi
(MD, PhD, FACS(H), FISS, DMCC) is the retired Chief of Emergency Surgery
at the Helsinki University Hospital, Finland.
He is a specialist General and Gastroenterological Surgery with subsequent training
and diplomas in Prehospital Medicine, Emergency Medicine, Disaster Medicine and
International Health Care. He has worked as a Field Surgeon for the International
Red Cross for civil wars of Cambodia, Sudan and Afghanistan, and as a Volunteer
Surgeon for UNDP in Tuvalu and as Senior House in Zaria, Nigeria.
He is the Past-President of the European Society for Trauma and Emergency Surgery,
Finnish Society of Surgery, International Association for Trauma Surgery and
Intensive Care, and the Ambroise Pare International Military Surgery Forum and
President-elect of the International Society of Surgery.
He has been the Editor-in-Chief of the Scandinavian Journal of Surgery, Editor of
the European Journal of Trauma and Emergency Surgery, and Associate Editor of the
World Journal of Surgery and World Journal of Emergency Surgery.
He is an Honorary Fellow of the American College of Surgeons, American Surgical
Association, European Society for Trauma and Emergency Surgery, Finnish Society
of Surgery, Finnish Trauma Association and Finnish Society for Digestive Surgery,
and in 2014 was appointed as Surgeon of the Year by the Finnish Surgical Society.
He has published more than 280 original articles, about 200 review articles, book
chapters and dissertations, and over 150 editorials, letters, commentaries and other
articles, mostly on abdominal trauma, acute pancreatitis and abdominal compartment
syndrome.
His hobbies include fishing, badminton, and jazz.
Gen. Prof. Pavel Georgievich Brusov
Educator, researcher,
Russian Surgeon, Recipient Laureate of state award of Union of the Soviet Socialist
Republics, 1989, Laureate of state award of Russia, 1997. With Russian military,
1961-1967, general major, since 1989. Member Society Surgeons Moscow (chairman
section military-field surgery since 1990)
Dr Kamal Jayasuriya
(MBBS,MS,FCSSL,FISS, FAACT)
Consultant Surgeon
Director NTMC
National Delegate ISS
Country Representative & Fellow of ACT
International Instructor DSTC
Instructor ATLS Singapore
Instructor DMMT,ITCN
Dr. Tanya Egodage, MD, FACS
She is a trauma surgeon working in the level 1 trauma center at Cooper university
health care and associate program director, surgical critical care fellowship. Assistant
professor of surgery at the cooper medical school of Rowan University.
ABSTRACTS OF KEY NOTE
PLENARY LECTURES
AND SYMPOSIA
KEY NOTE
Transforming Trauma Training with Technology:
The Next Revolution
Col (ret) Mark W. Bowyer, MD, FACS, FRCS (Glasg), FRCS Thai(Hon), DMCC
Ben Eiseman Professor of Surgery
Chief of Trauma and Combat Surgery
Surgical Director of Simulation Education and Training
Department of Surgery at the Uniformed Services University
And Walter Reed National Military Medical Center
Bethesda, Maryland, USA
There is an international need to prepare surgeons and medical teams to competently care for victims of trauma in military, rural, humanitarian, and intact civilian settings. Increasing sub specialization, minimally invasive and non-operative techniques, and trainee work hour restrictions have led to surgeons with limited experience with the variety of skills required to operate independently and competently. This is especially true of the skill set required to care for trauma as the procedures required are low frequency and high stakes, making it difficult to maintain currency and competency. Technological
advances in medical and surgical simulation, 3-D printing, serious games, and virtual/augmented reality offer the potential to revolutionize how we train and maintain these vital life, limb and eyesight saving skills. This presentation will review the current and near future state of the multiple technologies that might be used to improve trauma training that leverage best in class educational concepts and tools.
LATTER-DAY ADVANCEMENTS IN MILITARY SURGERY
Prof. Yusif-zade K.R.
(Col), MD, PhD, MBA, FACS
Leyla Medical Center, Baku Higher Oil School, UNEC School of Business,
Baku, Azerbaijan
Military surgery has undergone significant advancements in recent years, driven by a combination of technological innovations, interdisciplinary collaboration, and lessons learned from conflict zones. This abstract reviews notable developments in military surgery, focusing on enhancements in trauma care and combat medical support. The objective is to provide a comprehensive overview of how these advances are improving the survival rates and quality of life for wounded military personnel on the
battlefield. Latest military surgery is developing up to now, and it is high-tech tools which have been treated the war trauma. The following the main approaches in short below.
