Cawich O Shamir

Cawich O Shamir
University of the West Indies, St. Augustine | UWI · Department of Clinical Surgical Sciences

MBBS, DM

About

271
Publications
76,915
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
1,196
Citations
Additional affiliations
August 2013 - present
University of the West Indies, St. Augustine
Position
  • Professor (Associate)
January 2008 - July 2013
University Hospital of the West Indies
Position
  • Lecturer
January 2006 - September 2013
The University of the West Indies, Mona
Position
  • Lecturer

Publications

Publications (271)
Article
Full-text available
Introduction Women are underrepresented in orthopaedics. Recent studies have shown that women comprise only a very small proportion of all practising orthopaedic surgeons in the United States. One theory that seeks to explain this disparity is the lack of female mentors in orthopaedic surgery. Women are particularly influenced by same-sex mentors,...
Article
Conventional data suggest that complex operations, such as a pancreaticoduodenectomy (PD), should be limited to high volume centers. However, this is not practical in small, resource-poor countries in the Caribbean. In these settings, patients have no option but to have their PDs performed locally at low volumes, occasionally by general surgeons. I...
Article
Objective : We report a case of systemic arterial air embolism (SAAE), complicating the open repair of a ruptured descending thoracic aneurysm and aorto-bronchial fistula, while on cardiopulmonary bypass. Method : A 55-year-old patient was placed on beating heart cardiac bypass, for the open repair of a ruptured type C descending thoracic aneurysm...
Article
The aim of this study was to determine the rate of preoperative transthoracic echocardiography in hip fracture patients and to evaluate its effects on time to surgery and length of stay. We conducted a retrospective review of all patients with hip fractures treated at a tertiary referral hospital. Data examined included age, sex, comorbidities, tim...
Article
When Henri Hartmann invented his operation in 1921, his intent was not for use in benign disease but as an alternative for Miles’ abdominoperineal resection which, at that period, had a high mortality rate. With advancements in medicine, Hartmann’s procedure was replaced by abdominoperineal resection which had a significant drop in mortality. In th...
Book
Full-text available
Journal of the Caribbean College of Surgeons 2022 Volume 1 Full Text
Article
Full-text available
The median arcuate ligament compression syndrome is a rare entity that occurs in 2 per 100,000 unselected individuals. We present a case where the median arcuate ligament compression syndrome was associated with an equally uncommon anatomic variation—a celiac-mesenteric trunk, which occurs in 0.42-2.7% of unselected individuals. We could find no pr...
Article
Objective To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country. Methods The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had r...
Article
Full-text available
Introduction: Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience wi...
Article
Considering the fact that several anatomic variants of the liver have been described in the Jamaican population, we sought to document the prevalence and characteristics of Rouvière’s sulcus in this population. This paper has two parts. First, 60 cadaveric dissections were observed to document the prevalence of Rouvière’s sulcus as 81.7%. In the se...
Article
Traditional anatomic textbooks suggest that the recurrent laryngeal nerve (RLN) ascends in the tracheoesophageal groove (TEG). However, during thyroid and parathyroid surgery, we have noted that the RLN is often not in the groove. In this study, we objectively measured the course of 41 RLNs in relation to the TEG. We found that the RLN was in the g...
Article
Background: In the year 2021, the FreeHand robotic camera holder was introduced to a hospital in Trinidad & Tobago, amid strong opposition from postgraduate trainees who were concerned about diluted training opportunities. The aim of this study was to document trainees’ opinions on this surgical tool before and after its use. Methods: A self-admini...
Book
Full-text available
Journal of the Caribbean College of Surgeons 2021 VOl 3
Technical Report
Breast cancer patients often present very late with obvious skin tethering or dimpling. This late presentation is often associated with poor prognosis and bad outcome. Picking up these patients at an earlier stage before any obvious clinical signs and earlier treatment can often offer full cure to some of these patients. We have observed a new sign...
Technical Report
Full-text available
Skin tethering (ST) is regarded as a classical clinical feature of breast cancer. In many cases, ST is not evident on inspection, arm raising and skin pinching over the lump. We have observed that pushing the lump in one or other direction may elicit skin dimpling that was not otherwise evident. In these cases there is normal fat, grossly and histo...
Article
Laparoscopic hepatectomy brings many physiologic advantages over open hepatectomy and adheres to all oncologic principles. It is currently considered the standard of care. However, these are technically difficult operations to perform. Consequently, the expertise may not be universally available for all patients to benefit from laparoscopic hepatec...
Article
Pancreatic surgery has been one of the last areas for the application of minimally invasive surgery (MIS) because there are many factors that make laparoscopic pancreas resections difficult. The concept of service centralization has also limited expertise to a small cadre of high-volume centres in resource rich countries. However, this is not the e...
Article
Full-text available
Purpose: There are many known variations in the arterial supply to the liver. We sought to document the incidence and details of anomalies of the extrahepatic arteries in an unselected population in the West Indies. Methods: This study spanned 24 months. All 205 CT scans were evaluated at a hepatobiliary referral center in Trinidad and Tobago. W...
Article
