Archive for the ‘President’s Communication’ Category

Update on SASES and Bariatric Surgery

Thursday, November 23rd, 2017


Dear Members


The SASES Exco has been reviewing the position of bariatric and metabolic surgery in South Africa with the view to supporting this very necessary surgery.

From the outset the SASES Exco has undertaken to drive bariatric and metabolic surgery in the public sector and is excited to note the growth of metabolic surgery in the University of Stellenbosch; more recently New Somerset Hospital in Cape Town, the Steve Biko Academic Hospital in Pretoria and Sefako Makgatho Health Sciences University in Pretoria.


On the private sector front to date the only route to financing through medical aids has been to have fully accredited surgeons doing the procedure. This not only entails a fully accredited surgeon but more importantly the whole centre and support staff. One understands full well why the medical aids will only deal with accredited surgeons as it is an operation which can have potentially large financial consequences if not done properly.


Aquilo with Proventi are now in a position to offer a second accreditation model to the South African private surgeon. To date the only accreditation system has been through SASSO under the guidance of Prof Tessa van der Merwe and her team but with Aquilo and Proventi, who bring to the party a huge international experience in bariatric surgery, the South African surgeon will now have choices as to whom he or she approaches for accreditation.


As a Society we have evaluated the international accreditation offered by Proventi and confirm that, in terms of quality and standing, it is on par with the local SASSO accreditation. We are excited that the surgeon now has more choice. We believe that this will open up the field wider for more surgeons to be accredited, be it either through Aquilo/Proventi or SASSO, to the benefit of patients in the private sector.


Kind regards

Dick Brombacher





Update on your society’s activities since Port Elizabeth ASSA/SAGES

Sunday, October 15th, 2017

9 October 2017

President’s Report



Dear Membership




As we have entered the final quarter of 2017 it is fitting that you, the Membership, have an update on what your Society – SASES is doing for you and for endoscopic surgery.


  1. Fellowships

The Fellowships for the current year have been awarded.  The fellows are either in the process of leaving or have left for Germany, Amsterdam or Belgium.  The new Fellowships will be advertised in January 2018 together with the two HIG Fellowships.


We as an Exco get feedback about the adjudication process in awarding Fellowships.  Martin Brand – Exco member in charge of Fellowships – and I met with the member who had concerns and it has been a learning process for both parties.  We will look at a few aspects of the adjudications system and I think the member who brought these concerns to our attention – for which we are really grateful – is reassured that the system is a well run system.


  1. Interaction with Medical Aids

The laparoscopic appendectomy evaluation process is ongoing with Medscheme.  Medscheme have approached us for the practice numbers and names of our members – it might well be that based on the results to date they will limit the laparoscopic appendectomies to SASES and Surgicom members only – another good reason to be a member of this Society.


  1. Development of Minimal Access Surgery on the Academic Front

The Fellowship which has been run by Prof Zach Koto at Sefako Makgatho Health Sciences University is now into its third round.  The Fellowship has now been recognised by the College of Surgeons and will probably become a formal Fellowship to which we hope to attach bariatric surgery.


We were approached by individual members of the Society as to the future of bariatric surgery as well as concern from industry.  The concerns were that there are two few bariatric surgeries being done per year for the population size in South Africa and its needs.  One recognises that bariatric surgery is possibly no longer the right term and one should refer to metabolic surgery.  Because of these concerns the following has happened:

  • A start-up meeting with the Heads of Department, Zach Koto and myself at the start of the recent ASSA/SAGES meeting in Port Elizabeth.
  • A meeting with Industry in Johannesburg this Wednesday evening with Prof Zach Koto and myself.


  1. Professor Zach Koto

It gives me great pleasure to announce to the Membership that Zach Koto, a valued member of the SASES Exco and a driving force behind the MAS Fellowship and bariatric surgery’s re-evaluation has very deservedly been elected to the position of President of the College of Surgeons, South Africa – Zach, on behalf of all the Membership a heartfelt congratulations on this well deserved post.


  1. Stand Alone Meeting 2018

You the Membership had requested a Stand Alone meeting for 2018 – the thinking was to use the same venue because of the success we have had to date.  At the completion of the ASSA/SAGES meeting Denise Kemp and I wrote to all the sponsors who have supported us through the last two meetings to gauge their enthusiasm as well as discuss the choice of venue.


Their enthusiasm was overwhelming; the choice of venue however is proving problematic because of the European guidelines on corporate spending.  At the Exco meeting on 29 October 2017 we will debate whether to move ahead and see if there is enough support from the companies not aligned to the European chapter or whether a whole new venue needs to be looked at or combining with SAGES in Johannesburg next year.