Remote Surgery and Telemedicine: With the advancement of robotics and high-speed communication networks, remote surgery has become a possibility. Surgeons can now operate on wounded soldiers located far away using robotic
surgical systems. This is particularly valuable in situations where rapid medical intervention is needed but access to surgical expertise is limited.
Advanced Prosthetics and Orthotics: Military personnel who suffer from amputations or severe limb injuries can benefit from advanced prosthetics and orthotics. These devices are designed to closely mimic natural limb movement
and provide enhanced functionality. The integration of robotics and neural interfaces has also allowed for better control and sensory feedback in these prosthetic devices.
Regenerative Medicine: Research in regenerative medicine has led to breakthroughs in tissue engineering and organ transplantation. This could potentially allow for the regeneration of damaged tissues and organs, reducing the need for traditional surgical interventions in some cases.
Improved Trauma Care: Military medical teams have refined their trauma care strategies, leading to better survival rates for soldiers with life-threatening injuries. This includes advancements in hemorrhage control, resuscitation techniques, and rapid evacuation protocols.
Hemostatic Agents and Dressings: Advanced hemostatic agents and wound dressings are being developed to control bleeding quickly and efficiently on the battlefield. These products can significantly reduce the risk of hemorrhagerelated complications and improve survival rates.
3D Printing for Prosthetics and Implants: 3D printing has revolutionized the production of patient-specific prosthetics and implants. In military surgery, this technology allows for the creation of customized devices on-demand, improving both the fit and functionality for wounded soldiers.
Portable Imaging Technologies: Handheld ultrasound devices and portable X-ray machines have become integral to military surgical units. These technologies enable rapid assessment of injuries, aiding surgeons in making informed decisions about the course of treatment.
Neuroprosthetics: In cases of severe spinal cord injuries or neurological damage, neuroprosthetics have been developed to restore some level of functionality. These devices can interface directly with the nervous system to enable movement, sensory feedback, and even control of external devices.
Minimally Invasive Surgery: Techniques for minimally invasive surgery have improved, allowing for smaller incisions, reduced scarring, and quicker recovery times. This is especially relevant in military scenarios where rapid recovery is crucial to getting soldiers back to duty.
Advanced Training Simulators: Military surgeons are training with sophisticated simulators that replicate combat scenarios and surgical procedures. These simulators enhance surgical skills, decision-making, and teamwork in high-stress environments. These advancements collectively contribute to higher survival rates and improved long-term outcomes for military personnel injured in combat.
PROFOUND THERAPEUTIC HYPOTHERMIA TO
TREAT CIVILIAN AND COMBAT CASUALTIES WITH
TRAUMATIC CARDIAC ARREST
Prof. Viktor Reva, Anastasia Samakaeva, Vladimir Potemkin, Daniil Shelukhin.
Kirov Military Medical Academy, Saint Petersburg
Background. Non-compressible torso hemorrhage is considered to be the main source of potentially preventable deaths on the battlefield. If a patient is exsanguinated to death, then chances to survive are close to zero. A concept of emergency preservation and resuscitation was developed by P. Safar and S. Tisherman at the end of the XX century to prevent vital organs from irreversible damage and buy time for achieving hemostasis. Pilot animal experiments have shown a huge potential for this technique as cooling to brain temperature 10°C during traumatic cardiac arrest (TCA) can allow 2 hours for repairing of
injuries with normal neurologic recovery. The aim of our study was to evaluate this new technique in an experimental
model of non-human primates.
Methods. Five male Papio hamadryas weighing 19.6–27.0 kg were enrolled into the study. Right axillary artery and vein were exposed via an open incision for ECMO cannulation. Femoral artery and vein were cannulated percutaneously for aortic and inferior vena cava (IVC) balloon placement. 50% of circulated blood volume was withdrawn to achieve TCA. In a minute
of total arrest, closed CPR was initiated for 3 minutes followed by aortic and IVC balloon occlusion and rapid brain and heart intravascular cooling (2°C saline infusion). After brain cooling to 10°C, the balloons were deflated and the whole body was cooled to 10°C. ECMO was stopped for 60 minutes. To simulate damage control scenario, laparotomy and splenectomy was
performed followed by temporary abdominal wall closure. Animals were then slowly rewarmed to 35°C
Results. In all experiments, both brain and body were successfully cooled that took 30 and 45 minutes, respectively. In 4/5 animals, return of spontaneous circulation happened during rewarming. At the temperature of 26-30°С in 3/5 animals severe coagulopathy and bleeding from access cutdowns developed that necessitated hemostatic intervention. One animal was decannulated and extubated 16 h after initiation of experiment, but died on day 3rd due to brain swelling. Four of five animals died after 14,5-18,5 h of rewarming due to coagulopathy, multiorgan failure and brain swelling.
