Friday, April 11, 2008

Robotic Micro-Neurosurgery with the Da Vinci system: a preliminary experience

Author(s):
Prem K. Pillay, MBBS, FACS (Singapore, Singapore)



Introduction: We describe our preliminary experience in using the Da Vinci Robot in performing microsurgery. This clinical experience was preceded by animal laboratory work with this robot and prior experience in neurosurgical robotics with the Zeiss MKM robot and the Surgiscope. Methods: The first patient presented with a symptomatic lipomyelomeningocele. The robotic interface was used for active fine tissue dissection and to allow experience to be gained with the instrumentation, the three-dimensional interface, and the endo-wrist movements. The second patient presented with a large para-sagittal frontal brain metastasis involving the falx cerebri, sagittal sinus, and anterior to the motor cortex.

Results: The robotic set-up prolonged operative time by about 45-65 minutes. The robotic interface was intuitive for a neurosurgeon as it was similar to operative microsurgery with a magnified 3-D view. The endo-wrist system and instrumentation allowed precision in tissue dissection, with seven degrees of freedom and a tremor-free operation of tools in the operative field controlled by a surgeon’s hands remote from that site. Conclusions: The use of an active robotic device with 3-D visualization and active instrumentation allows a new dimension in micro-neurosurgery and points in a future direction of overcoming the limits of the human hand. However, proper training, patient selection, and tool tip development are required in neurosurgical applications.

Monday, March 24, 2008

Sucess Story - Dr. Lye Wai Choong

They agree to kidney transplant despite 3 hospitals turning him down due to weak heart
HIS kidney condition had caused his heart to fail.
The only way to save him was through a kidney transplant.
By Ng Wan Ching

09 March 2007
HIS kidney condition had caused his heart to fail.
The only way to save him was through a kidney transplant.
But he could not undergo a transplant operation unless his heart function improved.
That was the vicious circle in which Mr Kenneth Fong was trapped five years ago.
He was facing almost certain death. Yet, the three hospitals he went to refused to do the transplant because of the risks involved.
All his wife of 13 years, Madam Sheryl Cheong, could do was watch his life ebb away.
But today, Mr Fong, 41, is alive and building a new life.
All because two doctors took a big gamble in 2004.
Though they knew the operation could kill him, they went ahead and transplanted a kidney donated by his wife.
Said one of the doctors, Dr Lye Wai Choong, a senior consultant renal specialist in private practice: 'There may have been a higher risk of him dying on the operating table, but there was certainty of death if he did not have the transplant.'
Mr Fong's kidneys, affected by a childhood illness, failed in 2000, and he was placed on the transplant list.
In 2002, his heart, weakened by his condition, started to fail too, and he was removed from the transplant list.
He also had to give up his job as a civil engineer.
His ejection fraction or EF (which measures the capacity at which one's heart is pumping) was just 10 per cent. Normal EF is above 55 per cent.
Doctors he consulted at three hospitals told him the same grim news: he was too weak to undergo a kidney transplant because of his failing heart.
Said Mr Fong: 'I was in fluid overload. My lungs were filled with so much water that I could not lie down without choking.'
He would pace the floor at home late into every night. Madam Cheong stayed up with him to pound on his back.
It helped him forget his terrible backache.
Then, in early 2004, a friend recommended Dr Tan Seng Hoe, head and senior renal consultant at Tan Tock Seng Hospital.
DOCTOR TOOK RISK
Dr Tan's prognosis was no different from that of the other doctors, but he was willing to risk conventional blood dialysis or haemodialysis with Mr Fong.
The peritoneal dialysis that Mr Fong was doing himself was no longer enough.
But it would take a bigger toll on his heart. Said Dr Tan: 'Nobody knew whether his heart could take it.'
On the day he did his first haemodialysis, his wife, parents and family members gathered around him.
Dr Tan had told them he could die at any time if his heart gave up. He survived four sessions.
Said Mr Fong: 'I was 86kg before I started, because of all the fluid retention. After I finished, I was 68kg.'
Next, Dr Lye gave the go-ahead for the transplant, though Mr Fong's heart function was still very weak.
However, Mr Fong's sister, who was a perfect match for him, was then two months pregnant.
He could not wait for her to give birth before donating her kidney to him.
So the doctor asked his wife if she wanted to be a donor.
'I was overjoyed. I did not even know I could be a donor,' said Madam Cheong, 37, a business development manager.
She was a match. On 14 Oct 2004, she and her husband underwent their operations at Mount Elizabeth Hospital.
He now weighs a fit 69kg, his ejection fraction has improved to an almost normal level of 42 per cent and he can drink 1.5 litres of water a day.
'I can gulp it down instead of taking tiny precious sips,' he said.
He is training to be a full-time pastor.
To celebrate the second anniversary of his second chance, he and his wife wrote a book called 'Why me, God?'. It has a second cover which says, 'Why not you, my son?'.
It will be on sale by the end of this month at Kinokuniya, Times, Popular (Bras Basah) and MPH.
Said Madam Cheong: 'When Kenneth was suffering, he kept asking that question. Then he got the answer.
'We want people to know about the journey that Kenneth has gone through. And to let them know that they are not alone in their suffering.'
The couple are now trying for their first child.

