Robots take the world by storm in surgery - Dr. Lim Cheok Peng
Writing on Robotic surgery in a Singapore Medical Publication for
doctors - Parkway Medicine Dr. Lim Cheok Peng, Managing Director Parkway
Group Health Care says "Robotic surgery has taken the world by storm and
transformed the way surgeries are being performed".
The article goes on:
Da Vinci Surgical System - The Four-Armed Robot
Surgery with the four-armed da Vinci Robot
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Surgical System: The S$2.5 million da Vinci Surgical System combines
a camera that provides a magnified 3-D view of the patient's body with
robotic arms designed for greater levels of dexterity and equipped with
tremor elimination capabilities.
These features allow surgeons to do technically demanding procedures
with unparalleled surgical precision, control and accuracy. And when
surgeons are able to do their jobs better, patients benefit.
The da Vinci Surgical System was installed at Mount Elizabeth
Hospital in October 2004. Since then, at least 50 cases have been
successfully performed at the hospital.
It has been used for range of surgical procedures, from cardiac to
urology, and in obstetrics and gynaecology as well.
Surgeons have used the robotic system in a cardiac bypass procedure,
which involved the takedown of the internal mammary artery, which is
then used as a graft. The machine has also been used for prostatectomies,
the removal of the prostate, and for the removal of an ovarian cyst.
The widest use of the da Vinci system has been in general surgery. Dr
Susan Lim, a general surgeon at the hospital, has spent more than five
months over the last three years in training to use the system. Dr Lim
also acts as Chairman of the Parkway Centre for Robotic Surgery (for
training and research).
Together with Dr Kum Cheng Kiong, also a general surgeon, she has
operated on 38 patients using the da Vinci system.
"The system is good for any surgical procedure that requires fine
stitching, fine dissection or a magnified view," said Dr Lim.
"Robotic surgery is very much superior to laparoscopic surgery
because of the 10-times magnification and 3-D stereoscopic view," she
said.
"With traditional laparoscopic surgery, there is no magnification and
surgeons are limited to a two-dimensional (2-D) image," she explained.
Another advantage is that while laparoscopic surgery can only offer
four degrees of movement, robotic surgery can offer seven degrees of
movement.
This gives surgeons additional dexterity with surgical instruments,
which becomes especially important in parts of the body where space is
extremely tight, such as in the pelvis, or when operating on the liver,
making surgery safer and more effective for patients.
Finally, the system is physically more comfortable for the surgeon
when compared to laparoscopic surgery. With the da Vinci system, the
surgeon sits at a console, which is designed for long procedures and has
an armrest.
The surgeon then works the robotic arms while looking straight down
at the viewer. There is far less strain than in laparoscopic surgery
where the surgeon needs to stand, with his or her head twisted to the
side in order to look at the monitor.
Because it offers such clear advantages over traditional keyhole
surgery, robotic surgery can also be used in situations where the only
option was open surgery.
When a surgical procedure would take a long time or was very
complicated, surgeons had to opt for open surgery because laparoscopic
surgery was too physically uncomfortable and potentially difficult for
them to perform.
The ergonomic nature of robotic surgery and its increased range of
dexterity and vision make keyhole surgery an option again.
One patient who recently benefited from robotic surgery is a
Caucasian garment exporter based in Bali. He was diagnosed with cancer
of the rectum and because of the length and complexity of the procedure,
had to either undergo open surgery or opt for robotic surgery.
He chose robotic surgery, which left him with five incisions, each
measuring between 5 mm and 4 cm long. Had he used conventional open
surgery, he would have been left with a 40cm long incision on his
abdomen.
Another benefit was that he only had to stay for five days in the
hospital, half of the usual 10 days for a similar procedure.
According to Dr Susan Lim the technology is advancing rapidly. One
new development creates 'no fly zones' so that surgeons do not
accidentally venture outside where they are supposed to cut, she said.
In theory, sophisticated tools like the da Vinci system can also
bring senior surgeons out of retirement and back to the operating
theatre. The magnification and tremor reduction will allow patients to
benefit from the experience and expertise of these senior surgeons,
without increasing their risk.
Said Dr Lim Cheok Peng, Managing Director, Parkway Group Healthcare:
"Robotic surgery has taken the world by storm and transformed the way
surgeries are being performed.
Complicated operations, which were usually performed as open
surgeries, can now be done through keyhole surgery.
"We are very pleased to be the first private hospital in Southeast
Asia to extend its use to many different areas namely, general surgery,
cardiac and urology.
"This investment will further strengthen our position in the region
as a premium healthcare provider and medical referral centre, providing
cutting edge, quality, high-end medicine."
Courtesy: PARKWAY Medicine
How the Da Vinci surgical system works
A high-powered micro camera is mounted onto a telescope and inserted
into a thin tube inside the patient. This projects a high-quality 3-D
view of the area to be operated upon onto the surgeon's screen.
The pictures act as a map so that the surgeons can find their way
through the closely grouped organs, in order to place their incisions
precisely. Even delicate tissue can be easily manipulated due to the
camera's magnification capabilities.
The surgeon, who sits at a console next to the patient, guides the
system's four robotic arms as they go to work.
These robotic arms are inserted into those small incisions, and the
tiny scalpels and forceps on the ends of these arms then perform the
operation. There is minimal cutting of the body tissues, and the surgeon
is able to more accurately visualise and identify the problem area.
Every move the surgeon makes is precisely echoed by the surgical
instruments, inserted inside the patient's body.
Whilst these robotic arms were designed to mimic human wrists, they
have a much greater range of motion and possess tremor reducing
capabilities - both are distinct improvements over nature.