  1. The Red Cross Training Centre

On a personal note I was fortunate enough to attend the 2 day Tim Rockall cadaver workshop at the Red Cross Children’s Training Centre on 14‑15 September 2017.  The course was over subscribed.  One left that course realising that the Centre offers world class courses in a first world centre in our very own country with delegates attending it not only from South Africa but also from Namibia.


Having now attended two courses at the Red Cross Children’s Training Centre in this calendar year I can only but encourage the Membership, old and young, advanced and starting in their laparoscopic career to attend these courses as it is only when you leave this course that you realise how much each one of us still has to and can learn on an individual basis.  The courses are a master class, the facility is superb and it really is for our Membership to appreciate what they have on their own doorstep and to use it.


  1. Interaction with Industry

As of this year we have introduced a system where the leaders of the large pharmaceutical groups are given an opportunity to join us at Exco for an hour on a Sunday morning (hard bench) to discuss their plans going forward re education and training and to discuss with us concerns and hear our concerns.  To date we have met with Leanne Wood from J&J in February 2017; Colin Atkinson from Medtronic in May 2017 and we will be meeting with Stacey Meyer the new general manager of J&J at our Exco on 29 October 2017.  These meetings certainly are very beneficial.  It takes away the marketing aspect and brings it down to a working meeting as we realise as an Exco we are very dependent on industry for financial support with training and they benefit from the direct one on one feedback with Exco who after all represents the endoscopic surgeons.


  1. Exco Elections

A reminder that 2018 will be a voting year.  If you feel that you would like to contribute to the Society by getting onto Exco please make sure that you do attend the AGM – venue still to be announced – towards the end of 2018 and become an active member of this dynamic Society as it moves forward into the next decade.


Wishing you all well.

Yours sincerely


Dick Brombacher




Online report

Laparoscopic Appendectomy Study, Medscheme

Tuesday, May 23rd, 2017

22 May 2017

The final analysis of our six-month study was completed by Medscheme.  Fedhealth has now agreed to allow all appendectomies to be done laparoscopically, by SASES surgeons, in any hospital until the end of 2017.  The usual co‑payments which applied to these patients previously, still apply but letters of motivation by the surgeon will no longer be required.
The only criteria to be met are that:

  1. The surgeon stays within the set basket fee of R3 950 for disposable surgical equipment;
  2. The following plans are excluded:
  • Blue Door Plus
  • Dynamic Hospital
  • Dynamic Saver
  1. Should a surgeon operate on a Fedhealth patient and be found to have used more than the basket fee allocated, they will be contacted through SASES for an explanation as to why the cost was higher than the allocated cost structure.

We certainly, as Exco, are very pleased with the progress being made on this study but remind the surgeons that the ball is now squarely in our court – stay within the costing and we might well see this extended by other Medical Aids in 2018.
Yours sincerely
Dick Brombacher


Wednesday, March 1st, 2017


After our Laparoscopic Appendectomy Pilot Study which admittedly produced very small numbers, Bonitas Medical Scheme, who as you know falls under the Medscheme umbrella – our partners in the Laparoscopic Appendicectomy Study - have agreed to allow all appendectomies to be done laparoscopically without any letters of motivation being required.


The only two T’s and C’s which apply are:

  1. The surgeon stays within the R3950 basket fee for disposables.
  2. The lowest Bonitas schemes – Primary, BonSave, BonFit and Bon Essential – patients will be responsible for a R2750 co-payment.


An exciting breakthrough after a rather small cohort of patients were entered into the Pilot Study – we hope other medical aids will follow.


I will keep you posted.


Kind regards


Dick Brombacher







Wednesday, March 1st, 2017


The pilot project for Laparoscopic Appendicectomies under the Medscheme umbrella came to an end on 31/12/2016.   


Medscheme have started to unbundle the data which shows the following:

  1. A very small cohort of patients collected into the data base.
  2. Of those collected only 33% of the surgeons involved stayed within the designated price for basket of re-usables.
  3. One surgeon – two cases – overshot the basket being well above R8 000 for re-usables per case.


 The way forward:

  1. As the Project Co-ordinator, I plan to contact the individuals involved to see if there are explanations for the overshoot on the basket price.
  2. I have suggested to Medscheme that if it was done in more hospitals – not just Netcare – with more of the Medscheme medical aids being involved there might be a bigger pool.
  3. If there were a bigger cohort we would get a better overview of surgeons’ usages.


One of the concerning features for the SASES Exco is that in spite of a huge amount of work, negotiation, and a basket price being established, only 33% of cases were kept within the limits.   

