DUBAI // With a tiny needle, Dr Talib Majwal made a millimetre-wide puncture in his patient's groin area. As he did so, at the start of a "keyhole" heart surgery, some 15,000 cardiologists looked on from thousands of miles away.
While Dr Majwal operated at Dubai Hospital, his audience was watching from Paris via streaming video. Dr Majwal, the hospital's director of intervention cardiology, is one of 15 doctors from seven countries whose cardiovascular procedures will be performed over the course of four days for the cardiac surgeons attending the EuroPCR Congress in Paris. Dr Majwal is the first Arab doctor to have operated on camera for the congress, and the only surgeon to present from the Middle East for the 2010 session.
The procedure - an "unprotected left-main stenting" - was intended to remove blockages in an artery near the patient's heart. "This type of blockage would usually result in an immediate heart bypass surgery, because it is so dangerous and can kill a patient in minutes or even seconds," said Dr Majwal. Instead, by manipulating three wires that he had pushed through the puncture, he dislodged the three blockages from within.
"This way, there is no bleeding, no infection, no sutures, no anaesthesia as the patient is completely awake during the procedure, no opening of the chest, and [the patient] can go back to work and to his normal life within four hours," he said. As applause from the Paris audience rang out over a speaker in the cardiac catheterisation lab's procedure room, Mohammed al Sayed, 29, was wheeled out of the room fully alert, free of pain, and with no evidence of cardiac surgery beyond a small dressing on his inner thigh.
He was smiling, wiping beads of sweat off his forehead, and reassuring his uncle Ali that he felt no discomfort whatsoever. Dr Majwal, however, spent the next few hours fielding congratulatory calls from Paris. He performed another procedure later in the day for the benefit of the conference. This one, known as a "bifurcation stenting", was less critical, affording him time to explain, step by step, what he was doing to the patient, a 52-year-old Indian fisherman.
"The conference organisers came to us because they trust our work and have seen the results," he said, adding that very few cardiologists worldwide favour stenting for this kind of problem. "Medicine is constantly evolving," he said. "We have new equipment, new materials, new procedures that we as cardiologists need to learn. "Through this live transmission, I was given the opportunity to teach these cardiologists how to do this by showing them that it can easily be done and giving them encouragement."
The second procedure both removes a blockage from a crucial point where an artery divides, and protects the heart for the future. "We have special technique to treat this type of blockage," Dr Majwal said. "The EuroPCR organisers wanted us to show this procedure for doctors who are in their training and have not yet done it. "So I was asked to do it step-by-step, starting with my selection of equipment, to the point of entrance through a puncture in the patient's wrist, to how we protect the patient through the procedure."
He believes the broadcast marks a turning point in the relationship between doctors in the Middle East and the rest of the world. "Some doctors on the panel were hesitant to have a centre in Dubai and an Arab doctor be a presenter and teacher, because they have a misconception of us that we have nothing to teach them," Dr Majwal said. "We were able to prove them wrong and this is a breakthrough for the whole region - all healthcare centres now have the chance to prove they are not inferior to others."
For Mr al Sayed, however, that wider significance is beside the point; he seemed relieved that a life-threatening condition had been corrected. He admitted, though, that he had been dreading the surgery. "Thank God, it all went well. Thank God," was all he could say after the procedure. He was not in any pain or discomfort, but the look of exhaustion mixed with relief on his face, and his vice-like grip on his doctor's hand, told another story.
"I just want to go back to work, to my life," he said. He lives in Ras al Khaimah, where he has been working as a lawyer for the past three years. "I want to call my family back home in Egypt and tell them everything is OK." firstname.lastname@example.org