Conclusion. EPR allows temporary vital organ protection during TCA, but requires appropriate resuscitative care, close vital signs monitoring and intervention to improve final outcome. Coagulopathy during rewarming represents the most significant challenge and threat for patient’s survival.
ABDOMINAL GUNSHOT INJURIES
Prof. Ari Leppäniemi, MD, Department of Abdominal Surgery, Helsinki
University Hospital and University of Helsinki, Finland
Abdominal gunshot wounds are very often associated with internal organ injuries. In anterior abdominal gunshot wounds, the risk of organ injury is about 90%, and in gunshot wounds of the flanks or back about 40%.
The frequency of organ injuries in penetrating abdominal injuries depend mainly on the location and size of the organs, and is summarized in Table 1.
Table 1. Frequency of organ injuries (%) in abdominal trauma (collective series from several reports)
|
Organ Liver |
Stab wound 31 |
Gunshot wound 29 |
| Small bowel (jejunum, ileum) | 30 | 45 |
| Colon | 18 | 38 |
| Stomach | 14 | 18 |
| Duodenum | 2 | 11 |
| Spleen | 9 | 11 |
| Pancreas | 6 | 5 |
| Kidney | 7 | 12 |
| Major vascular | 9 | 11 |
| Diaphragm | 14 | 15 |
but can stop spontaneously. A large mesenteric tear may result in intestinal necrosis and perforation usually diagnosed during laparotomy. A pancreatic injury can remain initially silent, and manifest after several days, weeks or even months as pancreatic fistula, abscess or pseudocyst. A diaphragmatic injury is usually asymptomatic unless it is associated with herniation of abdominal contents into the thorax, especially on the left side. It can also manifest as diaphragmatic hernia, sometimes months or years after the initial trauma.
Although the majority of patients with abdominal gunshot wounds need surgery, in selected cases in stable patients and with proper assessment of a CT scan, a nonoperative approach can be attempted.
In a critically ill patient, primary assessment and life-saving measures should be performed rapidly, and the need for an urgent emergency laparotomy should be evaluated upon arrival to the hospital. If necessary, a massive hemoperitoneum can be diagnosed rapidly with an abdominal ultrasonography (FAST) performed at the Emergency Room.
All patients with abdominal gunshot wounds with significant intra-abdominal hemorrhage, generalized peritonitis or radiologically verified organ injury requiring surgical repair (perforations of the GI tract, isolated biliary or urinary tract lesions not amenable to endoscopic treatment, liver or spleen injuries requiring multiple blood transfusions, kidney lacerations extending to the collection system, diaphragmatic rupture, pancreatic rupture involving the main pancreatic duct, and major vascular injuries, for example) should undergo an early laparotomy. In addition, patients with undetermined lesions
getting worse during follow up require often an early diagnostic laparotomy.
Emergency laparotomy is always performed under general anesthesia using a large midline incision. The first priority is to control major bleeding with manual compression, clamps, balloons and temporary packing. In some cases, an aortic balloon may be utilized. Access to large retroperitoneal vessels may require left or right visceral rotations, or the Cattell-Braasch maneuver.
Techniques for temporary control of major hepatic bleeding include manual compression, packing, and the Pringle maneuver.
Once critical bleeding has been controlled, the major decision-making point is whether the patients is stable enough and the expertise is available, that all organ injuries can be fully repaired at this initial operation. If the patient is acidotic, hypothermic, and coagulopathic, or if the operation has already involved multiple transfusions and consumed a significant (>90 min.) amount of time, an alternative strategy should be considered.
Damage control surgery consists of an initial operation where the sources of bleeding and contamination are controlled. Major vascular injuries are either repaired, ligated or shunted with a temporary shunt. Liver injuries require definitive packing, splenic and renal injuries often splenectomy or nephrectomy, respectively. Contamination from bowel and other hollow organ
lesions are controlled with temporary suturing, tying or stapling. The abdomen is always left open, and one form of temporary abdominal closure method is used.
The patient is transferred to an ICU where the homeostasis is restored. Once stable, usually within 36-72 hours, the patient is returned to the operating room for definitive repair of all injuries.
