The Department of General Surgery has a distinguished history. Since its establishment with the founding of the hospital in the 19th century, it has witnessed numerous firsts in surgical milestones in Singapore.
These include the first open heart surgery, the first urological procedure, and the first perineal prostatectomy, amongst many others.
The department provides a comprehensive spectrum of services, tailored towards accurate diagnosis and management of all surgical conditions in an inpatient and outpatient setting. An increasing proportion of procedures are now performed in our ambulatory surgery centre where suitable patients are not required to be admitted to the hospital following their operation and can be discharged on the same day.
The following subspecialty services are offered by the team of surgeons in the department:-
The Colorectal Surgery Service comprises surgeons who have been trained in colon and rectal surgery and manage a broad spectrum of colorectal conditions.
By providing daily consultation sessions at the specialist outpatient clinic as well as operative and endoscopic blocks in the operating rooms throughout the week, we ensure that there is minimal delay in providing urgent care to patients who require it.
In addition to providing diagnostic and therapeutic lower gastrointestinal endoscopic services, the Service also provides effective surgical treatment of common colorectal diseases and develops modern techniques in operative surgery. The laparoscopic technique of colorectal resection has become part of the standard service offered to patients, thereby enabling them to reap the benefits of these minimally invasive procedures.
The Service also participates in research projects, both independently and in collaboration with other units in Singapore.
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The Upper Gastro-intestinal Unit is a subspecialty team that provides comprehensive diagnosis and treatment of all conditions affecting the oesophagus, stomach and intestines.
We have an experienced and dynamic team made up of surgeons trained at international centres of excellence in Brisbane, Tokyo and Edinburgh.
Emeritus Consultant, Clinical Professor and Associate Dean: Prof Low Cheng Hock
Unit Head and Consultant: Dr Jaideepraj Rao
Visiting Consultants: Dr Melvin Look, Dr Eric Teh
UPPER GI CLINIC AT THE DIGESTIVE DISEASES CENTRE (DDC)
Patients with Upper GI complaints can be comprehensively investigated here. Some of the indications for diagnostic gastroscopy include: abdominal distress/pain, dysphagia, haemetemesis, malaena, heartburn, nausea/vomiting, weight loss and anaemia
DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY
Examples of the therapeutic options that are available include: injection sclerotherapy, variceal banding, polypectomy, oesophageal stenting, dilatation and percutaneous endoscopic gastrostomy.
MINIMAL ACCESS SURGERY
Our team has a strong interest in Advanced Laparoscopic Surgery, which results in superior healing, minimal wound pain and keyhole scars. With the state-of-art facilities in our hospital, we are able to perform operations such as diagnostic laparoscopy, laparoscopic ultrasound, laparoscopic appendicectomy, laparoscopic hernia repair, laparoscopic gastric surgery, laparoscopic fundoplication and thoracoscopic oesophageal procedures.
We have a comprehensive management programme that is individually tailored for patients with oesophageal and gastric cancers. We work very closely with our colleagues from Gastroenterology, Medical Oncology, Radiation Oncology and Palliative Care Medicine to provide a multi-disciplinary approach. Required work-up before treatment includes endoscopy, CT scans, endoscopic ultrasound, staging laparoscopy and laparoscopic ultrasound. Surgery usually offers the best chance of cure for such patients and we are one of the centres which can perform radical resection with systematic lymphadenectomy. This is an aggressive form of surgery pioneered by the Japanese which requires extirpation of the tumour-bearing organ together with the meticulous removal of possible sites of spread to the regional lymph nodes.
Selected patients with early cancer can be cured with a function-preserving approach, with either endoscopic mucosal resection or laparoscopic wedge resection.
In some patients with advanced disease, chemotherapy or radiotherapy, with or without surgery, is required. We are currently involved in trials involving such modalities.
SURGERY FOR WEIGHT CONTROL
Morbid obesity is associated with major medical and psychosocial problems. Patients with morbid obesity have a much reduced life expectancy compared with age-gender-matched controls of a normal weight.
Conservative treatment fails in more than 95% of morbidly obese patients. Bariatric surgery is the most effective method to reduce weight and maintain weight loss in the severely or morbidly obese. A BMI of over 37.5 or over 32.5 in the presence of an associated disease (diabetes, hypertension, sleep apnoea etc) is a surgical indication.
