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Major surgery through the belly button

  Thursday, 19 l 05 l 2011  Source: Mind Your Body; The Straits Times   
By: Ng Wan Ching

More women are opting for what is called the single port surgery, which leaves barely any scar

surgery-belly-buttonAfter a biopsy showed that there was a chance of Ms Deborah Chow’s cervical cancer recurring, she agreed to have her uterus and fallopian tubes removed. Within a week, the 39-year-old was back in the kitchen cooking for her family. Despite the major surgery, she has no scars to show for it. Ms Chow, a mother of a four-year-old girl, is among a growing number of women opting for single port surgery to remove fibroids, cysts, wombs and fallopian tubes.

The procedure is carried out through a single cut in the navel. It leaves no visible scar and is thus less disfiguring than even conventional laparoscopic, or keyhole, surgery, which is done through three or four small cuts. Since surgeons at KK Women’s and Children’s Hospital performed its first single port surgery in 2009, they have gone on to perform more than 90 such operations.

Surgeons at Singapore General Hospital have done 10 single port operations so far, while surgeons at National University Hospital have done “fewer than 10”. At least one doctor in private practice has also started offering the procedure to patients. Ms Chow told Mind Your Body: “When my doctor broke the news to me that the hospital’s cancer management team had advised I should remove my uterus and fallopian tubes, he added there was a technique that was quite new.” The doctor told her he had done it on a few other patients but recommended she looked for more information about it on the Internet. The housewife did just that and agreed to the procedure. It took less than two hours and was done under general anaesthesia. Her only side effect, after waking up from the anaesthesia, was pain in her shoulder which went away after two or three days.


Madam Sulastri Slemat, 46, also had single port surgery to remove her womb. “I had so many fibroids growing in my womb I lost count,” she said. “One of the bigger fibroids was pressing on my bladder causing urine to leak. Once that fibroid was removed, the pressure on the bladder was no longer there and the leaking was resolved.” Madam Sulastri first had fibroids removed 11 years ago when they were getting in the way of her having a baby. There was no option then of single port surgery. She had open surgery, which used an incision similar to one for a Caesarean section, and it left a 10cm-long scar on her bikini line. But she was able to have a son, now nine years old, and a daughter, aged seven. “Both my children were born by Caesarean section. My doctor advised me against natural birth because I had surgery in my abdominal area and there was a risk of uterine rupture,” she said. She wanted more children, but doctors advised her against it. “They said it was not safe for me to have a cut in the same position three times or more,” she said.

“If there had been single port surgery, I would not have needed the Caesarean sections for my two children. I could have had them by natural birth and then I could have had two more children,” she said. At least, this time, she had the option of scarless surgery. “The first time I had surgery, I woke up with a big bandage on my abdomen. This time, there was only a small plaster. “After the first surgery, I would hold my tummy when I walked, because I was scared something would fall out!” she laughed.  Like Ms Chow, the only niggle was a pain in her shoulder that went away after two days. “There was only a small bruise around the navel. I recovered much faster and the bruise was gone in a couple of weeks,” said the language officer at the Subordinate Courts.

Dr Anthony Siow, a pioneer in the surgery here, said the pain is due to the remnant air and washing solution in the tummy irritating the diaphragm, a sheet of muscle that stretches across the bottom of the rib cage. It causes a referred pain in the shoulder. Dr Siow believes that as more surgeons are trained in this procedure, it will become a standard surgical option for patients, although not everyone is suited for it. One downside is that it is more expensive than conventional laparoscopic and open surgery.

The special ports cost at least $750 each. Each single port surgery could cost between $1,000 and $2,000 more than conventional laparoscopic surgery.


Those who have had the surgery are pleased with the quick recovery, suffer less pain and have invisible scars, Dr Siow said. As the navel or umbilicus inverts, the scar shrinks, he said. “I had a flight attendant ask for this surgery so she could recover fast enough for her next flight and not have any evidence of surgery,” he said.

An elderly woman, who was terrified of going under the knife, was relieved her ovarian cyst could be removed with only one small umbilical incision, he said. Another woman, Madam Koh Chew Li, 44, who had her womb removed, opted for the procedure because it would leave no scar. “I’m still very vain!” she laughed. Her ovaries were conserved in order to preserve normal hormonal function and libido as well as to avoid premature menopause. Her operation was carried out in Gleneagles Hospital on Feb 25.

The fibroid in her womb was not only large but also intricately wrapped around by its blood supply. Dr Kenneth Wong, an obstetrician and gynaecologist, who practises at Paragon and did the surgery, said: “We contemplated taking the oft-trodden path of an open method in view of the surgical complexity, but we persevered and finally managed to extricate the uterus and fibroid.” Madam Koh was left with a single scar buried in the umbilicus. And she was back to her usual work schedule after a week. “Thank goodness my doctor succeeded with the single port surgery. I’m very happy not to have any scars; no complaints at all,” said the businesswoman and mother of three.


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