SGH - Innovating Care in the World of Surgery

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SGH – Innovating Care in the World of Surgery

thesundaytimes

February 12, 2012

PRODUCED BY THE SPECIAL PROJECTS UNIT, MARKETING DIVISION, SPH

At the cutting edge SGH doctors make use of the latest technologies to perform surgical operations that offer patients better outcomes Lynn Seah IN ONE of the hybrid operating theatres (OTs) at Singapore General Hospital (SGH), the surgical team performing brain surgery can carry out brain scans on the patient without leaving the theatre. The Magnetic Resonance Imaging (MRI) machine, not a standard feature in OTs, comes in handy in cases such as the removal of a cancerous tumour. “In brain surgery, neurosurgeons tend to remove tumours bit by bit so they don’t do damage to the normal brain. But if they do it bit by bit, they don’t know how much they’ve got as they only have a very limited view of where they are operating. With the MRI on board, it’s very clear how much they’ve done or haven’t done,” says Professor London Lucian Ooi (right), chairman of the division of surgery at SGH, who used this to illustrate the capabilities of SGH’s new-breed OTs and how they have benefited patients and doctors. Hybrid theatres are those that combine operating and X-ray facilities. The new-breed OTs also include integrated theatres that link up the equipment in the theatre not just to each other but to external databases containing resources like X-rays and lab reports. Among the 25 operating suites at SGH’s Major Operating Theatre complex at Block 3 are some of the world’s most advanced theatres. Some of them are equipped with high-definition scopes, which give surgeons crystal-clear views of previously hard-to-see areas in the body like the pelvis, enabling them to operate with greater confidence. Coupled with the use of robots to manoeuvre instruments in these narrow areas, even greater operating precision can be achieved. These high-end OTs enable some operations to be carried out more efficiently and safely. “Sometimes they make things that were not possible be-

fore possible now,” adds Prof Ooi. For example, in the case of a blockage in the aorta, the largest vessel carrying blood away from the heart, open surgery used to be the only solution. But patients in some instances may be too ill to undergo such an operation. Now, with a hybrid OT installed with a system called Ziego iAngio, it is possible to manoeuvre a stent graft through a blood vessel to where the blockage is, without cutting open the chest. In an integrated OT, information on the patient can be pulled from multiple sources and displayed on a wall of monitors for all to see. This enables the surgical team to be on the same page and respond more quickly.

Previously, the anaesthetist used to see the patient only on the day of the operation. If he then discovered any health issues that might jeopardise the patient when he was under anaesthesia, the operation would have to be postponed or cancelled altogether. “The prime focus is how we can provide the best care for our patients, having seen what is available elsewhere in the world,” says Prof Ooi.

Beyond the operation

PHOTO: CHONG JUN LIANG

Learning from the best

To stay at the forefront of technology, SGH regularly sends teams out to different parts of the world to learn and bring back new ideas, such as newly available equipment that the hospital could consider acquiring or more efficient procedures used in other hospitals. One such idea implemented is the pre-operative evaluation clinic, which a team learnt about in the United States. This clinic allows the anaesthetist to evaluate the patient before the operation.

Levelling up Lights in the operating theatre are now gentler on the eyes than in to the past. Hospital staff talk to patients as they are wheeled in, explaining what they are doing and reassuring them. The airconditioning is no longer so cold, as the temperature in each theatre can now be controlled independently and need not be turned down so low unless the operation requires it. Operating theatres these days are also much more sophisticated. Apart from the operating table and lights in the centre of the room, a basic set-up comprises the anaesthetist’s equipment for monitoring breathing and heartbeat at the patient’s head, and the surgeon’s tools. The anaesthetist’s equipment is now less chunky than in the past, and the surgeon’s tools could range from simple instruments to a heart-lung machine for open-heart surgery and robots for keyhole operations. Some of the advanced theatres even contain X-ray facilities or have equipment that is networked so the surgical team can search for and call up information like past X-rays and lab test results if necessary.

The commitment of the surgical team to patient care goes beyond the operation itself. Says Prof Ooi: “Surgery is probably the most critical event someone goes through in the hospital. The care involved is tremendous from start to end, not just in the operating room, but the entire process from admission to discharge from hospital.” The hospital evaluated its processes and put in place a same-day admissions procedure that allows patients to be admitted on the day of their operations instead of having to come in a day before and waste time waiting. For same-day admissions, patients come at the appointed time and register at a counter that is just one floor below the Major Operating Theatre complex. An operating theatre nurse then walks them up to the complex where they are prepared for surgery immediately. To reduce the anxiety of family members while the patient is in the operating complex, monitors in the wards display a partial identity card number of each patient in the complex, along with information on where the patient is at that time – waiting to go into the OT, in the theatre, or in the recovery room following the operation. As SGH celebrates its 190th anniversary, Prof Ooi sums up the changes in surgery that the hospital has witnessed: “On their own, some of these changes may not seem important, but coming together the whole system works because every part has been addressed.”

PHOTOS: RAY KHOO, SGH


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