Adjustable gastric banding (AGB) has become the most frequently performed laparoscopic bariatric operation in many parts of the world. The AGB is fitted around the upper-most part of the stomach and induces an early feeling of satiety and thereby decreases food intake.AGB provides an effective minimal access surgical option.
Integrated Multidisciplinary Trauma Care Trauma Training Course:
- Advance Trauma Life Support
- Emergency Ultrasound Course
- Definitive Surgical Trauma Care Course
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The Breast and Endocrine Section provides surgical expertise to patients with breast and endocrine conditions.
This Section can be divided into the Breast Surgery Services and Endocrine Surgery Services.
Breast Surgery Services
From its humble beginnings of having only one surgeon with a special interest in breast surgery back in 2000, the Breast Service has matured and now comprises of 4 full time and 1 sessional breast specialists. Hand in hand with the increase in strength of the service is the availability of a full range of surgical techniques including the very latest procedures. (hyperlink to Breast Surgery). The setting up of the Breast Clinic @ TTSH in March 2010 marks another important milestone in our efforts to upgrade our services to our patients.
The majority of our patients have benign breast disease. Breast imaging like mammogram and ultrasound are frequently used as an adjunct in the diagnosis although occasionally a biopsy is also needed to confirm the diagnosis. Biopsy is often performed percutaneously and rarely is open surgery needed. We also offer minimally invasive procedures like mammotomy (hyperlink to mammotomy) which removes small lesions in the breast with minimal scars.
Prompt diagnosis and treatment of breast cancer remains the most important goal of the service. It has been shown that breast cancer often starts from a pre-invasive stage which has an excellent prognosis if treated adequately. Mammographic screening remains the only scientifically proven method of reducing breast cancer mortality by detecting cancers at an earlier stage. We are one of three centres designated as an assessment centre as part of the BreastScreen Singapore program. We have been involved in BreastScreen Singapore since 2002.
Our philosophy is that of a multidisciplinary approach towards the treatment of breast cancer. This ensures that patients benefit from the expertise of all the various specialities. The team includes Breast Surgeons, Plastic and Reconstructive Surgeons, Medical Oncologists, Radiation Oncologists, Radiologists, Pathologists, Breast Nurse Clinicans and Physiotherapists.
Surgery remains the mainstay of treatment of breast cancer. Breast cancer surgery has evolved from radical surgery of the past to conservative surgery that we now offer in our service. Suitable patients are offered breast conservative surgery where only the tumour is removed. Oncoplastic surgical techniques are employed to shape the breast to minimise breast asymmetry. A lesser procedure called sentinel lymph node biopsy has also been introduced where most of the underarm lymph glands are spared from removal if it is not necessary. Patients requiring radical surgery will be offered immediate breast reconstruction. Finally we have the expertise to perform skin cover for large tumours and even chest wall reconstruction should this be required.
Endocrine Surgery Services
Surgeons with special interest in endocrine surgery will help to evaluate patients with endocrine problems. As not all endocrine conditions need surgery, we work closely with the Department of Endocrinology to provide a full range of treatment options for patients.
Surgery for thyroid diseases is the most common procedure performed by our team. We are able to offer newer methods of thyroid surgery to certain suitable patients including minimal access surgery and endoscopic thyroidectomy. We also perform parathyroid surgery for patients with overactive parathyroid glands resulting in elevated blood calcium levels. Following pre-operative localisation scans, we can perform minimal invasive parathyroid surgery that leaves only a small scar in the neck.
- Core biopsy
- Image guided core biopsy (mammographic, ultrasound and MRI)
- Excision Biopsy including hookwire localisation for non-palpable lumps
- Microdochectomy and total duct excision
- Excision of mammillary fistula
- Excision of accessory breast
- Subcutaneous mastectomy for gynaecomastia
- Lumpectomy with or without oncoplastic techniques
- Axillary procedures including Sentinel lymph node biopsy and axillary clearance
- Internal mammary lymph node excision
- Immediate breast reconstruction including autologous and prosthetic reconstruction
- Chest wall reconstruction following radical excision
The Department of Surgery has been providing hepatobiliary and pancreatic surgery since its inception in 1884.