Although advanced minimally invasive surgery and robotic surgery were well accepted in developed countries by the turn of the 21st century, they did not enjoy the same popularity in the Anglophone Caribbean. Advanced minimally invasive surgery only became available in select Caribbean countries from the year 2010. And up to the year 2021, robotic s...
Article
This paper provides a field report on a hospital fire at the St. Jude hospital in the Eastern Caribbean Island of Saint Lucia. The hospital was completely destroyed by the fire and three deaths were recorded. This paper analyses the emergency response to this hospital fire and discusses the lessons learned from this experience. This is a valuable l...
Article
Full-text available
When the COVID-19 pandemic unfolded in March 2020, surgical care was impacted globally. The developing nations in the Caribbean were unprepared with fragile, resource poor healthcare systems. A series of rapid policy changes in response to the pandemic radically changed surgical care and prevented the usual oversight in the operating theatre. Atten...
Article
There is still no organised national screening programme for colorectal cancer in Jamaica. We sought to evaluate the detection of colorectal cancer precursor lesions in patients who underwent opportunistic screening over three years. Patients with colorectal polyps were selected for further study. In 431 procedures, there were 84 (19.5%) patients w...
Article
Full-text available
Major lower extremity amputations have been an area of much concern in the Caribbean population. Hence, the purpose of this research was to investigate the current trends in major lower-extremity amputations. Data regarding all major lower-extremity amputations performed at a tertiary care institution in Trinidad and Tobago, from January 2010 to De...
Article
Full-text available
Background: Major lower extremity amputation is defined as any amputation of the limb performed above the level of the ankle. Indications often include severe infection, ischemia, trauma and tumours. Total amputation rate in Trinidad and Tobago (T&T) is not yet known. Data is only available from a single center in Trinidad and Tobago over a two yea...
Article
Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done...
Article
Background: Variations in the anatomy of hepatic veins are of interest to transplant surgeons, interventional radiologists, and other medical practitioners who treat liver diseases. The drainage patterns of the right hepatic veins (RHVs) are particularly relevant to transplantation services. Aim: The aim was to identify variations of the pattern...
Article
Background: In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations. Aim: To evaluate the v...
Article
Full-text available
During damage control laparotomy, surgery is abbreviated to allow for the correction of physiologic disturbances, with a plan to return to the operating theatre for definitive surgical repair. Re-entry into the abdomen is facilitated by temporary abdominal closure (TAC). Skin-only closure is one of the many techniques described for TAC Numerous sou...
Article
Background In the classic descriptions of the human liver, the umbilical fissure (UF) is a long, narrow groove on the visceral surface that receives the ligamentum teres hepatis. In this study, we document the UF variations encountered in a series of cadaveric dissections. Methods We reported UF variations using the following classification: Type I...
Article
Barbados is a Caribbean island with a high incidence of colorectal cancer. This study collected epidemiologic data from Barbadian patients with colorectal cancer. There was an opportunity for targeted screening in patients actively enrolled in clinics for management of chronic diseases, accounting for 72% of cases. We also identified areas of high...
Article
There has been no prior report of single-incision laparoscopic surgery (SILS) from the Caribbean island of Turks and Caicos. We report our initial experience with SILS cholecystectomy to show that SILS in this environment is feasible with minimal change to the existing hardware. It is a safe alternative to conventional multi-trocar laparoscopic cho...
Article
Full-text available
PurposeIn the classical description of normal liver anatomy, the umbilical fissure is a long, narrow groove that receives the ligamentum teres hepatis. The pons hepatis is an anatomic variant, where the umbilical fissure is converted into a tunnel by an overlying bridge of liver parenchyma. We carried out a study to evaluate the existing variations...
Article
Full-text available
Background: The aim of this study was to identify social injustice by evaluating horizontal equity (allocation of similar resources to patients with the same clinical needs) in surgical care for gallstone disease in a Caribbean Country.
Article
Full-text available
Carotid arterial injuries occur in 5-6% of persons with penetrating trauma. Complete transection is rare in civilian practice and is most often due to penetrating injuries. Complete transection as an iatrogenic complication is rare. We present a case where we were required to repair a complete transection of the carotid artery with segmental loss w...
Article
Full-text available
Background: Prosthetic joint infection (PJI) is the second most common cause for revision following hip hemiarthroplasty (HHA) resulting in a mortality rate of 5.6%. The treatment of PJI is both challenging and controversial, without general consensus on best practice. In an attempt to avoid surgery, patients are commonly prescribed antibiotics, r...
Article
Introduction: Trauma is a leading cause of death in young patients. The prevalence of blunt and penetrating trauma varies widely across the globe. Similarly, the global experience with laparoscopy in trauma patients also varies. There is a growing body of evidence to suggest that laparoscopy is feasible in trauma patients. We sought to contribute t...
Article
Full-text available
Introduction: Total knee replacement (TKR) utilization is expected to increase by 673% in 2030, with patients between the ages of 45 to and 64 years representing the fastest-growingfastest growing age group requiring joint replacement. This group not only demands a higher- performinghigher performing, durable prosthesis but are is also the most li...
