39^th, Perioperative Nurses Scientific Conference, 2022 (Mombasa, Kenya

• Evidence based perioperative practice: Advances in surgical procedures at Kenyatta National Hospital.
• Presenters: Francis Mariach kenimak and Beatrice khandega.
• M.Sc. Med. Micro. Bio (u.o.n)/ BScN (U.E.A.BN/ KRPoN/ KRCHN/Microvascular specialist(KNH).
• Beatrice Khandega BScN(mku)/KRCNHN/KRPoN/Hepatobilliary(India-New Delhi)/Laparoscopy(Dubai)KNH,
• Date: 9^th,-----11^th,November,2022.

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Introduction

• Medicine is dynamic and surgery as well has technologically changed and advanced. Kenya is not an exception in this motion and Kenyatta National Hospital has remained to be a leading Centre of excellence in both patient care and advanced techniques of surgery.
• Dr. Richard SC Kerr, of the royal college of surgeons England states that, as the surgical workforce, surgical techniques and patient expectations changes, often for better, more specialized surgical technology must be available. Currently the world advanced technologies include; artificial intelligence (AI), genomics in diagnostics; 3D printing and robotic assistance in operating theatres.

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Cont.……..

In Kenyatta National Hospital the referrals are immense with landmark successes. The hospital’s rich history is not limited to the re-known separation of conjoined twins, limbs re-implantations, organs transfers, the current tumors excision and reconstructive surgeries not forgetting the congenital abnormalities corrections. The nurse is at the Centre of these technologies.

Lymph Oedema is one of the challenging conditions in our region today, it is almost termed a neglected condition affecting patients in all human aspect.

Minimally invasive surgeries available locally in the last few decades for simple procedures like appendicectomy, cholecystectomy, hysteroscopy and diagnostic endoscopies, have advanced into more sophisticated surgeries like hernia repairs, Hemicolectomy surgery, baliatric surgeries. among others.

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Cont.……..

Benign liver cysts, hepatocellular carcinomas, hemangiomas and trauma, necessitating liver transplantation (resections) surgery is now available locally.

3D printing is another technology we are adopting and is set to transform patient planning for surgery, and to conform effectively with the implants available.

3D printing software is used to extract data from patient imaging technologies and print personalized and custom-made guides for surgery and implants to reconstruct anatomical structures affected by diseases.

3D planning and printing technologies are likely to become widely available in Kenyan hospitals for surgical use.

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Cont.….

Artificial Intelligence

Artificial Intelligence is a method of making a computer, a computer-controlled robot, or a software think intelligently like the human mind. AI is accomplished by studying the patterns of the human brain and by analyzing the cognitive process. The outcome of these studies develops intelligent software and systems.

TYPES OF AI:

1. Purely Reactive: These machines do not have any memory or data to work with, specializing in just one field of work. For example, in a chess game, the machine observes the moves and makes the best possible decision to win. 

2. Limited Memory: Collect previous data and continue adding it to their memory. They have enough memory or experience to make proper decisions, but memory is minimal and can suggest places location.

3. Theory of Mind: Understand thoughts and emotions, as well as interact socially. A machine based on this type is yet to be built. 

4. Self-Aware: Self-aware machines are the future generation of these new technologies. They will be intelligent, sentient, and conscious.

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Penile amputation and reimplantation at KNH

• The evolution of penile re-implantation has come a long-way since the first reported case by Ehrich in 1929 to the first successful reports of microsurgical penile re-implantation by Tamai et al. and Cohen et al. in1977
• Males are prone to have external genitalia injuries more frequently than female because males are more exposed to violence or extreme exercise.
• External male genitalia injuries can be categorized as accidental i.e. during circumcision, zipper injury or penile fracture or as traumatic in origin i.e. motor vehicle accident (MVA), animal bite, gunshots, penetrating injury, strangulation injury, self-amputation, criminal, assault injury.
• Self-emasculation of the penis may be as a result of Klingsor syndrome (disease of self-mutilation by a psychiatric patient, often suffering from religious delusions). About 87% of penile amputations are due to an underlying psychiatric disorder. In Kenya we present 3 case reports with the first 17 year boy successfully done.

Organs re-implantations

8 hours post penile amputations

5 days post-operative day.

Lymphoedema

• Lymphedema is a term that refers to a pathological condition involving the lymphatic system, whereby there’s poor or impaired lymphatic drainage. This impaired lymphatic drainage then results in the buildup of proteinecious fluid in 3^rd space i.e. interstitium (Liakos et al., 2019).
• Lymphedema has been documented to be affecting over 200 million people worldwide, secondary lymphedema due to filariasis being the commonest cause (Greene, 2015; Greene et al., n.d.).
• Microsurgery has become a common and standard surgical method of managing lymphedema. Vascularized lymph node transfer(VLNT) has been popular over the past 10 years.
• Vascularized cervical lymph node transfer(VCLNT) by means of the knee/ forearm/ lower limbs as a recipient site is a unique and dependable method that significantly improves primary lower extremity lymphedema( Adegu.w, Nangole F.W and R. Njoroge,2022).

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Robotic assistance in operating theatres.

• Robotic surgery is a method of performing surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer. These instruments are mounted on three robotic arms, allowing a surgeon maximum range and precision of motion as he or she performs the procedure.
• In Kenya for example Longisa Hospital in Bomet county is already adopting this technology in consultations' and possibly surgical procedure.

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Conclusions:….

• Kenyatta national hospital despite numerous challenges has continued to excel and adopt different management of surgeries over a period of time.
• We look forward to continue adopting newer technologies as the world continues to advance in surgical techniques.

End�Q/A’s