It has been the mission of this Exco and those before us who initiated this project to make minimal access surgery financially affordable and sustainable – based on these results it would appear that the bench mark set for us by the medical aids was not attained by the membership making it difficult to try and renegotiate further pilot projects unless we, the membership, show intent to reduce costs.


More information to you as results or progress comes to hand.



Dick Brombacher

President SASES





Wednesday, March 1st, 2017


When I became President of the Society I took a decision to attend the first available course at our much spoken about Surgical Skills Lab at the Red Cross Children’s War Memorial Hospital.  As you will know we as a Society have backed Prof Alp Numanoglu in its establishment and got permission from you at our AGM some two years back in Cape Town to help fund Mr Clive van Geems, the Co‑ordinator of the Centre, financially for the first year to see if it could become financially self-sustaining.  


I therefore took the opportunity to attend, on 17 and 18 February 2017, the Advanced Laparoscopic Suturing Course at the Surgical Skills Lab.  


I arrived with a sense fear that here the President of the Society was going to be attending what I thought was a basic suturing course and it certainly took some humility to enter as a delegate with what was to be a team of Senior Registrars and other consultants in both the private and public sector.


Having attended a Suturing Course some twelve years ago I was absolutely astounded by the quality and level of this course.  From the very first introductory talk to two days later taking an advanced suturing test based on the gynaecology model from Europe I was in awe of how much we individually can learn with a refresher course but also realise that this course is not aimed at the Registrar or the Trainee but rather us surgeons who have been in practice for years, possibly believe we need no further retraining but realised that we all can benefit from it – hugely.  


I will encourage you, as members, to travel down and attend when courses are offered because the benefit is immense.   


It remains for me to, on behalf of SASES and the Exco, thank both Prof Alp Numanoglu and Clive van Geems for the amazing work they are doing – to encourage you to use this world-class facility which has surgeons travelling from other parts of Africa to attend courses and yet it is on our door step for us to benefit from its use.  Please see website info.

Wishing you well in your surgical year ahead.




Dick Brombacher






President’s Letter 2017

Saturday, January 7th, 2017

SASES logo

2 January 2017


Dear SASES Members


The new year has started and with it SASES is actively back at work hoping to make 2017 another bumper year for the Society.


1. Fellowships

The year will be launched with the online application for all four of the fellowships being offered this year. It is the first time they will be streamlined into one fellowship application with the candidates being given the opportunity to preference the fellowship they would most like to apply for.The membership will be informed the moment it has been loaded and applications are ready for processing.


2. FoSAS

The FoSAS meeting took place in Cape Town on 26 November 2016 at which Prof Eugenio Panieri represented the Society as I had other commitments. We will receive feedback on this at the next Exco meeting in Cape Town on 19 February 2017.


3. Champagne Sports Meeting

The meeting held at the Champagne Sports Resort from 27 to 30 October 2016 was a resounding success with lots of positive feedback from not only the Membership who attended but also the Foreign Delegates who were there and most importantly from the Trade who supported. The meeting for 2017 will be in Port Elizabeth. It will be an ASSA SAGES meeting from 9 through 12 August 2017.


4. Council of Medical Schemes

We have been approached by Michael Klipin to help with submissions to the Council of Medical Schemes as they work through the definitions and remuneration of Prescribed Minimum Benefit conditions. The Hernia Interest Group (HIG) under the umbrella of SASES and headed up by Ravi Oodit and his team will do the submissions on hernias. SASES will be handling the appendicectomy as we have done a lot of work on this already. All Exco members will be asked to submit their CV’s so that the Council of Medical Schemes can choose a committee to sit towards the end of January 2017 to look at all the submissions.


5. Laparoscopic Appendicectomy Pilot Study

You will have received an email towards the end of December 2016 informing you that the pilot study has now run its course. Medscheme is now going to sit down together with SASES and look at the results of the study and see if there is ground to move forward by either expanding the hospitals involved and the medical aids of the Medscheme Group which will join it or whether enough data was made available to possibly move forward and implement laparoscopic appendicectomies. You will be kept informed of progress as and when it occurs.


6. SASES Website

Please continue to actively use the website where you will get updates on Webinars, workshops and the likes. The next Webinar is scheduled for 15 February 2017 and the next Advanced Suturing course at the skills lab at the Red Cross Children’s Hospital for 17 and 18 February 2017.


7. Membership

A Society is only as strong as its membership base. Please continue to encourage newly qualified colleagues to become members of SASES which can be done on line through the SASES website. Wishing you all a very good 2017. Please keep your Exco informed of areas of concern where we can be of help.