Wednesday, March 12, 2008

HAEMATOLOGY & STEM CELL TRANSPLANT CENTRE-MOUNT ELIZABETH HOSPITAL, SINGAPORE

Previously incurable or possibly fatal blood disorders such as Multiple Myeloma, Chronic Lymphatic Leukemia and Thalassaemia Major cannot be cured using conventional therapy, such as Chemotherapy and Radiotherapy.

However, in recent years, there have been dramatic breakthroughs in the field of haematology and stem cell transplant that offer new therapies help patients live longer and better quality lives. Cure rates:

Multiple Myeloma : Greater than 70% cure with Allogeneic Stem Cell Tx.
Chronic Lymphatic Leukaemia : Greater than 70% cure with Allogeneic Stem Cell Tx.
Thalassaemia Major : Upto 90% cure with Allogeneic Stem Cell Tx.

For Allogeneic Stem Cell Tx., patient is required to stay in Singapore for 3 – 4 months. The success rate is dependant on individual patient’s condition, but the cure rate is high if the patient is in the early stage of cancer. The cost depends on complexicity of case as well as some other factors such as age, disease, status etc.


Mount Elizabeth Hospital, Singapore is owned by Parkway Group Healthcare, Singapore, the largest private healthcare group in Asia. The Group manages an extensive network of hospital and integrated healthcare facilities in the region. Mount Elizabeth is the first hospital in Asia Pacific to achieve ISO 9002 international quality certification – a set of world recognized quality management and assurance standards. It is also the first private hospital in Asia to win the Asian Management Award for exceptional people development and management. It is a 505-bed hospital which provides a comprehensive range of medical and surgical services.


Our Centre is spearheaded by Dr. Patrick Tan, a world renowned specialist who has achieved numerous medical milestones and pioneered revolutionary procedures. He has more than 20 years experience in haematology and stem cell transplant, and has performed more than 600 cases of stem cell transplants.

Dr Tan graduated with a degree in medicine at the University of Singapore in 1980. From 1988 to 1989, he was a special fellow to the Fred Hutchinson Cancer Centre (FHCRC) in Seattle, USA, to do subspecialty work in bone marrow transplant. He was re-invited back to the FHCRC in 1991 to further his research in the area of transplant immunology. In 1993, he returned back to Singapore to serve as the head of the Department of Haematology, Singapore General Hospital for more than a decade before joining Parkway Group Healthcare, Singapore in May 2004. From 1998 to 2002, Dr Tan was also the Director of the National blood Bank. In 2003, he was appointed as the first Director of the Singapore cord blood bank.