In January 1998, this service was formerly organized into a specialized Hepato-Pancreato-Biliary (HPB) Surgery Unit. Surgeons who have received further training abroad in the fields of hepatobiliary and pancreatic surgery drive the various clinical service programmes to deliver quality care and surgery.
We provide comprehensive laparoscopic surgery services. The benefits of keyhole surgery have been extended to patients with hepatobiliary diseases. Laparoscopic ultrasonography, laparoscopic cholecystectomy, laparoscopic common bile duct exploration with stone removal, laparoscopic splenectomy, laparoscopic excision of liver cysts and laparoscopic adrenal gland operation are some examples. Special expertise is required in performing laparoscopic cholecystectomy for acute cholecystitis, because it is technically more demanding.
In diagnosis, laparoscopic ultrasonography is a useful assessment tool for patients with hepatocellular carcinoma, and endoscopic ultrasonography for idiopathic pancreatitis. These are some of the highly specialised technology services offered through a multi-disciplinary disease management team in the unit.
Hepatobiliary and pancreatic surgery demands high technical skill. Often, the pathological conditions that affect the liver, gallbladder, bile ducts, pancreas and duodenum are challenging and complex. In general, these conditions can be due to variety of causes such as congenital abnormalities, infection, inflammation, degeneration, benign or malignant tumors, or traumatic injury.
Over the past two decades, hepatobiliary surgery has made tremendous improvement. We have expanded its manpower and medical capabilities. Under the Health Manpower Development Programme, our surgeons are sent abroad to acquire and polish their surgical skills and also to bring back new operative techniques. The high morbidity and mortality rates, once amounted with HPB operations, are now a thing of the past. This is attributed to the better understanding of the liver anatomy, improvement of surgical techniques, better pre-operative imaging, advances in anaesthesiology and surgical intensive care. Liver and pancreatic operations have become safer and less morbid with a low death rate and high success rate.
Over the years, we have expanded its range of clinical services for diseases of the liver, gallbladder, biliary tract, pancreas and spleen. These include hepatic surgery, surgical oncology, diagnostic and therapeutic endoscopies, biliary reconstructive surgery, digestive surgery and complex pancreatic surgery.
In partnership with the Centre of Advanced Laparoscopic Surgery (CALS), the HPB Surgery Unit also provides advanced laparoscopic and minimal access surgery, endo-lapararoscopic surgery to treat these diseases. We also serve KK Women’s and Children’s Hospital, Ang Mo Kio Community Hospital, National Skin Centre, Communicable Disease Centre and the Singapore Johns Hopkins International Medical Centre. We also receives and treats international patients.
Our strategy in improving surgical outcome is the multidisciplinary approach that brings together various specialities and expertise including cardiology, medical oncology, surgical oncology, palliative oncology, radiation oncology, hepatology, infectious disease, pathology, and radiology.
This multi-disciplinary disease management team meets regularly to provide a comprehensive service dedicated to precisely diagnose, treat, and manage liver, gallbladder, biliary tract, pancreas and spleen conditions. Our philosophy in the treatment of diseases is every patient is thoroughly assessed so that each patient receives the best treatment option that is tailor made for the specific condition. We also adopt an intensive surveillance and aggressive treatment for tumour recurrence, with the goal of ensuring the best long-term results for our cancer patients.
Currently, we have 3 consultants, 1 visiting consultant, and 1 clinician-scientist, supported by 1 specialized HPB nurse clinician and 2 research executives. We conduct lectures and training workshops for our surgical trainees and family physicians regularly. We are also the teaching center for surgery, laparoscopy, endoscopy and hepatobiliary and pancreatic surgery for international fellows and observers.
We have numerous close collaborative ties with the various national research centres and pharmaceutic industries such as the Genomic Institute of Singapore, Biopolis, Psi-Oncology,National University of Singapore and Johns Hopkins Institute. The unit also belongs to the Asia Pacific Hepatocellular Carcinoma Research Group (APHCC) and the Singapore Cancer Syndicate Hepatocellular Carcinoma Consortium (SCSHCC). Our clinical trials are funded by these groups and consortium and coordinated by our trial nurses, clinician scientist and clinicians.