Kind regards

Dick Brombacher







TREASURER: Dr C Sofianos SECRETARY: Dr E Coetzee

MEMBERS: Prof A Numanoglu, Prof Z Koto, Dr R Oodit, Dr M Brand



2017 Greetings (91.0 KiB)


President’s Report 2016

Wednesday, August 31st, 2016

The South African Society of Endoscopic SurgeonsSASES logo


Dear Member

Spring is officially in the air, heralded by the warm weather and Kites in the sky

This bodes well for our upcoming congress in Champagne Sports Conference Centre from the 27th to 30th October.

To those of you already registered, I look forward to catching up with you once again and will hopefully enthral you with our star-studded cast of 9 international guest speakers. It promises to be a great meeting. To those who haven’t registered, it’s never to late, check out the link below:

It has been two years since I took over the presidency of the society, and the one observation I have made is that we have evolved into what can only be described as a slow-moving juggernaut. Over time we have managed to set in place various programs and policies to help benefit and uplift our members, and these days all that is left is for our members to capitalise on these efforts.


Travelling Fellowships

This program has been running for roughly 5 years now and has proven one of our greatest successes. Members are afforded the opportunity to apply for 3 international travelling fellowships to help further their laparoscopic skills. Credit must be given to our sponsors Medtronic, Karl-Storz and Johnson & Johnson (J&J) without whom, none of this would be possible.


  • Medtronic sponsorship is to Amsterdam to work with Willem Bemelman
  • Karl-Storz sponsorship is to Bavaria to work with Markus Walz
  • J&J sponsorship is to Leuven to work with Andre D’Hoore

Congratulations to this years recipients viz.

Dr Ebrahim Delwai

Dr Mark Hampton

Dr Zafar Khan

We look forward to hearing their feedback.

A special thanks to Eugenio Panieri for his tireless efforts in helping to streamline and co-ordinate the fellowships.


Red Cross Training Centre

Another tireless effort is co-ordinating the training centre. Special mention must be made of Alp Numanoglu who is the driving force behind the unit.

He is now ably assisted by Clive van Geems, the course co-ordinator (another SASES venture that has proven fruitful) and they have managed to move from strength to strength.

The unit offers courses for a wide variety of individuals viz.

Surgeons with our advanced laparoscopic courses

Students and Registrars with the basic laparoscopy courses

Nurses – our nursing laparoscopy course have proven quite popular and we look forward to hosting more in the future

Trade – we have recently successfully completed a course for sales reps hosted by their company to familiarise themselves with the equipment

Please look out on our website and our flyers for dates for the upcoming courses, you won’t be disappointed.



A congress in the comfort of your own home, well not quite, but close enough

SASES offers 4 meetings a year whereby members can login from home and participate in a discussion on a surgically relevant topic. Incisional hernia was the topic presented by Dino Sofianos a fortnight ago and was very well attended. CPD points are on offer, need I say more.


Laparoscopic Appendectomy Collaboration with Medscheme

As you may be aware, we have undertaken a pilot study into the costing of laparoscopic appendectomy in an effort to control costs and encourage buy in from our funders. The project is currently underway at Netcare hospitals with Medscheme funded patients and will run until the end of the year. We are hoping to use this data to prove that appendectomy can be done laparoscopically and, more importantly, cost-effectively thereby encouraging buy in from the other funders. Watch this space.


Hernia Interest Group

From the same people who brought you the blockbuster inguinal hernia guidelines, we are pleased to announce that the Ventral Hernia Guidelines will be revealed at the upcoming SASES congress. Credit must be given to the members of HIG and the superhuman effort they have put into developing these guidelines. Members are urged to reference this material as the sole aim is promote responsible surgery and best surgical practice with regards to hernia management, thereby optimising patient outcome. The Inguinal Hernia guidelines are available on the link:

Other exciting news is that HIG has also secured travelling fellowships pertaining specifically to hernia surgery. These should be advertised early in the New Year. Well done HIG, take a bow.



The ERAS project is well underway in a joint project. The private practice of Matley and Partners is well on their way to recruiting patients and accumulating data. Groote Schuur has recently joined the party and will start recruiting in next month. This project will continue until the end of the year.
Well done Ravi Oodit on single-handedly getting this project off the ground. We are hoping to slowly recruit additional institutions and develop a substantial national database on ERAS in the future.
Without having to go on and on, it is clearly evident that your EXCO is hard at work. In order to be truly successful, we require an active membership. I implore to log onto our website, join the webinars and most importantly support our meetings, cos without you, we have no society.