Under his leadership, Singapore General Hospital’s Department of Haematology flourished to become a renowned centre for Bone Marrow Transplant in Southeast Asia. Since 1985, the Department performed more than 600 cases of haematopoietic stem cell transplant. The wide varieties of transplants done were mainly for the haematological malignancies and the lymphomas. However, there were also transplants done for some cases of life threatening non-malignant disorders, auto-immune disorders and certain solid tumors.

These transplants include the classical matched unrelated donor transplants which were mainly done for the acute leukemias, the severe aplastic anaemias, the mydsplasias, the chronic leukemias, the Thalassaemias, and certain cases of lymphomas and myelomas; the autologous peripheral blood stem cell transplants done mainly for the lymphomas, myelomasw, the acute myeloid leukemias and certain solid tumours; the non-myeloablative sallogeneic stem cell transplants done mainly for older patients but now found to be useful in younger patients and the umbilical blood stem cell transplants done not only for paediatric patients but also for the older patients.

He has contributed tremendously to the field and has achieved several ‘world firsts’ in this area. These include:


First syngeneic bone marrow transplant July 1985
First allogeneic bone marrow transplant September 1985
First autologous peripheral blood stem cell transplant January 1988
First matched unrelated donor BMT September 1994
First allogeneic peripheral blood stem cell transplant May 1995
First unrelated cord blood stem cell transplant March 1998
First non-myeloablative allogeneic HSCT November 1999
First Non-myeloablative unrelated cord blood transplant November 2001



In recognition of his achievements on transplant for Thalassaemia and for non-myeloabltive stem cell transplant using umbilical cord as the source of transplant, he was awarded the prestigious national award, the excellence award for Singapore in 2002.

Tuesday, March 11, 2008

Medical Tourism to Singapore - A Boom



Posting an article in the Express Healthcare in 2005 by Miss Sapna Dogra

Medical tourism boom takes Singapore by storm

Malaysia, Thailand and India also to ride medical tourism boom, reports Sapna Dogra from Singapore

