|
KKH’s successful surgery last month spells shorter downtime for patients
SURGEONS here scored a first last month when they removed four large fibroids from a woman – through a cut in her navel no bigger than 2cm.
The operation to take out the noncancerous growths from the uterus of the 46-year-old patient took two hours.
Because the incision was so small, the patient healed quickly from the operation, called a myomectomy.
She was on her feet the next day.
This was despite having had fibroids with a combined weight of 203g taken out of her. Some of the growths were as big as tennis balls.
The scar in her navel is practically invisible.
Traditionally, fibroids have been removed through conventional surgery, which can leave a 10cm-long scar below the bikini line, or keyhole surgery, which requires surgeons to make several 1cm-long cuts to create access for various surgical instruments.
But doing “single port” or single-cut surgery through the patient’s belly button presented two main challenges to the surgeons.
One is that manipulating the surgical tools through an incision that small takes more dexterity than is required in conventional keyhole surgery.
The other challenge comes from minimising bleeding after the fibroids are cut away and the surface of the uterus has to be repaired.
These challenges fell to Dr Quek Swee Chong, who heads the gynaecological oncology department at the KK Women’s and Children’s Hospital (KKH), and Dr Anthony Siow, director of its Minimally Invasive Surgery Centre.Dr Siow said that, to remove a fibroid, a surgeon has to pull it away from the uterine wall to expose the thin neck of tissue anchoring the fibroid to the uterus, so it can be cut.
“With single-incision surgery, this pulling is no longer possible, as all instruments enter the tummy through the umbilicus,” he said.
The fibroids are cut up into smaller pieces while still in the patient and removed through the navel.
Dr Siow added that the challenge of stemming bleeding comes from the surgical team performing the operation without first having sealed the main blood vessels supplying blood to the uterus.
On the off-chance that more bleeding than expected occurs, the surgical team would have to revert to conventional keyhole surgery, making three or four incisions, or even to traditional open surgery, to arrest the bleeding.
The single-port myomectomy is done using specialised instruments just 5mm thick and a gel-surface port that holds the various instruments in place. A wound retractor clipped to the port keeps the incision open.
Dr Siow limits this minimally invasive surgery option to patients whose fibroids are smaller than a five-month-old pregnancy, that is, those weighing 800g or less.
Within a month of that first local ground-breaking operation on Aug 18, five more of such procedures were done
at KKH.
Uterine fibroids, which develop during a woman’s childbearing years, almost never become cancerous. As many as three in four women have them, but most are unaware of them because these growths often do not come with symptoms.
Those who have symptoms often complain of unusually heavy periods and bad cramps, making surgery to remove them advisable.
Last year, 342 cases of fibroids were treated at KKH using conventional multi-incision keyhole surgery; another 326 patients underwent open surgery.
Related article:
|