The most common surgical postoperative complications following laparotomy for abdominal gunshot wounds include wound infection, hemorrhage, anastomotic leakage, intra-abdominal abscess, prolonged bowel paralysis or obstruction, postoperative pancreatitis and Abdominal Compartment Syndrome. Major injuries, extensive blood loss and transfusions, prolonged preoperative hypotension, and long operative time may be followed by multiple organ dysfunction syndrome or failure (MOF) requiring prolonged treatment in the ICU. Missed injuries are feared complications associated with
significant mortality. Incisional hernia and adhesive bowel obstruction are the most common late complications after trauma laparotomy. Occasionally, a missed diaphragmatic rupture or an isolated pancreatic injury may manifest later as a diaphragmatic hernia or pancreatic fistula, respectively.
The prognosis of patients with abdominal trauma is usually good. The hospital mortality rate for abdominal gunshot wounds is about 10-13%. The most common causes of death include uncontrolled hemorrhage from vascular or liver injuries, sepsis and multiple organ failure, and associated thoracic injuries. Cardiac complications and pulmonary embolism account for the
majority of remaining fatalities.
THE EXPERIENCE OF U.S. SURGEONS IN THE GARRISON
AND DEPLOYED ENVIRONMENT
Dr. Kirby R. Gross COL (Retired) U.S. Army, M.D., F.A.C.S.
Background: Military surgeons must always maintain readiness. However, the dual mission of the U.S. military health system to provide garrison health care and care in the operational environment may not always complement each other. The U.S. maintains military hospitals to provide care to service members, families of service members and military retirees. The acuity and complexity of this clinical experience may not closely align with deployed surgical care.
Methods: Published articles were reviewed to ascertain the volume and acuity of clinical volume of U.S. military surgeons. The clinical experience of U.S. military surgeons while deployed was also reviewed.
Results: U.S. military surgeons while in garrison have a clinical experience which is significantly slower than U.S. civilian surgeons. The clinical experience of surgeons while providing care in U.S. military hospitals differs from the clinical experience in the operational environment.
Conclusions: The U.S. military services are partnering with U.S. civilian hospitals to provide military surgeons (and other members of the deployed healthcare team) an experience to ensure military surgeons maintain optimal
readiness. This review is specific for the U.S. military surgeons as each nation’s military health system and civilian health system is unique. However, U.S. lessons may have application to other nations as each nation seeks to maintain optimal readiness of their military surgeons.
DUODENOPANCREATIC TRAUMA AND DUODENAL
FISTULAS – A SURGEON’S NIGHTMARE
Prof. Ari Leppäniemi, MD, Department of Abdominal Surgery, Helsinki
University Hospital and University of Helsinki, Finland
Pancreatic and duodenal injuries are rare, easily missed and associated with severe consequences if the treatment is delayed. This is especially true in injuries involving the main pancreatic duct or in cases where duodenal injuries
are detected after a delay.
The treatment of pancreatic trauma is based on its severity classification by radiological evaluation and/or surgical exploration. Exploration of the pancreas at surgery requires mobilization of both the head and the body and tail of the pancreas in order to determine the grade of the injury. Grade I and II injuries where the main pancreatic duct is intact, can be managed nonoperatively or at surgery with simple suture and drainage procedures.
A pancreatic injury with main duct involvement (Grades III-V) requires operative intervention. Grade III injuries (main duct involvement left to the superior mesenteric vein) are usually treated with distal pancreatectomy and external drainage. Under favorable conditions (no associated major injuries, no severe bleeding, sufficient surgical expertise), the spleen can be preserved. Injuries to the pancreatic head with intact common bile duct and ampulla (Grade IV) usually require some form of debridement resulting in a divided pancreas to the right of the superior mesenteric vein. The best results can be achieved
with closure of the proximal pancreatic duct and parenchyma (avoid accidental common bile duct ligation!) and distal Roux-en-Y pancreaticojejunostomy. Under less favorable conditions, hemostasis and external drainage are acceptable. A subtotal pancreatectomy preserving at least 20% of the pancreas might not result to diabetes and is an option.
Massive destruction of the pancreatic head with ampullary involvement (Grade V) is rare and requires sometimes a pancreaticoduodenectomy as a debridement and hemostatic procedure. The reconstruction of the anastomoses
can sometimes be postponed to a secondary operation 1-2 days later when the patient’s condition has been stabilized.
The overall mortality rate in pancreatic injuries is about 20% and the pancreatic morbidity rate about 40%.
The diagnosis of duodenal injuries is based on radiological imaging, especially CT scan, or detection at surgical exploration for abdominal trauma. Exploration of all four parts of duodenum require exposing the front and back portions of
the first and second parts of the duodenum (Kocher’s mobilization), exposing the 4th part at ligamentum of Treitz, and a Cattell-Braasch maneuver to expose the third part of the duodenum. In full-thickness duodenal injuries detected early, simple 2-layer tension-free suture is usually the best option. Even in these cases it is important to insert a periduodenal drain, and protect the suture line with intraluminal decompression achieved most easily with a naso-gastro-duodenal tube.
