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

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 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