We were the first hospital in Singapore to perform splenectomy in 1910 by Dr A. Dickson Wright. As a testimonial to our commitment to minimal access surgery, laparoscopic cholecystectomy was first performed in the institution in 1 Feb 1991 by Prof Low Cheng Hock. We were also the first in Singapore to perform laparoscopic common bile duct exploration and clearance of ductal stones. Other significant milestones in our development include the formation of dedicated Specialized Liver Disease Clinic, Pancreatic Disease Clinic, our multi-disciplinary HPB Disease Management Team and Liver Cancer Management Team.
HPB Surgery Unit’s Mission
We endeavour to continually improve our management of hepatobiliary and pancreatic conditions by mastering advanced procedures & complex surgery that will prolong our patient’s survival and improve their quality of life. We are also committed to training future generations of clinicians to keep this momentum of progress and advancement in HPB surgery.
- Liver tumours
- Liver cancers
- Liver cysts
- Liver metastasis
- Liver Infection and Abscess
- Echinococcosis / Parasite Infestation
- Liver trauma
- Portal Hypertension and Liver Cirrhosis
- Segment-oriented Anatomic Liver Resection Surgery
- Three Dimentional Reformatted Images Operation Planning
- Chemoembolization of Tumors Liver
- Radiofrequency Induced Thermal Ablation of Liver Tumour
- Cholecystitis (gallbladder inflammation) / Gallbladder infection
- Cholecystolithiasis (gallbladder stones)
- Congenital deformities: choledochal cysts and etc
- Gallbladder cancer
- Gallbladder polyps
- Biliary Tract Stricture (narrowing)
- Acute Biliary Tract Infection: Cholangitis
- Endoscopic, Laparoscopic and Endo-laparoscopic Surgery
- Recurrent Pyogenic Cholangitis
- Primary or Secondary Choledocholithiasis (common bile duct stones)
- Biliary Tract Cancer: Peripheral, Hilar and Distal Duct Cholangocarcinoma
- Biliary Reconstruction for Stricture or Cancer (operation to re-establish bile flow into the small intestine to provide drainage without reflux)
PANCREAS AND SPLEEN
- Pancreatic Cancer
- Pancreatic Cyst and Cystic Tumours
- Chronic Pancreatitis
- Pancreatic Endocrine Tumours
- Acute Pancreatitis
- Congenital Anomaly
- Pancreatic Traumatic Injury
- Whipple’s Operation: Pylorus Preserving and Conventional
DIAGNOSTIC IMAGING & ENDOSCOPY TECHNOLOGY
- High Definition Endoscopy
- Endoscopic Ultrasonography
- Ultrasonography for various hepatobiliary and pancreatic diseases
- 64 Slices Multi-detector CT scanner with 3D reformatting capability
- CT Angiography
- Magnetic Resonance Imaging and Angiography
- Magnetic Resonance Cholangio Pancreaticogram (MRCP)
LIVER & PANCREATIC RESECTION TECHNIQUE & TECHNOLOGY
- Segment-oriented Anatomic Liver Resection Surgery
- Parenchyma Sparing Liver Resection
- Extra-Glissonian Extra hepatic Inflow and Outflow Control
- Surgical Stapler Assisted Liver Parenchyma Resection
- Duodenal Preserving Pancreas Resection Surgery
- Spleen Preserving Distal Resection Surgery
- Segmental Pancreatic Resection
- Pancreas Preserving Duodenectomy
- Transduodenal Ampullectomy
- Technology available at TTSH
- Argon Plasma Coagulator
- Harmonic Scalpel
- Cavitation Ultrasonic Aspirator
- Surgical Vascular Staplers
- Bipolar Coagulator
- Laparoscopic Intraoperative Ultrasonography
- Doppler Ultrasonography
- Ligasure Dissector and Coagulator
- Image Intensifier Fluroscopy
- High Definition Endoscopy Radiofrequency Generator and Tumours Ablator
- Habib Sealer
Treatment Options for Liver Cancer
Major liver resections are now routinely performed for liver cancer. Surgery offers the chance for long-term survival for liver cancer patient. Liver tumors that cannot be removed for various reasons can be destroyed with alternative methods such as radiofrequency ablation technique or alcohol injections into the tumor. Other effective modalities include chemotherapy with embolization of the vessels nourishing the tumor, or through a hepatic artery pump.
