The origins of Laparoscopic surgery by general surgeons in South Africa go back to thoracoscopic sympathectomy by Bob Goetz in the 1940’s and diagnostic laparoscopy by Jack Heselson in the 1960’s. In January 1990 Karl Zucker , a surgeon from Baltimore in Maryland (hence the Maryland dissecter) was visiting Professor Bornman’s unit at GSH to learn ERCP. He casually mentioned that just prior to returning to the USA he had done a few laparoscopic cholecystectomies and offered to demonstrate the technique. 2 pigs were rustled up by Rosemary Hickman and some instruments borrowed from the gynaecology theatre. Professor  Bornman and Sydney Cullis , a part-time surgeon in the GIT Clinic, proceeded to remove the gall bladders laparoscopically – one of the observers was John Dunn, a surgeon from New Zealand who, when he returned to Auckland, established laparoscopic surgery in that country. In April, thanks to sponsorship by Storz arranged with Mrs Storz by Professor Terblanche, Bornman and Cullis visited Professors Du Bois in Paris and Alfred Cuschieri in Dundee to observe the procedure done in humans. In October that year the first laparoscopic cholecystectomy in South Africa, and possibly in Africa, was done by Philip Bornman at Groote Schuur Hospital.

Laparoscopic surgery started in 1990 in SA but it was only formally introduced to South Africa in 1991 when a number of workshops were held in Johannesburg (Ron Hinder, a South African  from Nebraska, was the facilitator), Pretoria (Eddie Reddick from Nashville) , and Groote Schuur (Alfred Cuschieri)

By 1991 a number of Laparoscopic interest groups were established globally and since there was a real need for intensive training in all aspects of laparoscopy a steering committee was established to develop guidelines and a new constitution for the to be established South African Endoscopic Society. The decision was that the South African chapter of IFSES (that was established in 1991) was not the correct vehicle to address the specific needs for training, credentialing and generating guidelines for the safe practice of laparoscopic surgery in SA.

Readers will remember that general laparoscopy was at this time basically restricted to diagnostic examinations although laparoscopic sterilizations, endometriosis treatment etc were already being performed by Gynecologists. It was only as recent as 1987 that a successful laparoscopic appendicectomy was performed by a gynecologist for the first time.

The steering committee was formed with Phillip Bornman as chairman and members serving on this panel were Dr GF Ferreira (OFS), Dr G Gecelter (WITS), Dr F Goor (Mayfair), Prof AA Haffejee (KZN), Dr N Laage (Pretoria – private ) , Prof C Modiba (Medunsa), Prof J A Myburgh (Wits) , Dr P Perdikis ( Parktown – private) and Prof B L Warren ( Stellenbosch).

The first steering committee meeting took place on Saturday 24th October 1992. The South African Society of Endoscopic Surgeons finally came into existence in Cape Town on October 1st, 1993. This, the inaugural meeting of SASES  took place at the Graduate School of Business with Mike McMahon from Leeds as the official guest speaker and at this venue quite a number of surgeons and surgeons in training enrolled to become members of SASES. I was one of these enthusiastic junior consultants enrolling into this new Society. The first elected Executive Council was Prof P C Bornman (President), Prof Ariff Haffajee (Vice President), Prof B L Warren ( Secretary), Dr SNR Cullis ( Treasurer), Dr P Perdikis, Dr G F Ferreira, Dr N Laage, Prof C Modiba and Dr C Schulenburg. The first Executive council meeting took place at the J & J offices in Jhb on Saturday 27th of November 1993. It needs to be mentioned that J & J Ethicon sponsored all the meetings of the steering committee during this phase and SASES are obviously indebted to the Company for this substantial support at a crucial time in the development of the new Society. The term of office was decided at 2 years with postal nominations for council member elections and actual election by ballot at the AGM every 2 years.

The inaugural scientific meeting of SASES was planned to combine with the SAGES meeting at Sun City in July 1994 but because of industrial action had to be relocated to the World Trade Centre at the last hour. Miraculously Dr Nic Laage succeeded to achieve this almost impossible task. The first official SASES visitor was Mr. David Rosin from the UK. At the time of the meeting SASES had managed to recruit 174 registered members.

