Asian Pacific Digestive Week (APDW) 2020
Dates:17-20 September 2020, in Kuala Lumpur Convention Centre (KLCC), Malaysia.
Hosted by the Asian PacificDigestive Week Federation and presented by the Asian Pacific Association ofGastroenterology, the Asian Pacific Society of Digestive Endoscopy, the AsianPacific Association for the Study of the Liver and the International Societyfor Digestive Surgery, APDW 2020 promises to be truly a gathering of like-minded professionals with the theme-“Vision of Excellence in DigestiveDisorders and Sciences”. Please click HERE to go to the website.
1st Inaugural Meeting of Asia-Pacific Laryngology Association on 1st to 3rd November 2019
The first Inaugural Conference of APLA took place in Singapore during 1st - 3rd November 2019. By any standard, it was the most successful conference, with 355 delegates from 32 countries. The theme was ‘Frontiers in Laryngology’; and the programme was befitting to the title, with so many up to date presentations from the world over.
Considering a highly specialised, and a small, but significant part of the body ‘The Larynx’, a large attendance owed it to the a vast array of scientific papers, courses, keynote lectures and, not in the least, the articulate scheduling by David Lau and his colleague Vyas Prasad and team Click here (www.aplameeting.com/programme.html) for the Scientific Programme. There was something for everyone, to take home. APLA board is grateful to the organising committee for making the Inaugural Conference a landmark event, in a beautiful location, Singapore. They set the standard for others to follow. The second APLA conference is set to take place in Manila, Philippines, during 1st – 3rd December 2020 – so please mark your diary.
In the past six decades, most Health Care sectors have been impacted with technological advances, and the speciality of Otolaryngology is no exception. In fact, examination and management of Ear Nose and Throat conditions have always been challenging since these structures are located in dark and convoluted cavities. From the rudimentary but ingenious endeavour of Manuel Garcia, a singing teacher, who visualised his own glottis in action with dental mirror and the Sun rays in 1854, the past few decades have witnessed an explosion of new techniques for diagnosis and transoral management of a number of laryngeal conditions.
Use of hi-tech equipment including Robots and Lasers has led to challenging training requirements and skill acquisition. A number of courses specialising in Laryngology are now widely available in developed and developing countries.
Asia Pacific Laryngology Association (APLA)
Asia Pacific region represents a diverse socio-economic mix. Some centres, particularly in metropolises, have advance technology in dedicated Laryngology suites, but others remain rudimentary by today’s standard. A bold initiative was proposed under my Chairmanship and Dr Sachin Gandhi’s Presidency to enlarge the scope of the science and art of Laryngology for a wider audience in the Asia Pacific countries. Asia Pacific Laryngology Association (APLA) was formally established during the annual conference of Laryngology and Voice Association (LVA) in Bangalore, India, in 2017. Under the direction and enthusiasm of David Lau, an inaugural conference of APLA, aptly titled ‘Frontiers in Laryngology’, http://www.aplameeting.com/ took place in Singapore during 1st - 3rd November 2019. It was enriched by the concurrent participation of the 8th International Conference of the Laryngology and Voice Association and the 6th Asia Pacific Paediatric Airway Course. The 3-day programme was the usual mix of the age-old topics. Most of the laryngeal surgery including malignancy is now carried out transorally. But how far this keyhole route can be stretched? Read on - the title ‘Frontiers in Laryngology’ is apt, with some fascinating innovations. Tomorrow’s world indeed.
Highlights of the Scientific Programme
Image enhancement and 3D profiling: Marina Baki from Malaysia presented an overview of ‘Advance imaging in Laryngology – what role?’ Narrow band and I-scan imaging, which emphasises increased vascularity and sharp demarcation allows early differential diagnosis and more precision surgery.
Lasers in laryngology: CO2, KTP and TruBlue lasers: The CO2 laser continues to remain the workhorse laser in laryngology. Matthew Broadhurst from Australia demonstrated angiolytic KTP and Trublue lasers which have started to make inroads. Being fibre-transmissible, they enable many procedures to be carried out in the office-based setting with lower costs and reduced morbidity. There is an added advantage of preservation of mucosa due to blood as their main absorbing chromophore.
Transoral laryngectomy? No, not a joke. Georges Lawson from Belgium showed how such a procedure is feasible with the combination of robot and the laser. The surgery is carried out ‘inside-out’, and the only complication was bleeding from the superior laryngeal artery! Will this approach become a routine? Time will tell.
‘Oswal Oration’ – Office based surgery: was delivered by Ramon Franco from Boston, USA. The theme was ‘In-office Treatment of Benign and Malignant Laryngeal Lesions – what is feasible?’. It emphasised how cost-effectiveness and reduced patient-morbidity are gradually assuming a pivotal role in the health care sector!
Trans Nasal Oesophagoscopy: A live demonstration by David Lau of Transnasal Endoscopic Oesophagoscopy (TNE) was a masterpiece. He made it look like a child’s play; doing it more for his relaxation after hard day’s work; rather than for the benefit of the patient. It showed us a remarkable technological progress from the rigid oesophagoscopy of the sixties of the last century, with a flickering tungsten bulb which had a habit of going dim just at the crucial moment of grasping a foreign body. Oesophageal perforation with mediastinitis was a not uncommon occurrence. The patient was given barium soaked cotton wool to swallow. A spillage of a radio-opaque shadow in the chest confirmed the worse. Muscle relaxants were still to be invented!.