Article
Full-text available
PurposeHepatic surface grooves (HSGs) are prominent depressions on the antero-superior surface of the liver. We sought to document the prevalence of HSGs in an Eastern Caribbean population.Methods We observed all consecutive autopsies performed at a facility in Trinidad and Tobago and recorded the presence, number, location, width, length and depth...
Article
Full-text available
We report a near-fatal rectal perforation due to a phosphate en-ema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intralumina...
Article
Objective Removal of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean. Methods We...
Article
Introduction As single-incision laparoscopic surgery (SILS) became popular, many access platforms and techniques emerged. When we initially described the direct fascial puncture (DFP) technique, many suggested it was not practical for three reasons: (1) increased hernia formation, (2) inability to complete operations without instrument changes and...
Article
Aim: To evaluate the variations in venous drainage from the left liver. Materials and methods: A retrospective evaluation was performed of all consecutive abdominal computed tomography (CT) examinations at a tertiary referral facility between 1 January and 30 June 2018. Osirix (Pixmeo SARL, Bernex, Switzerland) was used to examine the major hepa...
Article
Necrotizing fasciitis, commonly known as "flesh-eating disease," is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early...
Article
Full-text available
INTRODUCTION: Cardiac rupture is a full thickness laceration of the myocardium that occurs after bluntchest trauma. They are notoriously fatal, with only a handful of patients documented to have survived.These injuries are not commonly associated with low energy chest trauma and may be overlooked as adifferential in trauma cases if health care prov...
Preprint
Full-text available
Introduction Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived. These injuries are not commonly associated with low energy chest trauma and may be overlooked as a differential in trauma cases if health care pr...
Article
Full-text available
Classic descriptions of the visceral surface of the human liver only define three fissures: transverse, sagittal and umbilical fissures. Any additional fissures that are present on the visceral surface of the liver are considered variant inferior hepatic fissures (IHFs). This study was carried out to document the prevalence of IHFs in the Eastern C...
Article
Full-text available
Oncologic surgery in the Caribbean has evolved over the past decade, with increasing reports of advanced minimally invasive operations being performed. However, the minimally invasive approach has not been used for peri-ampullary lesions. This is because a laparoscopic Whipple’s operation is a technically demanding and time-consuming operation. We...
Technical Report
Full-text available
Retrograde thyroidectomy ensures adequate exposure with resultant decrease in risk of injury of the EBSLN. Ligasure shortens the operating time, provides a relatively bloodless field, minimises injury to the parathyroids and the laryngeal nerves. The combined use of retrograde thyroidectomy and ligasure ensures adequate safety for patients undergoi...
Article
The first recorded laparoscopic operation in the Caribbean was a cholecystectomy performed in 1991. After a temporary peak in basic laparoscopic operations in subsequent years, the initial interest waned. While laparoscopic surgery was being popularized in the developed world, there was a stagnation in the Caribbean. There were many reasons for thi...
Article
We report a rare case of Staphylococcus caprae hip arthroplasty infection. To be best of our knowledge, this is the 38th case of S. caprae prosthetic joint infection and the 9th case of S. caprae hip arthroplasty infection to be reported in the medical literature. The case was successfully treated by minor partial one-stage revision and culture-dir...
Article
Background: Ulcers in diabetic neuropathic feet are quite common but should be differentiated from the distinctive but rare ulceration due to rat bite in these insensate feet. We describe and analyse the features of rat bites in 2 patients with diabetic neuropathic feet and highlight 8 clinical features that should raise suspicion and alert the cl...
Article
Full-text available
Laparoscopic liver resections require advanced laparoscopic skill sets. In the Caribbean, a unique situation exists where centers of excellence for liver resections exist, but surgeons who are trained in advanced laparoscopic surgery are not available throughout the region. Therefore, many patients who are candidates for liver resection in the Cari...
Article
Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging i...
Article
Staggering statistics regarding the global burden of disease due to lack of surgical care worldwide has been gaining attention in the global health literature over the last 10 years. The Lancet Commission on Global Surgery reported that 16.9 million lives were lost due to an absence of surgical care in 2010, equivalent to 33% of all deaths worldwid...
Book
Full-text available
Full edition of the Journal of the Caribbean College of Surgeons 2019 Volume 2
Article
Full-text available
The Authors' Instructions for papers in the Journal of the Caribbean College of Surgeons are detailed.
Article
Background Large rectal polyps can be approached by endoscopic mucosal resection or endoscopic submucosal dissection. A recent application of endoluminal resection, called transanal minimally invasive surgery (TAMIS), has been introduced. Video A 79‐year‐old man presenting with two large polyps in the anal canal (uTisN0) and low rectum (uTis vs T1...
Article
Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.
Article
OBJECTIVE: To report the development of minimally invasive training courses and workshops in the Caribbean and specifically the establishment of the Basic Surgical Skills Course of the Royal College of Surgeons of England (RCSEng) in Trinidad with respect to their value toward Surgical laparoscopic or minimally invasive training in the Caribbean....
Conference Paper
Full-text available