In more complex injuries and especially after a delayed detection, more complex procedures, such as duodenal resection with duodeno-duodenal or duodeno-jejunal anastomosis, pyloric exclusion, duodenal diverticulization or even pancreaticoduodenectomy may be needed. In all repairs the importance of periduodenal drains and intraluminal decompression cannot be overemphasized. The overall mortality in duodenal injuries has remained constantly around 18%, and complication rate at about 60%. Specifically, the duodenal leak or fistula rate is usually around 7%. Duodenal leaks (external duodenal fistulas) comprise 3-14% of all enterocutaneous fistulas and are most commonly caused by complications
associated with the treatment of perforated duodenal ulcers, elective duodenal surgery, trauma and acute pancreatitis. A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and
pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. The mortality rate among larger series remains around 40%.
The diagnosis is usually obvious if a periduodenal drain has been left in place after duodenal surgery. CT scan with oral and iv contrast is the second most commonly used diagnostic technique.
In most cases, a surgical approach is needed, and consists of duodenal repair or resection accompanied with adequate periduodenal drainage and intraluminal decompression. Under favourable conditions in stable, non-septic patients,
a nonoperative approach can be attempted including percutaneous drainage of abscesses. However, if the nonoperative approach fails, prompt surgery is indicated. Regardless of the management technique, adequate antimicrobial
therapy and nutrition, preferable by enteric route form the other cornerstone of the treatment.
In a recent study of 50 patients with complex duodenal fistulas, the first line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal
drainage in all but 2 cases. The fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died
with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure crates among initially operatively vs. nonoperatively managed
patients (29/38 vs. 9/12, p=1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p=0.036). The primary intervention was more successful in patients with peptic ulcer perforation vs. other diagnoses (12/16 vs. 15/34, p=0.041), or when the surgeon performing the initial intervention was a full-time emergency surgeon vs. elective surgeon (19/28 vs. 8/22, p=0.027). The overall in-hospital mortality rate was 20/50 (40%). The authors concluded that surgical closure combined with duodenal
decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried accepting that some patients may require surgery later.
PROGRESS OF SURGERY THROUGH WAR; MANAGING
BATTLEFIELD LIVER INJURIES TO CIVILIAN LIVER
RESECTIONS
Dr. Kosala Somaratne
War always gave a major impetus for the advancement of surgery. So much so that it is said, “only the weapons industry and the surgical discipline profits from war”. Ambroise Pare, the 16th century surgeon to the French Monarchy, after whom the global body of the military surgeons, the APIMSF is named, himself made major advancements in the way gun-shot injuries are managed.
World war one made great strides in the management of fractures and world war two made similar changes in the vascular trauma care. Afghan campaign of the Soviets added ground breaking concepts in the damage control surgery
as well as the Gulf campaigns of the Americans did to the acute trauma care.
During the anti-terrorist operations of the Sri Lankan Army of 2006-09, working at the Northern outpost military hospital of Palaly, my personnel experience of managing high velocity shrapnel injuries of the liver is discussed in this talk.
How the new “Rajasinghe technique of liver resection” became really handy in saving lives in exsanguinating liver trauma. The way this technique is used in civilian liver resections for malignancies will be further discussed.
Single events in frontline operation theatres makes way for interesting innovations, the “Walagamba technique of vascular repair for gunshot injuries at the origin of the Profunda Femoris artery” is such a one. Similarly the concept of 48hr re-exploratory laparotomy and the concept of conservative wound debridement in facial and extremity war injuries.
Decision making and innovation in austere war environments make long lasting changes in the surgical thinking and carries forward it to the civilian practice. The way this has affected the civilian practice is dealt with in this talk.
LEADERSHIP IN SURGERY: A PERSONAL PERCEPTION
AND A GERMAN PERSPECTIVE
Gen. Prof. Horst Peter Becker
The German healthcare system has substantially changed in the past 20 years. Due to different influences, such as digitalization, working hour restrictions, and economization, the field of surgery has come under massive pressure
with increasing demands on leading cultures and personalities. Traditional virtues like passion for work and patients, for example, have been cleared out for organizational aspects such as business plans and personnel acquisition.
Indeed, the lack of medically trained personnel has become a crucial problem in health care, not only in Germany. The patients have been pushed somewhat into the background because hospital directors have become too busy to keep
up with the economic issues. The talk presented at the meeting in Colombo will clear up the role of leadership in surgery and show potential ways into the future.
