I have been doing laparoscopic surgery for about 25 years. I have visited many famous laparoscopic surgeons and learnt from them. There are many tips and tricks I have learnt over the years. I wanted to write a book on athis topic but that will take a long time. I have decided to blog all my thoughts. In this was it could be always updated. The aim of these series of blogs is to educate young doctors keen on learning laparoscopic surgery. My plan is to make videos to accompany this blog so that learning will be more fun. I will be grateful if experts in laparoscopic surgery could give me pointers on improving these blogs as well as give other tips that will benefit everyone. You can follow all the videos and blogs by clicking #laparoscopytips. Bowel preparation There is controversy as to whether bowel preparation should be done before laparoscopic gynaecological. My personal policy is that, I don’t
Early daysWhen I was training as a Registrar in the Obstetrics and Gynaecology Unit at Hospital Sultanah Aminah, Johor Bahru, between 1988 and 1991 the only laparoscopy we did was diagnostic laparoscopy and laparoscopic tubal ligation using the Falope ring. UK I went on to work in a small hospital in the UK. Very few surgeries were done by laparoscopy in that hospital. One of my consultants was starting to do some hysteroscopic surgeries at that time.Specialist in OBGYNOn returning from the UK, I became a specialist at the same hospital. This was the time went the hospital acquired a video laparoscopy system. The general surgeons were doing laparoscopic cholecystectomy and I frequently watched them struggling with this surgery. I was trying out simple surgeries by laparoscopy which includes laparoscopic salpingectomy for ectopic pregnancies and simple laparoscopic cystectomies. We had several consultants from the National University Hospital, Singapore who used to come and do laparoscopy cases with us. I learned from them.Training in TaiwanI was frustrated, as my skills
In one of my earlier blogs entitled “12 reasons why laparoscopic surgery is not popular in Malaysia”, the 9th reason I stated was “You don’t get good assistants when performing surgery by laparoscopy”This is a common complaint by gynaecologist keen to perform laparoscopic surgery. Laparoscopic surgery is an instrument intensive procedure. You need nurses who can prepare all the necessary equipments to perform the surgery. Even if one item is missing, it will be difficult to perform the surgery. For example, recently I performed 2 total laparoscopic surgeries on very large uteruses measuring more than 1 kg. The suction irrigation system was not working properly and it took a longer time for me to complete the surgery.The importance of nurses It is difficult for a gynaecologist to be present in the operating room to make sure that all the equipments are there before starting the surgery. This is the job of the nurses. Once the instruments are prepared, the next step is
I have been performing surgery by laparoscopy surgery for more than 25 years. Unfortunately, the progress made in surgery by laparoscopy in gynaecology in Malaysia is very slow. These are the reasons I think why gynaecologists in Malaysia perform so few surgeries are performed by laparoscopy. You don’t get paid extra for performing Surgery by Laparoscopy Malaysian Private Health Care Act 1998 states that the fees that can be charged for a procedure is the same whether it is performed by laparoscopy or laparotomy. This means that if I were to perform a hysterectomy by an open laparotomy, vaginally or by laparoscopy, the doctor’s fees is the same. Surgery by Laparoscopy in gynaecology requires extra skills. It takes a long time to acquire these skills and the surgery takes a longer time to perform. Off course the benefits to a patient when undergoing surgery by laparoscopy compared to laparotomy are enormous. When the remuneration is the same, most gynaecologist do
Dare to be Different” In the last 22 years that I have been in private practice, I have dedicated my professional life to laparoscopic surgery and infertility. I started my laparoscopic surgery training after spending 2 months with Prof Song and Dr. Lee Chyi Long at the Chang Gung Memorial Hospital in 1994. After that I gradually honed my skills by visiting laparoscopic surgeons in di erent parts of the world, watching them operate and at times assisting them. I am indeed grateful to these doctors who have unselfishly shared their knowledge and skills with me.