The 1995 meeting was again combined with SAGES in July at Malelane Country Club. At the AGM a new Council was elected. During the first 2 years of existence a Society logo was designed, Letterheads printed and a Society tie was later added. The Constitution was written by Prof B L Warren and the objectives for which the Society was created are today what it was then namely.

1.1. To promote a high standard of endoscopic surgery by formulating guidelines for basic and advanced training in recognized training centers.
1.2. To provide guidelines as to the credentialing and ethics of the practice of endoscopic surgery and to advise and assist official bodies such as South African Medical Association and the Health Professions Council of South Africa (HPCSA) on these matters.
1.3. To promote the dissemination of knowledge of the science of endoscopic surgery through continued education programmes which will include the holding of regular congresses and/or workshops on the subject, sponsorship of journals, distribution of newsletters, and liaison with allied local and international societies.
1.4. To support and encourage laboratory and clinical research in endoscopic surgery.
Endoscopic surgery shall include all gastrointestinal endoscopic surgery as well as laparoscopic and thoracoscopy surgery which may be broadened to include other modalities of this form of surgery.

During the first years we saw the establishment of centers of interest where laparoscopic surgery was performed in large numbers. An example of this was the paper presented by a private surgeon on his first 100 Lap Nissen procedures delivered at the inaugural meeting of the Society. This was at a time when the average surgeon had not even been introduced to lap surgery. This became the rule for a number of years namely that Lap surgery was performed in the private sector much more than at the Universities and it had all to do with money. Cost constraints hampered surgery departments at Universities in rolling out comprehensive laparoscopic surgery training programs. It also meant low consumption by patients in the public sector. Sadly this problem has remained the Achilles heal for MAS in the public sector. Currently we still have real problems of exposure of trainees to meaningful numbers of laparoscopic surgery. I can still remember with great admiration how Brian Warren, myself and sister Berny did the first Lap Chole at Tygerberg Hospital. It took 2 and ½ hours and eventually we were successful after the third attempt. We were so absolutely protective of our equipment that we used to wash, sterilize and store the instruments ourselves. These were kept under lock and key during my tenure at the varsity.

During the early years Prof Bornman, Dr Perdikis, Dr Elgar Rogaly, Prof Brian Warren and others started training workshops for surgeons and early on it became clear that this had to be a dedicated function of SASES. Since the late 90`s SASES has been actively involved in training workshops throughout South Africa in association with the major role players in the Industry. There is and has been a long-standing legacy of excellent working relationships with the Industry. Many workshops were done on upper GIT surgery, solid organ surgery and later Colo-rectal work. Many of these were presented by Heine van der Walt, Stephen Grobler and other highly skilled South African surgeons. A great number of International surgeons came to SA for such training events. Heine van der Walt became an internationally known and acknowledged surgeon based on his uncanny skills and surgical ability. He is regarded as a genius in laparoscopic surgery and has gone on to host numerous workshops to date. In addition Grootte Schuur Hospital has hosted many such workshops and later on we saw Private Hospitals becoming interested in this field of training. There are a few such Private Institutes namely Unitas Hospital, Kingsbury Hospital, and N 1 City Hospital to name a few. In KZN the Pietermaritzburg Public Hospital came on board early on and has hosted many such workshops. This is testimony to the dedicated effort of the Private surgeons working there. Attending such workshops is very important for surgeons at large to learn about new techniques and procedures. However the backbone of laparoscopic surgery has to be one-on-one proctoring and preceptor ship programs were surgeons are visited by experts at their respective centers. This aspect of training has been and still is a complex challenge for the Society.

Towards the end of the 90's the basic skills course and intermediate skills course were extended nation-wide. These courses started at WITS after surgeons attended the train-the trainer courses in the UK. Prof D Bizos and Dr J Ramos were primarily involved with the development of this concept and it was later extended to all Universities. It is aimed at surgeons in training of all disciplines. For the more advanced laparoscopic surgeon there are many opportunities to attend advanced courses. These are endorsed by SASES and usually hosted in collaboration with SASES. The ideal situation would be to establish a national calendar for advanced laparoscopic courses so that individual surgeons can apply to attend these events. However these courses are mostly initiated by the various Device Companies and therefore they (the Companies) retain the prerogative to invite surgeons of their choice.