Leadership is a virtue by itself. It is somewhat different from management. According to John Kotter, management refers to tools or structures intended to keep any change effort under control. Leadership, on the other hand, concerns
the driving forces, visions, and processes that fuel transformation. In surgery, things of today are more complicated because the skills and technical aspects of the procedures must be trained and educated daily. The connectivity of a team influences the willingness to perform surgery at a high quality.
Training in surgery and the profession of surgeon are physically and mentally demanding. Expertise and technical skills are learned stepwise from simple to complex in a wishful well-disposed atmosphere. The educational process has
to be structured according to the learning progress. The department leader is responsible for the organization and becomes more and more of a manager. They must consider the exponentially growing medical-technical progress, the integration of medical products in existing data and communication networks, the increasing financial pressure, and the demand for quality assurance.
Leadership in surgery and the medical field, in general, has become a difficult task. Today´s leaders must be excellently trained in surgical and management skills to convince their team members to perform qualified surgery. Leadership
has multiple facets: assumption of responsibility, the will to lead, readiness for teamwork, transparency, and positive and motivating communication.
And lastly, leadership needs people who are willing to follow. To achieve all the goals and to avoid future crisis, we probably stay with the old virtues: competence, passion, and self-awareness.
BLAST INJURIES – WHAT TO EXPECT AND HOW TO
DEAL WITH THE INJURY
Prof Kenneth Boffard
Modern asymmetric warfare where only one side even has a uniform is now unfortunately commonplace. Exposure to military injury drops dramatically in times of peace. Explosives are often used outside the military environment, and many medical care providers do not have the expertise to deal with the injuries sustained. To understand how to best treat these injuries, it is also
necessary to understand the mechanism of injury involved.
This presentation will cover both the prevention of injury if possible, the effects of explosions, as well as the initial medical care. and the pitfalls resulting if injuries are missed.
Training, simulation and military - civilian partnerships
TRAUMA TRAINING, THE GLOBAL SCENARIO AND
WHERE TO PLACE THE KDU.
Prof K D Boffard.
Milpark Academic Trauma Centre, Johannesburg, South Africa.
In order to train in any discipline (not just Trauma), that training must contain three components, rather like a camera tripod. A tripod, if balanced is stable, if unbalanced, falls over.
Education and training are different.
“Education” is the change of mind set produced by the furnishing of knowledges of the problem (The “What and when”)
“Training” is the improvement in skills set required to act on the information from Education. (The “How”).
The training of our next generation of surgeons has to be based on these three legs.
a) Adequate patient load to allow exposure to training
b) Adequate resources to allow credible teaching
c) Adequate Educators
If these components are balanced, then good photographs are possible = balanced education.
This talk will focus on what it takes for KDU to create a stable, credible, academic teaching and training environment for Trauma
NTMC AND THE TRAUMA TRAINING IN SRI LANKA
Dr Kamal Jayasuriya
(MBBS,MS,FCSSL,FISS, FAACT)
Trauma training is a challenge in trauma care in Sri Lanka. Training in management of injured patients to be targeted on initial trauma care and definitive trauma care.
Initial trauma care training is to be given to the primary care doctors and nursing officers in PCU, ETU, OPD, A&E, Disaster medicine, Emergency medicine, Anaesthesiology and Military system.
National Trauma Management Course (NTMC) is the main initial trauma training course for medical officers in Sri Lanka conducted by the College of Surgeons and nearly 3000 doctors have been trained. Furthermore the college
conducts Initial Trauma Care for Nurses (ITCN) for training of nursing officers The challenge in definitive trauma care training for postgraduate trainees and consultants, is covered by Definitive Management of Major Trauma (DMMT).
Prehospital and other paramedics in the trauma teams also to be trained.
Preventive measures, trauma database, system improvement disaster preparedness are the main elements in trauma education to be addressed in future.
U.S. CIVILIAN HOSPITALS IMPROVE U.S. MILITARY
TRAUMA CARE BY PARTNERSHIPS
Dr. Tanya Egodage, MD, FACS
Background: Military medical providers require maintenance of knowledge and skills in both war and peace. Military surgeons must remain adept at treating servicemember injuries in the event of war, however, in times of peace, these skills wane. Civilian surgeons in the U.S., primarily those at level 1 trauma centers, maintain skills which may be useful to those who deploy.
Methods: A review of pertinent literature was initially performed. Subsequently a retrospective evaluation of 15 years of specialized training, including 5 years of an established Army Military-Civilian Trauma Team Training Center at Cooper University Hospital in Camden, New Jersey was performed.