There is more to Singapore than just being a honeymoon destination. The tiny island of Singapore, having a populace of 4.4 million, is fast positioning itself as a medical tourism hub. Attracting about 200,000 overseas patients every year, Singapore Medicine, a multi-agency government initiative, is strategising to increase the number manifold. The authorities are ambitious of serving one million foreign patients annually by 2012 and generate USD 3 billion in revenue.
The private sector hospitals here are the true centres of excellence known for providing world class treatment and having state-of-the-art infrastructure and the best possible medical expertise, avers a Mumbai-based doctor undergoing training at Gleneagles hospital.
Parkway hospitals is Singapore’s largest private healthcare group in Asia, owning three tertiary care private hospitals: East Shore, Gleneagles and Mount Elizabeth. The magnificent façade of these hospitals are complemented by equally competent doctors and excellent services with world class equipment. Comprehensive patient care and treatment of a wide array of ailments is the hallmark of these hospitals, thus attracting patients from southeast Asia and Middle East.
Incidentally, quite a few patients come from India for liver transplant. Nitin Saxena, who brought his father all the way from Delhi to Gleneagles for a liver transplant, opines unlike Indian hospitals, the services and facilities value for money.
The Living Donor Liver Transplant (LDLT) programme at Gleneagles gets 80 per cent of patients from overseas. The centre, head by world renowned transplant and hepatobiliary surgeon Dr KC Tan, performs both living as well as cadaveric liver transplants. The popularity of the programme lies in the fact that unlike India, Singapore law allows transplants in situations where there is an emotional link between the donor and recipient. The ethics committee within the hospital reviews every case and makes its recommendations to the Ministry of Health, informs Dr Tan.
Stem cell transplant is yet another field developing rapidly on the health map of Singapore. The haematology and stem cell transplant centre of Mount Elizabeth Hospital has pioneered stem cell treatment for patients with advanced cancer tumours. Headed by director Dr Patrick Tan, a world renowned specialist in the field of oncology, cost of treatment here ranges from USD 72,000 to USD 90,000 per person, compared to USD 235,000 for similar treatment in the US.
According to Dr Patrick Tan, the centre currently treats four-five cases a month and hopes to increase this further. Recently, a 12-year-old girl from Delhi underwent cord blood transplant at the centre. Besides treatment, the hospitals offer special clinics for people of different countries. For instance, there are Korean clinics and Japanese clinics. As a mark of hospitality, hospital staff goes to receive patients and their relatives from the airport, make arrangements for their stay and even provide with language whenever required. The efficient and effective healthcare system in Singapore coupled with the breathtaking scenic beauty is the perfect getaway for patients. Other countries can surely try and emulate this model if they want to become the favorite medical tourism destinations.
To address the need and demand for quality healthcare facilities in Asia and Middle East, a specialised trade event ‘The International Healthcare Facilities Exhibition & Conference (IHFEC) 2005’ is being organised by Parkway promotions in Singapore. The theme of the conference, likely to be attended by about 600 delegates and 2,000 trade visitors, is: ‘New Century healthcare: Creating World Class Healthcare Delivery Facilities in Emerging Markets’.
The medical tourism boom is just not restricted to Singapore alone. Current trend of economic developments in the Asian region, higher life expectancies, an ageing population and an ever-increasing awareness of the benefits of the quality healthcare have given a shot in the arm to the Asian healthcare industry, taking it to witness an unprecedented growth.
Countries like Malaysia, Thailand and India are expected to ride the health industry boom in the near future. Presently, there are only 140,000 hospitals serving an Asian population of 3.5 billion. With Asian population expected to grow to 5.6 billion by 2050, the consumer expenditure on healthcare services and goods will increase from US$90 billion in 1999 to US$188 billion in 2013. Malaysia is targeting the Middle East and China to generate a whopping revenue of 2.2 billion ringgit by 2010. These emerging markets prove that there’s immense potential in the Asian healthcare business and it will see a stupendous growth, remarked Ms Tan-Hoong Chu Eng, MD, Parkway Promotions Pte Ltd., a subsidiary company of Parkway-Holdings Ltd. the largest private healthcare group in Asia.
In Thailand, another hot spot for medical tourism, 1.1 million foreign patients have been treated last year alone by virtue of its excellent health services, world-class facilities and competent doctors and experts at affordable rates. Besides, the country is positioning itself differently by offering five star services with holistic approach, said Dr Surapong Ambhanwong, president, Advisory Board in Foreign Affairs at the Private Hospital Associaion of Thailand.
On the home turf, the India’s healthcare industry has been growing by 15 per cent in the last five years. Last year alone, the country received about 1,50,000 international patients for treatment.
The healthcare industry in India is worth Rs 1,00,000 crore and accounts for nearly five per cent of the GDP.
According to a study on healthcare by the CII, medical tourism can generate an additional Rs 10,000 crore by 2012 and will account for 3-5 per cent of the market.
Research has shown that healthcare demand is related to population size, life expectancy and purchasing power, added Tan-Hoong Chu Eng.
According to Peter Kappart, president of the private hospitals of Switzerland and vice president of the Swiss Leading Hospitals of Switzerland, the spurt in healthcare industry in countries like India, China, Vietnam and UAE will make them international healthcare destinations and the growing demand for premium healthcare services in these markets will require five-star know-how.
Demand for healthcare is rising in the Middle East with millions of dollars spent in establishing specialised hospitals and clinics, expanding existing facilities and adopting world class technology in Bahrain, Kuwait, Yemen, Oman and Qatar. In the UAE, for instance, the government plans to double the bed capacity of public hospitals to achieve a target of one for every 300 people by the end of the decade.
Similarly, the need to replace ageing facilities and upgrade with the latest state-of-the-art medical technologies, planning and development of new hospitals especially in China, Indonesia, India and the Middle East, present excellent business opportunities for companies with products to offer and expertise in management and consultancy.
According to David Campbell, deputy high commissioner, director of trade and investment, British High Commission, Singapore healthcare is an important sector for the UK trade. Investment in Asia is a very important market for the UK. “Public-private-partnerships can play a significant role in sprucing up these emerging healthcare markets,” said Campbell.