Over the years the Society has grown to become an important independent member Society in the surgical fraternity in SA. In 1997 a SASES Lectureship was started and sponsored by Roche. It was to become an annual eponymous lecture presented by a chosen local surgeon and specifically on a topic in laparoscopic surgery. To date these lectures have been a proud legacy of SASES and will continue in the future.

In 2000 a new logo was accepted and the SASES website was established. SASES embarked on a process of establishing guidelines and a vast number of documents saw the light. These include the guidelines for accreditation in minimal access surgery, safety standards of laparoscopic equipment, instrument utilization guidelines as well as guidelines on the various surgical laparoscopic procedures. Bariatric surgery criteria and guidelines have been added later. Drs. SP Grobler and Andre Potgieter (as President and Secretary at the time) were basically tasked with this and Dr Grobler has contributed a significant amount of work /material for this task. The first workshop on Bariatric surgery was hosted at the Durbanville Mediclinic by Dr E Swanepoel with Dr Claude Desaive form Belgium as Instructor / operator.

Initially SASES opted to align with the International federation of Societies of Endoscopic Surgery (IFSES) but because of cost implications it never came to fruition. The AESGBI (Association of Endoscopic Surgeons of Great Britain and Ireland) formally joined SASES in a combined meeting in 1999 at the Sun City Conference. This was a very successful meeting and the Society reciprocated in 2001 when SASES visited AESGBI in Guildford in England. At this meeting five SASES members received Honorary membership of the AESGBI. They were Prof P Bornman, Dr SP Grobler, Prof S Thomson, Dr J Jamieson and Dr J A Potgieter.

In 2002 SASES embarked on the laparoscopic bariatric program. It was a first for the Society in many aspects namely the first opportunity to establish guidelines for training, minimum criteria for accreditation of surgeons embarking on this highly challenging surgery, establishment of Bariatric centers of excellence and a proctoring program. The then Secretary, Dr Potgieter embarked on this vast program with the assistance of Dr E Swanepoel and started to develop an obesity surgery program. SASES obtained the very valued support of Prof Tessa van der Merwe in rolling out the program and in 2004 a National program was initiated. To date 12 centers have been accredited and 18 surgeons trained to do bariatric surgery. Currently the most of this work is done in Netcare Hospitals purely because of the financial and other support received from Netcare. Prof van der Merwe is the current Director for the Netcare Bariatric centre of Excellence program. However there are Life Health and Mediclinic Hospitals offering this service as well. There is also interest in the public sector to start with similar programs and SASES will remain involved with this task. SASES has been approached by SEMDSA to roll out a program for the Public sector for obesity treatment.

In 2002 SASES was privileged to host the 10th Annual Symposium of the European Surgical Institute in Hamburg, Germany. Prof Heine van der Walt the chairman of the meeting and International presenters from all over the world presented at this meeting. South African surgeons did themselves proud in hosting this prestigious meeting. Among the RSA presenters were Prof Brian Warren – the first Honorary Secretary of SASES. Dr JA Potgieter managed the wet lab sessions where procedures were performed on anaesthetized pigs. This was certainly a prestigious contribution that SASES and South Africa can be proud of.

The late 90`s and early 2000`s saw a worrying number of laparoscopic surgery complications and medico-legal cases reaching court. The Council of SASES spent a lot of time and effort on aspects of governance, safe surgery, interacting with funders on various aspects around MAS and ascertaining adherence to guidelines. To this effect the SASES Council approached the HPCSA, HASA, CMS and usual legal firms representing MPS clients to offer assistance with such cases. Experts were to be made available to assist whoever asked for advice. Sadly this offer was initially met with little enthusiasm. Fortunately today we are seeing a change in the manner in which these matters are handled and SASES doctors are regularly asked to assist with such cases currently. This new development bodes well for this arm of surgery both for patients and practitioners.

Since 2009 SASES has aligned itself with two major new projects. The first involves the newly established SASSIT (South African Society of Surgeons in training). Traditionally there has been little interest in laparoscopy among the surgeons in training and the SASES Executive identified this as a significant problem. Not only are young surgeons not trained adequately in laparoscopy but more importantly very little if any original research is being done in this field. SASES has a vested interest to change this. To address this problem two Scholarships have been created with generous assistance from the industry and the third aspect is substantial financial assistance for registrars to attend meetings of the Society. The scholarships are firstly the Covidien-SASES laparoscopic grant of maximum.