1. LIVER RESECTION SURGERY
Liver can be resected up to 75% of its volume. After liver resection surgery, the remaining liver can regenerate to its original size in about two weeks. The operation is performed to remove the liver tumours with the goal of completely removing the portion of the liver where the tumour is located and normal liver tissue is preserved as much as possible. This is achieved by parenchyma preserving segment oriented anatomic liver resection. This technique is particularly important for patients with compromised liver function from the underlying liver disease such as liver cirrhosis.
2. TRANSARTERIAL CHEMOEMBOLIZATION (TACE)
TACE is a treatment option for patients with liver cancer. A small catheter is inserted in an artery through the groin. Under the guidance of an X-ray, the catheter is threaded into the artery that provides blood into the liver as well as the liver tumor. Then a high concentration of chemotherapy is injected directly into the tumor. In addition to the chemotherapy, the blood supply to the tumor is blocked (embolized) by injecting some particles. Over time, this treatment causes the tumor to decrease in size or break down completely.
3. RADIOFREQUENCY ABLATION (RFA)
RFA is used to treat tumors that cannot be surgically removed because of the tumor size or location. RFA is a process in which radiofrequency energy is delivered to the liver tumor to destroy the liver tumor. Ultrasound is used to precisely target the liver tumor using an electrode needle system. This radiofrequency energy produces heat that destroys the tumor without causing much harm to the surrounding healthy liver tissue.
4. PERCUTANEOUS ETHANOL INJECTION THERAPY (PEIT)
PEIT is used to treat liver cancer that may be difficult or unsafe to ablate with thermal radiofrequency. The alcohol injected into liver tumor causes the tumor to dry out and eventually break down. Ultrasound is used to guide the injection of alcohol through the skin via the liver into the liver tumor. Ethanol injection is effective in treating patients with small liver cancer.
Treatment Options for Portal Hypertension
1. ENDOSCOPIC VARICEAL LIGATION
Oesophageal varices can be ligated via endoscopic visualization. This is minimally invasive procedure and it offers an effective mean of arresting oesophageal variceal bleeding. This procedure is generally safe and it can be performed in our day-surgery facilities.
2. TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT
TIPS is a non-surgical procedure used to control bleeding from varices and reduce portal hypertension, which results from scarring or other blockage that increases the pressure in the portal vein in the liver. A radiologist performs this procedure using an x-ray. A tunnel is created in the liver to connect the portal vein to a hepatic vein. The stent is then placed in the tunnel to allow blood to flow from the portal vein to the hepatic vein that helps reduce portal hypertension and bleeding from varices.
3. PORTO-SYSTEMIC SHUNT OPERATION
Portosystemic shunt: operation is performed to divert the blood flow from the portal system to stop emergent bleeding or prevent rebleeding in patients with portal hypertension. This operation is reserved for patients with good liver function and physical fitness.
Treatment plan for pancreatic disease
1. PANCREATIC TUMOR
The most frequent malignant tumor of the pancreas is the ductal- adenocarcinoma, usually located in the head of the pancreas. We have favoured Pylorus Preserving Pancreaticoduodenectomy (PPPD) over the conventional Whipple’s. In PPPD, the stomach is preserved whilst in the conventional operation, one third of the stomach is removed. Studies have found that PPPD does not compromise the oncological resection, but by preserving the gastric function, the patient’s quality of life can be improved. We have also developed strict protocol and care-paths on how to manage such patients before their operation, during the operation and after the operation.
2. CYSTIC TUMORS AND OTHER LESS AGGRESSIVE TUMORS OF THE PANCREAS
With a multi-disciplinary pancreatic management team, we work closely with our gastroenterologist, which allow the surgeon rapid access to Endoscopic Ultrasonography for characterization of pancreatic lesions. This information is extremely useful in the management algorithm. For selected patients with optic tumors and other less aggressive tumors, we can contemplate more tailor-made parenchyma preserving procedures such as segmental pancreatectomy and spleen-preserving distal pancreatectomy.