Yours sincerely



Masee Naidoo

President of SASES






SASES Update: Past, Present and Future

Wednesday, February 25th, 2015

President's Report

23 February 2015

2015 is well and truly on its way as we see out the first quarter of the year. This affords us the opportunity to reflect on the year that has past and look forward to what lies ahead.
Our society has truly evolved into a self-propelling juggernaut that is constantly evolving and improving in whatever way we can.

Last year saw the introduction of a third International Travelling Fellowship to our existing program. For those members who are unaware, SASES now offers its membership the opportunity to travel to an international surgical unit for a period of 2-3 months on a training fellowship. The fellowships are open to all our members and have largely been facilitated through our collaboration with various companies:

  • The Karl Storz Fellowship is hosted by Dr Markus Walz at Straubing Klinik in Bavaria, Germany for 2 months.
  • The Covidien Fellowship is hosted by Professor Willem Bemelman at the AMC in Amsterdam for 3 months. This fellowship has a colorectal focus.
  • The Ethicon Fellowship is hosted by Professor Andre D’Hoore at the University Hospital in Leuven, Belgium.


Last year’s recipients were Dr Hugo Stark, Dr Zaheer Moolla and Dr Nelson Latakgomo. Their glowing feedback will be posted on the website shortly.


Look out for the advertisements for this year. The Ethicon travelling fellowship has already been advertised on our website, and the two remaining fellowship adverts will follow shortly.


The Red Cross Training Centre has now been established as a centre for national training (largely thanks to the tireless efforts of Professor Alp Numanoglu). We host various laparoscopic programs that cover suturing, cholecystectomy and appendicectomy. At present we are engaging with the College of Surgeons to ascertain if these workshops could be incorporated into the training curriculum of every registrar to ensure adequate exposure to laparoscopic training and techniques. In due course we are hoping to establish more units like this across the country to make this proposal feasible. Kindly refer to our website for upcoming workshops.


This year saw your society together with the Red Cross Centre take a massive leap forward in the appointment to Mr Clive Van Geems as the course co-ordinator at the Red Cross facility. Clive’s role would be to co-ordinate as well as host the workshops being held at the Red Cross centre. Clive’s other role is to actively seek sponsorship for the courses in an effort to reduce the costs to our members. We wish Clive (and Prof Numanoglu) all the best in this bold, new endeavour


Last year saw the inaugural meeting of Hernia Interest Group. They have since moved on to draw up a constitution as well as establish a working relationship with various companies from the industry. Together they are focused on establishing guidelines aimed at standardising and optimising hernia surgery for all. Look out for their guidelines in the upcoming national journals as well as the patient information brochures that will soon be freely available on our website. This little document is a colour illustration of what hernia surgery entails and provides useful need to know information to your patients. I encourage everyone to make use of this. HIG also has a session at the upcoming ASSA-SAGES congress in Durban from 7-10 August.


Our Private Practice negotiation has also proven fruitful, with SASES having already previously attained approval of the use of wound protectors. More recently we have managed to reverse a funder’s decision to not allow a SASES member to do a laparoscopic adrenalectomy. After SASES intervention this will now be reversed. Negotiations are still ongoing for the acceptance of laparoscopy rather than open procedures in the management of appendicitis and inguinal hernias.


Last year saw SASES and SAGES play host to the ISUCRS at our national congress in Cape Town. This has certainly proved to be one of our best attended congresses with over 900 delegates registered. SASES also took the opportunity to play host to Professor Willem Bemelman and Professor Andre D’Hoore as our visiting international speakers. Willem is a well-known friend of the society, having first attended the stand alone meeting at Champagne sports resort as well as hosting the annual Covidien Travelling Fellowship award. Andre is a new friend of the society having agreed to host to the recently established Ethicon Travelling Fellowship. Both of our visitors proved extremely popular and were very well received at the meeting. We look forward to seeing them again soon.


This year we will be participating in the biannual ASSA-SAGES meeting in Durban on the 7-10th August. The program will be advertised shortly, and we are hoping for a diverse meeting focussing on topics relevant to the general surgeon from the various sub-specialities. As is always the case, we will be hosting a guest international speaker whose resume will undoubtedly leave you speechless. See you there.


Last but not least, SASES is proud to announce that we will once again be hosting a stand-alone congress in the Drakensberg from 27 – 30 October 2016. The program will be very similar to the last meeting we held in 2011 with a host of international speakers talking about topics ranging from their favourite operation to their worst, do and don’ts and most importantly simply liaising with our membership. Don’t miss this!


Masee Naidoo





SASES AGM 5 September 2014

Wednesday, October 29th, 2014

Click here  to view the minutes from the SASES AGM on 5 September 2014.

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