R 150 000.00 to attend a training facility abroad for a few months and is probably aimed at the less experienced individual and the second is the Storz-SASES Sponsorship for a slightly more experienced surgeon to visit a centre of excellence in Germany at the cost of Storz for a 2-3month period.

The executive Council is proud to present these sponsorships because it finally addresses one of the primary objectives of the Society as stipulated in the constitution namely training. The first recipient of the SASES-Covidien Grant is Dr Masee Naidoo and he visited a centre in Germany for 2 months where he was fortunate to spent a lot of time in theatre. It was a great success and a worthwhile experience.

Apart from the two mentioned scholarships, the Society makes funds available to junior investigators to attend the annual scientific meeting of the Society. As SASES has combined meetings on a biennial basis with either SAGES or ASSA it means that a successful applicant will receive full or part sponsorship to attend such a meeting. Since 1999 J & J Ethicon has also been sponsoring a junior investigators award valued at R 5000.00 for any applicant who has a paper accepted at the annual meeting. The recipient is selected by the Executive council. Lastly there is another sponsorship that SASES has been funding over the last few years namely the opportunity for all members to apply for financial assistance for a laparoscopic project. This is a stipendium that is awarded annually but candidates may be able to re-apply annually if the project is regarded as a worthwhile endeavour. Clearly such sponsorship is awarded only on receiving a proper application and adjudicated for merit by Council. Directions for such applications are available from either the secretariat or on the website.

The other project currently under investigation is the realization of a National South African Laparoscopic Training centre. There is a need for a training centre where all surgeons can receive state of the art training on safe laparoscopic surgery and were surgeons can be introduced to new devices and instruments before embarking on surgery themselves individually. We are not only catering for the general surgeon but will also support other surgical disciplines where laparoscopic skills are required. These include a diverse group such as Thoracic surgery, Pediatric surgery, Gynaecology, Urology and even Orthopaedics. There appears to be interest in this endeavour from the DOH, local Government as well as the Industry at large. There is no question that private –public partnerships will ultimately be the catalyst to get this grand project of the ground and turn it into a reality. The President in 2013/2014, Prof B Baigrie was the driver of this project.

Soon a new substantially upgraded and interactive website will be introduced and members as well as the public will then be able engage the Society in many different ways. With more than 230 current members, SASES is the largest sub-Society in surgery in South Africa. It has a proud legacy and the future is full of promise.

I am proud to be part of this new initiative and trust that SASES will flourish in time to come.