3. CHRONIC PANCREATITIS
Many patients with this disease suffer from chronic pain, which may be debilitatory. In our multi-disciplinary team, we have inputs from our pain specialists, as well as our endocrinologists, who will address the endocrine insufficiencies. If despite pharmacological agents, the pain remains an issue, we have other modalities like coeliac neurolysis, or even thoracoscopic sympathectomy. If patient has an inflammatory pancreatic head mass, we can also perform a duodenum-preserving pancreatic head resection: either a Beger procedure or a Frey’s procedure or a Berne modification of the Beger procedure.
Research and Clinical Trials in the unit
CURRENT CLINICAL TRIALS
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- Randomised Trial of Adjuvant Hepatic Intra-Arterial Iodine 131-Lipiodol Following Curative Resection of Hepatocellular Carcinoma. (Clinical Research Grant)
- Pilot Study of Adjuvant Therapy of Gefitinib (Iressa, ZD 1839) in Patients with Resectable Hepatocellular Carcinoma. (Singapore Cancer Syndicate Grant)
- Protein Biomarkers for Early Detection and Prognostication in Hepatocellular Carcinoma (HCC)
The Vascular Surgery team is actively involved in managing the whole range of vascular disorders in Singapore and we are a tertiary referral center for the management of patients with vascular disorders.
This includes managing patients with peripheral arterial disease and limb ischaemia, varicose veins, abdominal and thoracic aortic aneurysms, vascular trauma, renal transplantation, creation of vascular access for dialysis in patients with end-stage renal failure and providing complementary skills to the practice of oncological surgery. The Vascular Surgical team functions as the lead team in coordinating and organizing multidisciplinary holistic care for vascular patients. Other specialties involved in the care of vascular patients include interventional radiologists, cardiologists, endocrinologists and allied health specialties including physiotherapy, occupational therapy, podiatry and speech therapy.
Management of Peripheral Arterial Disease
One of the foremost programs launched by the Ministry of Health in studying the treatment of patients with peripheral arterial disease was conducted in TTSH by the Vascular Surgery team. The LEAP (Lower Amputation Prevention) for Life program was first proposed by the late Dr Alexandre Chao who successfully managed to institute a 4 year program in TTSH. The program began in 2001 and was completed in 2005. During this period, a total of 413 patients were enrolled. These patients were assessed and treated with a combination of modalities including bypass surgery, limb angioplasty, pneumatic compression therapy or hyperbaric oxygen therapy. Early analysis of the results has shown successful prevention of lower limb amputations with successful limb salvage in 81.3% of patients. Patients have also managed to retain their functional status following successful intervention, with at least 80% of patients being able to resume their premorbid daily activities.
In this day and age of a rapidly ageing population and increasing prevalence of chronic diseases, the incidence of peripheral arterial disease is definitely on the rise. Early identification of the presence of peripheral arterial disease allows the institution of simple non-invasive interventions such as lifestyle modifications and exercise therapy conducted by dedicated physiotherapists in our hospital as well medications or pharmacological therapy. Patients at risk include patients with risk factors of diabetes mellitus, hypertension, hyperlipidaemia, hypercholesterolaemia, smokers or past history of tobacco use, family history of peripheral vascular disease.
Assessment of patients with peripheral vascular diseases will include a detailed history-taking and physical examination and non-invasive vascular tests including Ankle-Brachial Pressure Index, which is a measure of the blood pressure in the legs and Toe Pressure Index which measures the blood circulation in the peripheries. Duplex scanning of the arteries in the lower limb provides a picture of the arteries of the lower limb and may demonstrate areas of narrowing (stenosis) or blockage (occlusion). These non-invasive tests are performed in-house in our dedicated Vascular Diagnostics Laboratory.
Management options for patients with significant or critical ischaemia include bypass surgery or percutaneous angioplasty. Bypass surgery involves open surgery and creating a new conduit to channel blood to the leg and foot using either the patients’ own vein as a graft or using a prosthetic graft. Percutaneous angioplasty, for suitable patients, obviates the need for open surgery. Guidewires and catheters are inserted into the artery in the groin from a needle puncture. Balloons are passed to segments of narrowed arteries and expanded to try to increase the flow of blood past the narrowed segments. Close cooperation with our skilled colleagues in Interventional Radiology enables us to offer this option to salvage patients with peripheral arterial disease.