Parkway Group Healthcare - An introduction

Indian healthcare system has matured significantly during past one decade compared to post independence era, the world has started to recognize Indian talent and research in medical field. Vast experience of many Indian Doctors and their large patient population has given it a lead in dealing effectively with most common diseases that includes Heart, Gynecology, Eye, Cosmetic Procedure, Orthopaedic, Dental and other common surgical procedures. The success rate in India in these treatments is among best in the world. India is providing the world class treatment not only to Indian patients but also to foreign nationals especially from USA and some other western countries where health costs are unbelievably high as compare to India. For such treatments, people come here for treatment and enjoy the benefits of medical tourism.

Though the private sector has been responsible and appreciated in bringing about the desired changes in the health industry in India still the skills and techniques in complex procedure like Transplants such as Living Donor Liver Transplant, Stem Cell Transplant, Living Donor Renal Transplant, advance targeted therapies for cancer, IVF, Orthopedic and many more where we have limited pool of doctors, high tech equipments and infrastructure for managing such complex cases. The success rate in India for these treatments is still evolving when compared to other international centers of repute.

While suffering from any of the above mentioned diseases, one has limited choices or look for options overseas as no one would like to compromise or take risk in matter of life. Often these treatment options are suggested by our treating doctors or our relatives and friends residing overseas. Common belief is considered in favor of the good medical care in U.K and U.S.A. The treatment cost inclusive of travel, accommodation, treatment in hospital, medicines, food etc. is very high and many patients give up due to cost constraints. Then they are left with limited options but to rely on existing Services here for such treatments.

I am pleased to share with my fellow Indians that Singapore based Parkway Group Healthcare which owns and manage 3 hospitals in Singapore namely East Shore, Gleneagles & Mount Elizabeth Hospitals, are having a pool of world renowned 1400 doctors, providing all facilities under one roof that meets the international standards in healthcare is performing all high end treatments with 85-90% success rates and at quite affordable cost compared to U.S. and U.K. Getting good hands is a challenge. Our people policies are good and the team, excellent. What we commit, we deliver.

Our Vision - The global leader in value-base integrated healthcare
Our Mission - To make a difference in people’s lives through excellent patient care
We Value - People above all.. by treating those we serve and each other with Compassion, dignity and respect excellence by acting with integrity and striving for the highest quality care and service results by exceeding the expectations of the people we serve and those we set for ourselves.

Parkway’s facilities:

Parkway Cancer Centre
Parkway Liver Centre including living donor liver transplant
Haematology and Stem Cell Transplant Centre
Minimally Invasive and Robotic Surgery Centre
Centre for Kidney diseases and liver donor Kidney Transplant

This series will make you familiar with Parkway Group Healthcare, Singapore. We are sure that now you would be curious to know treatments in detail. We will keep you posted by sending regular updates on innovative treatments in detail and Parkway services. Alternatively you can also logged-in to our website: www.parkwayhealth.com .

Should you or your dear ones need any help from doctors of international repute in terms of their expert opinion, scheduled appointments, medical evacuation, visa or passport assistance for any critical medical condition, please write to us or call us at given below numbers.

For any queries you can call our International Patient Assistance Center in Delhi Chennai and Ludhiana without having to wait you will be immediately assisted by our expert staff dedicated for 24X7 response. You would be pleased to know that such assistance from IPAC is not charged.
Please Contact
vikesh@counsellor.com