‘Medico-legal Issues in Laryngology’: A departure from the offensive posturing of the knife (or laser) wielding surgeon was provided by ‘Medico-legal Issues in Laryngology’. Teoh Ming Keng from Medical Protection Society of UK presented an analysis of claims, with a very welcome paucity of laryngeal lawsuits! Guri Sandhu from UK enlightened the audience with a masterly presentation of safe practices in laryngology, while Rohan Bhidaye, also from UK, listed all the potential risks that may accompany seemingly straightforward laryngoscopy and surgical procedures on the larynx. How many potential complications should you pre-warn the patient? They range from damaging the teeth to injuring the hypoglossal and lingual nerve, from postoperative bleeding to unplanned tracheostomy. Guri reassured that in many hundreds of laryngeal procedures he had undertaken, he could recall at the most two or three unplanned tracheostomies. Is anterior web formation after removal of papilloma a complication or a sequela? How do you warn the parents that an obstruction by papilloma in a child will be successfully treated, only to be replaced by an obstruction due to web formation? In the triad of the patient, the surgeon and the technology, the most danger comes from? A poorly trained surgeon!
With some sixty years of experience in ENT, Vasant Oswal rightly pointed out that any injury on the edge of the tongue is never due to a clumsy insertion of laryngoscope. Hypaesthesia of the tongue results from prolonged pressure on the lingual nerve. Resulting numbness causes the patient to unwittingly bite his or her own tongue!
Surgical fire: Having acquired the very first laser for laryngo-bronchology in the UK in 1982 with the funds raised by public appeal and having carried out pioneering bench experiments to establish clinical parameters and safety issues, Vasant Oswal urged the audience to be vigilant of potential to surgical fire, not only due to laser beam and hot tissue debris but also due to sparks from diathermy.
Best presentations: winners of various categories
Young trained or trainee surgeons work hard to progress their career. It is a duty of the peers to acknowledge the effort that goes in to the vastness of learning as the technology opens new avenues for old problems. The organisers deserve our thanks to have given a due consideration by creating several categories for competition: Oral presentation, Video, Posters, Resident /post-graduate presentation and Young consultant presentation. Each category had three prizes. Our congratulations to the winners and equally, to non-winners (without whom, there will be no winners!). Please click here for the names and categories of winners: www.aplameeting.com/.
It is heartening to know that some 355 delegates from 32 countries participated in this landmark Inaugural Conference of APLA in Singapore, no small achievement for David Lau, Prasad Vyas and many colleagues who worked tirelessly and were well rewarded with huge attendance for a highly specialised area of ENT practice. The huge success prompted a number of countries in the Asia Pacific region wanting to host the APLA conferences. Philippines was chosen to host the second APLA conference, pencil your diary: 3rd - 5th December 2020. Indonesia, Malaysia, Thailand, Bangladesh and India are waiting for their turn.
The APLA website: The launch of E-Learning portal
The APLA website was launched by Vasant Oswal during the conference. Launching a website? Never heard of it before? Yes, you are right. Vasant Oswal had a special reason to do so. With his now retired colleague Liam Flood, he conceptuated a novel learning method: ‘Image-based’ E-learning’. A high quality image showing unequivocal pathological changes sets the scene for self-learning process. A series of multiple choice questions follow. Correct answers have a brief narration of reasoning. Uniquely, incorrect answers also have similar relevant narration. The learning process then expands in to ‘Salient Points’ about the image to reinforce structured learning. The section on Current Thinking updates the knowledge up to the time of writing. A list of supporting references completes the exercise.
The uniqueness of this method lies in the fact that everything in a quiz revolves round the image, the likes of which the reader sees frequently in his or her daily practice. A few clicks on the mobile device will give an overview of the condition, enabling him or her to apply the knowledge so gained to the job in hand. There are no weighty volumes to browse. They invariably contain long passages of descriptive texts, more suitable for passing examinations. Likewise, there is no mere ‘copy-paste’ repetition of what is already available on the net.
The programme is fully oriented to clinical situations encountered in everyday working of a wide range of professionals – medical practitioners, nursing, technicians, therapists etc., in the field of Laryngology. Other platforms in the programme will cover practical aspects of laser physics, stroboscopy, methods of voice therapies etc., supported by slides and short video clips.
Open Access Web Resource Free to All
An important aspect of the e-learning programme is that It is an open access web resource freely available to anyone anywhere on all platforms with a connection to the internet.
Readership of this report is urged to log on to www.aplameeting.com/ and follow simple instructions to get a first-hand experience.
Although we started this programme, it is for your future. If you wish to contribute, please send a brief to me in the first place for assessment.
Postscript by Mr Oswal
After continuing to be involved in ENT in different roles in the past sixty years, I hope I have left a legacy behind in the shape and the name of APLA. Long may it continue to provide inspiration and education for the generations to come.
My first ENT residency job was in 1960 when mastoids were done with chisel and hammer and tonsils were whipped out with guillotines in sixty seconds flat. Another thirty seconds to curette the adenoids, smartly turn the child on the side and put handful of ice on the neck for a minute. Ten guillotines to an hour.
People ask me when I am going to retire. My answer to them: People, who work, retire. I never worked. What I did and continue to do gives me pleasure, a sense of fulfilment. I hope some of you might feel the same way in time to come, and continue to serve the community and generations of our future colleagues.
Vasant Oswal, Founder Chair, Asia Pacific Laryngology Association.
From Left to Right:
Rakesh Shrivastav, Prasad Vyas, Ashok Purohit, David Lau, Vasant Oswal, Sachin Gandhi, Henry Tan
‘Frontiers in Laryngology’
Inaugural Conference, Asia Pacific Laryngology Association, 1st – 3rd November 2019, Singapore.
Vasant Oswal, Founder Chair, Asia Pacific Laryngology Association
Delegates from countries (in Alphabetic order)
Dr David Lau Organising Chairman
Inaugural Congress of Asia-Pacific Laryngology Association 2019
Dr Sachin Gandhi Founder President
Asia-Pacific Laryngology Association