1993
President: P C Borman Vice Presidient: A Hafejee
Secretary: B Warren Treasurer: SR Cullis
Members: N Laage, C Schulenburg, P Perdikis, G F Ferreira, C Modiba
1995
President: P Perdikis Vice Presidient: B L Warren
Secretary: J R Jamieson Treasurer: N J Laage
Members: G F Ferreira, S P Grobler, J M Ramos, H van der Walt
Co-opted: S Thomson , Rob Brown (paediatrics)
1997
President: B L Warren Vice Presidient: S P Grobler
Secretary: S Thomson Treasurer: N J Laage
Members: P Bornman, J Ramos, H van der Walt, J Jamieson
1999
President: Dr S P Grobler Vice Presidient: Prof S Thomson
Secretary: J A Potgieter Treasurer: J Jamieson
Members: C Simonsz, D Bizos, J Ramos, H van der Walt
2002
President: S Thomson Vice Presidient: H van der Walt
Secretary: J A Potgieter Treasurer: J Jamieson
Members: C Simmonsz, H Docrat, H van Rooyen, D Bizos
2004
President: H van der Walt Vice Presidient: D Bizos
Secretary: J A Potgieter Treasurer: J Jamieson
Members: B Baigrie, H Docrat, R Oodit, E Swanepoel
2006
President: D Bizos Vice Presidient: B Baigrie
Secretary: J A Potgieter Treasurer: E Swanepoel
Members: S P Grobler, H Docrat, D Brombacher, JB Fichardt, D Fölscher
Co-opted: J Nel (Namibia)
2008
President: J A Potgieter Vice Presidient: B Baigrie
Secretary: D Brombacher Treasurer: E Swanepoel
Members: D Fölscher, R de Beer, Emil Loots, Masee Naidoo,
Co-opted: J Nel (Namibia), H van der Walt, S P Grobler
2010
President: B Baigrie Vice Presidient: D Fölscher
Secretary: D Brombacher Treasurer: E Swanepoel
Members: R de Beer, Masee Naidoo, Eugene Panieri
Co-opted: S P Grobler, H van der Walt, A Numanoglu
2012
President: D Folscher Vice Presidient: M Naidoo
Secretary: D Brombacher Treasurer: R de Beer
Members: M Brand, E Panieri, C Jann-Kruger, A Numanoglu
Co-opted: S P Grobler, A Potgieter, Z Koto
2014
President: M Naidoo Vice Presidient: D Brombacher
Secretary: E Coetzee Treasurer: D Sofianos
Members: E Panieri, Z Koto, A Numanoglu, R Oodit
Co-opted: G Reimers
2016
President: GD Brombacher Vice Presidient: E Panieri
Secretary: E Coetzee Treasurer: D Sofianos
Members: Z Koto, A Numanoglu, R Oodit, M Brand
Co-opted: G Reimers; Dr H Bougard
2018
President: E Panieri Vice Presidient:
Secretary: E Coetzee Treasurer: D Sofianos
Members: Z Koto, A Numanoglu, R Oodit, M Brand, G Reimers, Dr H Bougard, J Lubbe
Prof P Bornman was awarded the honorary position in 2004.
Dr P Perdikis, Dr John Jamieson (posthumous)
1994 Mr Dave Rosin - UK
1997 Dr Rick Greene
1998 Dr Joe Petelin
1999 Dr Barry Salky – NY (USA)
2000 Dr Lesley Nathanson - Australia
2002 Prof Michael Bailey - Guildford, England
2004 Prof Hans Lonroth (Sweden), Prof Ferdinand Köckerling(Germany)
2005 Prof Guy-Bernard Cadiere(Belgium), Prof Monson(UK)
2006 Prof Nicola Scopinaro(Italy), Prof J Tooulli (Australia)
2008 Prof Michael Kendrick (Mayo, USA)
2010 Prof W Bemelman(Holland)
2011 Prof A Fingerhut, Prof D Alderson, Prof M Bailey, Prof G Jamieson, Prof M Smithers, Prof M Griffin, Mr I Beckingham, Dr T Tollens, Prof K Fuchs, Prof W Bemelman, Mr J Hill, Dr D Parekh, Prof D Watson
2012 Prof Chowbey(India)
2013 Dr R Carter (Scotland), Prof T Rockall(UK)
2014 Prof T Rockall, Prof W Bemelman(Holland), Prof A d'Hoore(Belgium)
2016 Prof Tim Rockall (UK), Dr Francis Seow Choen (Singapore), Dr Tim Bright (Australia), Prof Nicholas Demartines (Switzerland), Dr Pieter Tanis (Holland), Mr James Horwood (UK), Mr Ian Beckingham (UK), Prof Sven Bringman(Sweden)
2017 Dr Bernard M Ndung'u (Kenya)
2018 Prof Nicholas Demartines (Switzerland), Prof Willem Bemelman (Holland), Prof Ernesto Leva (Italy), Mr Ian Beckingham (England), Dr Roger Gerjy (Sweden), Dr Johanna Osterberg (Sweden), Mr Jonathan Shenfine (Australia), Prof Dieter Hahnloser (Switzerland), Prof Jared Torkington (Wales)
1999 Mr Rodger Motson, Mr Chris Royston, Mr Dave Rosin, Prof Ari Darzi, Mr Herschmann.
2000 Prof M E Bailley, England
2014 Prof W Bemelman(Holland), Prof A d'Hoore(Belgium)

The Society will gladly accept new members and we urge all surgeons who are involved with Laparoscopy to strongly consider joining this vibrant Society.

SASES has regular meetings with SAGES during the alternative years that ASSA is not meeting. As part of the Federation of Surgical Societies of South Africa, SASES is involved with ASSA/SAGES, meeting on a biennial basis.

A Society can only be active and vibrant if the membership remains actively involved and we urge all members to avail themselves of the opportunity to make suggestions, add information and participate actively in Society affairs.

Author:  Andre Potgieter

Updated 2014-2017: Grahame Reimers