By Shabiya Ali Ahlam
The Parkway Pantai Patient Assistant Centre in Sri Lanka invited two renowned specialists from Singapore, Mount Elizabeth Novena Hospital Cardiothoracic Surgeon Dr. Lim Yeong Phang and Gleneagles Hospital Urological Surgeon Dr. Ho Siew Hong to deliver insights on developments in their respective areas of practice at the public health education seminar which was held in Colombo last week.
While most of the technology used in the practice of cardiology and urology is yet to be adopted in Sri Lanka, the Parkway Pantai Assistance Center in Sri Lanka facilitates the local population to experience expert medical care in Singapore.
Representing leading hospitals such as Gleneagles, Mouth Elizabeth Noverna, Mouth Elizabeth, and the Park East Hospital, Parkway Pantai establishment in Sri Lanka sends over 15 in-patients and 30 out-patients to the Singapore every month for medical treatments.
The numbers have been showing an increase in trend according to Parkway Pantai Patient Assistant Center Sri Lanka Country Director Shuvo Hridayesh. Hridayesh told the Daily FT that considering the fact, the assistant center has been in the country for only about a year, by bringing in medical experts to speak to the public regarding emerging trends in Singapore, many are confidently embracing the alternatives placed before them.
“When technology is the limiting factor for certain complicated procedures, local doctors refer their patents to doctors of the Parkway Pantai for specialised treatment,” expressed Hridayesh. He added that in such instances, the assistant center takes over all logistical arrangements of the patients which includes, air ticket, visa, lodging and other services and ensures close coordination of the patient’s doctor in Sri Lanka and Singapore throughout the treatment process in both the regions.
While patients are not taxed along the process, Hridayesh stressed that no transactions take place in the assistant center in Sri Lanka and all payments are to be made directly to the hospital in Singapore.
Dr. Phang and Dr. Hong shared some groundbreaking technology and surgical procedures that are highly popular and successful in Singapore.
New technique in nerve harvesting
For bypass patients who have lot of blockages in the coronary arteries, a typical bypass requires vessels to be removed from the leg or arm region which needs to be harvested. Traditional method of removal requires long incisions made in the limbs for the removal of the vessels while the scar remains nearly forever.
With the new Endoscopic Vessel Harvest (EVH) techniques, a small incision is made using specialised minimal invasive instruments to internally view, cut and seal side branches and remove the required healthy blood vessels with minimal trauma to the vessel, surrounding tissues and skin. This method comes highly recommended as in addition to the procedure being least scarring, benefits include reduced risk of infection (common for diabetic patients), wound complications and postoperative pain and swelling leading to faster recovery.
“The advanced procedure allows patients to get back on their feet and return to their normal mobility much sooner and the cut is mere two centimetres comparing to the inches made in the regular vessel harvesting technique,” said Dr Phang.
Minimally Invasive Cardiac Surgery (MICS)
The MICS is the least invasive procedure available for bypass surgery. The surgery is performed through small incisions of three to five inches between the ribs, instead of the medial sternotomy approach where a 10 to 12 inch incision is made to operate at the heart. The procedure is noted to be favoured by patients as well as surgeons due to the obvious fact that it allows faster healing, lowered ricks of infection and complications and most importantly reduces post operative discomfort.
While the procedure makes heart surgery possible for those previously considered being at risk for traditional surgery due to age or medical history, MICS is not for all, according to Dr. Phang. The viability of this procedure on a patient depends on the number of blockages at the time and the size of the chest. Dr. Phang stated that the procedure is performed mostly on European patients as their body is larger compared to Asians.
“We need more space between the breast bone and the heart to operate, else the procedure gets complicated and difficult to perform.” He acknowledged that MICS could only be performed on patients who have larger body dimensions.
Hybrid Coronary Revascularisation (HCR)
A relatively new procedure where a best of both worlds approach of coronary bypass and stenting is performed simultaneously, the HCR is an optimal therapy with a minimally invasive approach which translates to a shorter recovery time, fewer complications and quicker return to work and regular activity. While the results look promising, Dr. Phang stated that there is ‘no long term data’ to justify the effectiveness of the method.
Robotic assisted procedures
While most urological surgeries are performed using high tech robotic assistance, Dr. Hong clarified the common misconception where majority of the people tend to think that such assisted procedures are performed by robots alone without human involvement. “Specialised doctors control and use the advantage of the robot to perform a surgery,” he said.
The Parkway Pantai hospitals in Singapore are equipped with the state-of-the-art technology and recently purchased the latest four-armed robot for SG$ 3.4 million to provide minimal invasive surgeries when it comes to removal of prostate cancer kidney stones, cardiac surgeries and many others.
With the laparoscopic technique, kidney cancer where the entire kidney, which is a good 15 centimetres, could be removed through a small cut made in the lower parts of the body. The procedure is noted to be less painful thus the recovery time shorted to one-third of the recovery time compared to an open surgery, according to Dr. Hong. The recovery time spent before resuming activities is reduced from three months to three weeks by opting for the laparoscopic procedure compared to the traditional open surgery.
“When I analyse the feedback I receive, it is certain that the robotic assisted procedures are much easier and comfortable for the patients as they are in much less pain,” said Dr. Hong. The laparoscopic technique is used not only for kidney removal but also for issues regarding prostate cancer, hernia repair, and fertility treatments as well.
Since kidney and gall bladder stones are common in the South Asia Region, convenient procedures such as the shockwave treatment, also known as shock wave lithotripsy, have been adopted by Singapore. “This procedure is appealing to majority of the patients as there are no cuts involved,” said Dr. Hong.
While the patient lies on his back, high energy shockwaves are passed through the surface of the skin targeting the stone, causing it to break into pieces that are small enough to pass through the urine tube.
Similar to the tsunami concept, Dr. Hong explained that the shock wave is transferred to energy when it comes to contact with the first solid it meets. ”The rock being the target, the internal organs of the body are considered as the surface of the sea. When the tsunami strikes, the water goes up and down, but when it hits the shore, which is the stone, the energy is concentrated on destroying the hard surface it meets,” he explained.
Dr. Hong added that the internal organs do not get damaged but simply swing along to the rhythm of the shockwave and confirmed that treatment of this nature has been 100% successful so far.
Moving along with advanced technology, Gleneagles Hospital has upgraded its machines to the latest generation of shock wave machines offered by its manufacturers, which will be functional by end March 2013.The new addition enables the treatment to adjust to the patient’s position as the shockwave can rotate 360 degrees to find a stone and destroy it.
Pix by Sameera Wijesinghe