Management of Varicose Veins
The problem of varicose veins continue to plague many patients, especially women. Surgical interventions are not only indicated purely for cosmesis but also in preventing progression of the disease to the stage of developing venous ulcers and treating the often disturbing ‘bursting’ pain due to congestion in the varicose veins.
In recognizing the scope of the problem, we have proposed the setting up of the “Vein Centre” specifically targeted to the treatment of this disorder. We propose to employ cutting-edge technology to be able to better treat patients with varicose veins. This includes the use of EndoVenous Laser Therapy (EVLT) to reduce the pain and discomfort associated with open surgery. This involves passage of a laser fibre from a needle puncture near the knee and application of laser energy to cause fibrosis of the long saphenous vein. Other treatment modalities include injection sclerotherapy for treating fine “spider” veins in the skin and Trivex Transilluminated Phlebectomy for recurrent varicose veins.
Management of Thoracic and Abdominal Aortic Aneurysms
Aortic aneurysms occur when the walls of the aorta become thinned and the aorta starts to balloon out becoming prone to rupture, leading to death. Patients at risk include patients with history of smoking and tobacco use, hypertension and positive family history of aneurysms.
The standard of treatment has been open surgery with replacement of the aneurysmal segment of aorta. This involves major thoracic or abdominal surgery and is associated with significant morbidity and mortality. A recent innovation is the use of endovascular stent-grafting of aneurysmal aorta where a stent-graft is delivered into the aorta via incisions in the groins, obviating the need for a long surgical incision in the chest or abdomen.
In the section of Vascular Surgery in TTSH, we have successfully instituted the Prevention of Aneurysm Rupture program from 2001 to 2005. A total of 39 patients with either thoracic or abdominal aortic aneurysms were enrolled in the program and had endovascular stent-graft repair performed with less morbidity and mortality compared to open surgery.
In close cooperation with the Tan Tock Seng-National Neuroscience Institute Trauma (TNT) Team, the Vascular Surgery is also involved in the management of acute vascular trauma, most commonly following motor vehicle accidents, fall from height or work-related injuries. We also work closely with our colleagues in Orthopaedic Surgery in managing complex limb injuries with vascular compromise and in complex limb reconstruction.
Transplantation Surgery and Dialysis Access
The Vascular Surgery team works with the Renal Physicians in providing a surgical service for the creation of arterio-venous fistulas for long-term haemodialysis. This includes the use of both native veins for fistula creation and prosthetic grafts in patients who have no suitable veins. We are also involved in the national kidney dialysis program where Dr Chia Kok Hoong is a registered renal transplant surgeon and Dr Cheng SC is a registered assistant transplant surgeon.
The Vascular Surgical Team is also involved in oncological surgery in conjunction with other surgical disciplines. Our involvement includes surgery for complex tumours requiring vascular control or vascular reconstruction. We also have an interest in surgery for retroperitoneal tumours.
Carotid surgery for prevention of stroke
One common cause of stroke is due to narrowing of the arteries leading to the brain. One correctable cause of narrowing is stenosis of the Internal Carotid Artery which is the main artery supplying the brain. Carotid endarterectomy surgery involves removing the atherosclerotic plaques causing the narrowing and repairing the artery and this has been shown to reduce the incidence of stroke.
Vascular Diagnostics Laboratory
Our in-house Vascular Diagnostic Laboratory provides timely and accurate non-invasive imaging of vascular pathology. The Vascular Lab employs Duplex Ultrasonography for vascular imaging and other adjunct investigative modalities to assist us in the workup of a vascular patient.
- Vascular Ultrasound (Duplex)
- Non-invasive Investigation of:
- Arterial, Venous Diseases
- Deep Venous Thrombosis
- Ankle Brachial Pressure Index
- Digit Phlethysmography
- Varicose Veins
- Carotid Artery Disease
- Thoracic Outlet Syndrome
- Aortic Aneurysms
- Endovascular Surgery of Aortic Aneurysms
- Management of Arterio-occlusive Disease in:
- Lower Extremity Amputation Prevention
- Carotid and Extracranial Circulation