For delicate and complicated operations, the risk of natural human
error is effectively reduced, with better results for patients.
Dr. Sanjeevan Somasunderam from UK feels
Professional relationship among doctors here is better than those in
UK
Dr. Sanjeevan Somasunderam a young trainee psychiatrist from St.
George Hospital, London feels that our doctors here have a better
relationship with each other professionally than those in the UK.
Dr. Sanjeevan Somasunderam |
Dr. Sanjeevan who is in Colombo to attend the Sri Lanka College of
Psychiatrists' Annual Academic Sessions, made this observation in an
interview with the Healthwatch on Tuesday.
He said in the hospital where he worked, there was no common room for
doctors to meet each other and talk, where as here that facility was
available in any of the hospitals.
Dr. Sanjeevan had been here in February 2005 helping the tsunami
affected in Matara and Galle.
He said in his career so far this is the first time he met with a
tsunami affected group to check their mental condition and after
treatment.
He said out of the affected people he met except for one or two,
others were not severely affected mentally though somewhat disturbed.
This could be mostly due to the deep impact of Buddhism most of them had
in their lives.
It will be interesting to find out the mental state of those people
now because we believe that it takes some time for stress problems to
surface in affected people of this kind of a disaster.
He sounded sympathy to the doctors here when he spoke of one tsunami
affected doctor, Jayasekera in Matara who had lost eight members in his
family; mother, father, wife, child, sister had yet come for work as
they didn't have compassionate leave for doctors as in UK where for
family losses two three weeks compassionate leave is given.
Fighting liver disorder
Hepatic Encephalopathy triggers memory loss accompanied with
personality changes. Still, the disease could be effectively treated, if
the functioning of the liver could be improved, writes Manoj Rammohan.
In comparison with the prevalence of diseases like cancer and AIDS,
the incidence of Hepatic Encephalopathy might not present nightmares.
Still, affecting around 0.16 per cent of Indian population and thanks to
alcoholism, it could well be a bad dream.
For the uninitiated, Hepatic Encephalopathy is a syndrome seen in
patients with liver cirrhosis, ushered in by the presence of neurotoxic
substances which affects the brain metabolism.
"The most common cause for the disorder is consumption of alcohol and
observed in people with chronic cirrhosis.
And the chances of being affected with encephalopathy is all the more
high, if there is an infection of viral hepatitis, says Dr Rajiv Jalan,
Senior Lecturer in Hepatology at University College Medical School,
London and Honorary Consultant, University College, London Hospital and
Royal Free Hospitals. He along with Dr Butterworth were in the city
recently to attend a medical conference.
Among the disease causing factors, the accumulation of ammonia is the
most prominent. The brain metabolism of the patient gets altered with
the influx of neurotoxins into the brain.
Interestingly, the disease is characterised not just by bodily
reactions but by personality changes, intellectual impairment, and a
depressed level of consciousness. Other symptoms include tiredness and
severe bleeding of the liver. And in certain instances, the patient
could slip into a coma. Is it a psychological disorder?
In the initial stages, the patient would have memory loss and psychic
problems such as 'depressed consciousness'. In the words of Dr Roger F.
Butterworth, Director of Neuroscience Research Unit, University of
Montreal, Canada, the chances of permanent psychic disorder due to
Hepatic Encephalopathy is very rare.
"An extensive study on the brain's neuro-transmitters (due to this
disease) has not been done though research works are progressing in that
direction," he adds.
Most of the times, Hepatic Encephalopathy is a complication arising
out of severe liver cirrhosis. Among the effective treatments (or
medicines) available, the emerging one is L-ornithine-aspartate - a
mixture of amino acids.
Courtesy: Deccan Herald
Want to live longer? Think positive thoughts - CHICAGO (Reuters)
Optimism is good for the heart, a study said recently.
The most optimistic among a group of 545 Dutch men aged 64 to 84 had
a roughly 50 per cent lower risk of cardiovascular death over 15 years
of follow-up, according to the study published in the Archives of
Internal Medicine.
Previous research has suggested being optimistic boosts overall
physical health and lowers the risk of death from all causes. A positive
attitude also has been shown to help patients who suffer from heart
disease caused by narrowed arteries.
"Optimism can be estimated easily and is stable over long periods,"
though it does tend to decrease with age, said lead researcher Erik
Giltay of the Institute of Mental Health in Deft, the Netherlands.
WHO Mental Health Director commends services at Mental Hospital,
Angoda
The WHO Director for Substance Misuse Dr. B. Saracino who visited
Mental Hospital, Angoda commended its services and the recent
improvements made to the institution, under its present Medical Director
Dr. Jayan Mendis.
The hospital which was working with a depleted staff earlier has now
been strengthened with additional doctors, nurses and attendants, thus
human rights of the patients are being respected and honoured.
For the first time in the history of the hospital the patients have
designed a calendar for the year 2006, which had been printed and
distributed among doctors. WHO Director Dr. Saracino had been greatly
impressed with the Calendar, and he had been offered few of them by Dr.
Mendis.
On Medical Crossword
Thank you so much for inviting me for the 'presentation of awards'
ceremony on the 10th instant. I was very happy to witness the good
service you have rendered by your interest and effort.
I have not been successful in my attempt at the No. 18 Crossword (I
was knocked out by 'stress') I have nevertheless vied to compete in the
No. 19 for which I have sent in two entries and I am hoping to get even
a consolation prize.
Though I have nieces, pupils who are doctors, I take pride in doing
the X' words by myself. Thank you once again and hoping you will for
many more years continue to render your valuable service to the
Healthwatch page - a splendid challenge to both young and old.
Ranee Fernando - Dehiwala |