Results: Military-civilian partnerships result in mutually beneficial relationships. This review of our experience at an Army Military-Civilian Trauma Team Training Center, led by Colonel John Chovanes, demonstrates the benefit to enlisted servicemembers, as well as benefits to the civilian facility.
Conclusions: Implementation of joint military-civilian partnerships strengthen the experience and training of both civilian and military medical providers internationally.
SIMULATION IN MEDICAL EDUCATION
Dr. Thilanka Seneviratne,
Simulation is becoming an essential and integral part in medical education. In teaching medical undergraduates,
Undergraduates always learnt medicine in books and saw how others treat patients. They hardly had the chance to treat real patients. Simulation gives this wonderful real life opportunity to treat patients by students themselves and to learn by trial and error, the best time-tested way of learning.
The fact that we were well on-board with simulation was of real help when the Covid-19 pandemic did hit the shores. Students had to be taken off from clinical settings, simulation and virtual simulation came really handy in this difficult circumstances. Limited exposure to patients invariably limit the clinical knowledge gain, hence the importance of simulation in this regard.
Having to teach and train medicine without real patients is a real pain for teachers and students alike. Though we were pushed to this end with the Covid-19 pandemic, this has been the case in military surgery since the advent of that particular specialty. Those who were trained in civilian surgery always found them to be the square pegs in round holes when they were put to operate in austere war situations. As a solution to this problem it is some time now, that simulation has been in wide use in the training processes of military surgery. In this regard simulation has progressed to virtual simulation, virtual reality
and augmented reality.
We researched how students perceive the simulation based teaching, the techniques to enhance simulation based teaching. Simulation based teaching vs. traditional bed side teaching in procedural skill acquisition and use of Artificial intelligence to enhance simulation based teaching and learning.
In this presentation I will be discussing our journey through simulation.
SELECTIVE AORTIC ARCH PERFUSION AND OTHER EXTRACORPOREAL LIFE SUPPORT TECHNIQUES IN SEVERE
COMBAT TRAUMA
Viktor Reva, Ivan Neganov, Rustam Kasimov, Vladimir Potemkin, Aleksander
Pochtarnik, Vladimir Kudryashov.
Kirov Military Medical Academy, Saint Petersburg
Background. Modern military field surgery is supposed to rescue the wounded, the rendering of aid to which was previously considered futile. One of such technologies that allows to provide hemodynamic support to exsanguinated wounded (whole body or organ), is the technology of extracorporeal membrane oxygenation (ECMO), widely used in civilian healthcare and scaled up during the COVID-19 pandemic.
Methods. We initiated the ECMO procedure 9 times during a 3-month period of forward surgical care in a frontline medical facility: 5 times as a venoarterial V-A ECMO (extracorporeal cardiopulmonary resuscitation, ECPR) to the wounded with traumatic cardiac arrest (ascertained by ECG and ultrasound data) and 4 times for extracorporeal limb perfusion (ELP) for critical uncompensated ischemia (1 - upper and 3 - lower extremity). The ECMO circuit was in a pre-prepared state and consisted of a portable Ex-Stream device (Transbiotech, Russia), an oxygenator, a set of lines and cannulas. For ECMOCPR, a 17Fr intake cannula was placed in the femoral vein, and a 15Fr return cannula was placed either in the femoral artery (traditional ECMO, n=2) or in the brachial artery (when used together with REBOA - for selective aortic arch perfusion (SAAP), n=3). The main objective of ECMO was to restore spontaneous cardiac activity or prosthetic hemodynamics for the period of
transportation to the next stage of care.
ECMO contours were formed differently depending on the clinical situation:
1) from the femoral vein to the brachial artery, 2) from the femoral vein to the posterior tibial artery, 3) from the femoral vein to the ipsilateral femoral artery (isolated perfusion), and 4) from the femoral artery to the posterior tibial artery. A 15-17 Fr cannula was inserted into the femoral vein and an 8-10 Fr cannula was inserted into the artery. In all cases EPL was performed
intraoperatively during the period of preparation for reconstructive surgery.
Results. As a result, out of 5 wounded with cardiac arrest, 4 patients managed to achieve spontaneous recovery of cardiac activity on the background of extracorporeal perfusion. In one case, due to a technical error it was not possible to reach the target perfusion parameters (oxygenator malfunction), and ECMO was terminated. The second wounded person with ECMO lived for 5 h, but died due to repeated refractory cardiac arrest. Of the three wounded patients who underwent SAAP, one survived. The second one (after laparotomy, liver tamponade, ligation of small and large intestine) had a repeated episode of
asystole, which turned out to be fatal (survival time 3 h 45 min). The third wounded person after the performed operations (laparotomy, nephrectomy, liver tamponade, suturing of the diaphragm wound) was temporarily stabilized by ECMO and then transported to hospital (2 hours), where the patient, despite the treatment, died (life time 5 h 30 min).Among the wounded who underwent ELP, all survived, no amputations were performed, the limitation of function that occurred in some cases was mostly due to concomitant damage to large nerve trunks and/or extensive musculoskeletal damage.
Conclusion. Thus, even today perfusion technologies, including REBOA and ECMO allow saving lives and limbs of the wounded at the advanced stages of medical evacuation.
“Ways and means to make KDU a global centre and hub in Military
and trauma surgery”
HOW KDU CAN BUILD UP PRACTICAL COLLABORATION
WITH AZERBAIJANI HOSPITALS / UNIVERSITIES / MILITARY
ACADEMIC INSTITUTIONS
Prof. Kenan Yusif-zade
General Sir John Kotelawala Defence University (KDU) is state defense university of Sri Lanka which is administered by the Ministry of Defense. KDU is the first university in Sri Lanka, running its own University Hospital with modern facilities. The university hospital provide medical services to general public and service personnel free of charge.
The KDU is the only university in Sri Lanka offering Bachelor of Science in Degrees in Marine Engineering and Aeronautical Engineering. Building practical collaboration between Kotelawa Defence University and institutions in Azerbaijan (universities, hospitals, and military academic institutions) requires a strategic and well-planned approach, and a clear understanding of goals and mutual benefits. Here's a step-by-step guide on how to establish and enhance such collaborations:
Identify Common Objectives: Determine the specific areas of interest and expertise that both Kotelawa Defence University and the institutions in Azerbaijan share. This could be in fields such as as trauma surgery techniques, disaster response, and military medical research, etc.
Memorandums of Understanding (MoUs): Initiate discussions with Azerbaijani universities, hospitals, and military institutions to establish formal MoUs outlining the framework for collaboration. MoUs could include faculty
and student exchange programs, joint research initiatives, and collaborative conferences.
Faculty and Student Exchange Programs: Facilitate the exchange of faculty members and students between Kotelawala Defence University and Azerbaijani institutions. Professors can teach specialized courses, conduct
workshops, and participate in joint research projects, enhancing cross-cultural knowledge exchange.
Collaborative Workshops and Conferences: Organize joint workshops, seminars, and conferences focusing on military medical advancements, trauma surgery techniques, and disaster response. These events provide platforms for
experts from both countries to share insights and build networks.
Telemedicine Partnerships: Establish telemedicine connections between medical professionals and surgeons in both countries. Create a system for real-time consultation during complex surgeries or emergency cases, allowing experts to provide guidance from afar.
Shared Resource Utilization:Share educational resources, surgical simulation facilities, and training materials to maximize the benefits of collaboration. Provide access to online courses, lecture materials, and research databases.
Practical Training and Workshops: Collaborate on hands-on training sessions and workshops for medical professionals, focusing on practical skills in trauma surgery, field medicine, and disaster response.
Disaster Preparedness and Response Collaboration: Jointly develop protocols and strategies for disaster preparedness and response, leveraging each institution's expertise in military medical operations.
Joint Publications and Research Output: Encourage joint research teams to publish their findings in reputable international journals, showcasing the collaborative efforts between the two countries.
Cultural Exchange and Networking: Organize cultural exchange programs and networking events to foster strong relationships among faculty, students, and medical professionals from both countries.
Government and Institutional Support: Seek support and endorsement from government bodies and relevant institutions in both countries to promote and facilitate collaboration.
Long-Term Sustainability:Develop a roadmap for the long-term sustainability of collaborations, including regular evaluation of outcomes and continuous improvement. By actively pursuing these collaborative avenues, Kotelawala Defence
University can establish a strong and productive partnership with Azerbaijani universities, hospitals, and military institutions, leading to mutual growth and advancements in the field of military and trauma surgery.
KDU AND JAPAN - WHAT CAN WE DO TOGETHER
Dr. Hiroya Goto, MD
Medical Attaché, Embassy of Japan in Djibouti, Republic of Djibouti, Africa
Japanese large efforts on combat medicine ended with the loss of World WarⅡ.
Fortunately, Japan Self Defense Forces (JSDF) has no combat casualties since its establishment in 1950; however, recent situation surrounding Japan demands robust combat casualty care capabilities. National Defense Medical
College and JSDF Central Hospital are promoting research and education in trauma surgery and have developed some simulation trainings by learning from the others’ experience in modern war. KDU’s experience and knowledge will contribute to the progress of combat medicine research and education in Japan.
