|Gynecological Minimal Access Surgery|
Dr Alex Ooi is a senior obstetrician and gynecologist. He has served on the Mount Elizabeth Hospital Medical Advisory Board and was Chairman on the Minimal Access [“keyhole”] Surgery group which revamped the dedicated operating theatres and initiated educational activities in this fascinating field of surgery. He has also been visiting consultant to Fudan University in Shanghai and several other hospitals in the region.
DR ALEX K H OOI
MBBS, MMED [O&G], FRCOG, FAMS, FICS, MBA.
Gynecologic Minimal Access Surgeon
3 Mount Elizabeth, #11-07
Mount Elizabeth Medical Centre
T +65-67388331 F +65-67348896
Treatment of gynaecological problems can be by medical means (preferred) or, surgery. Surgery may be the method of choice, especially if it is for or to exclude a cancer, or as adjunct to medical therapy. Surgery for cancerous conditions may be followed by chemo(drug) or radio(X-ray) therapy.
Surgery can be approached by a laparotomy (a large enough up-&-down or side-to-side cut on the abdomen) or via the vagina. In many cases, it can also be done by Minimal Access Surgery (see overleaf). The priority is to ensure the problem is adequately and safely treated with the choice of mode of approach mainly for your comfort and outcome.
I understand this is a stressful time for you (and family) but, by understanding your condition fully, it is more likely you are well prepared and less anxious. I will give you as much information as possible. Feel free to clear your queries/doubts with me.
Most minor and some major surgery can be performed under local (you can request for general) anaesthesia. Most major surgery will be performed under general anaesthesia.
Either way, surgery will be pain-free and after surgery, effective pain-relief will be given.
If you have general anaesthesia, you may have a breathing tube down your throat. Do not be alarmed – it will be removed once you are breathing well. After that, if you have phlegm, you can cough and bring it out to your lips for the nurse to remove.
Feeding will be allowed as soon as you are improving and the “drip” removed. Usually, the faster you ambulate, the quicker will be your recovery. Your cuts will be covered by water-proof plaster and you can wet over them. Recovery will generally be faster and hospital stay shorter (with faster return to normal activity after discharge) if you had MAS approach. If there is a urinary catheter, you need not get up to micturate. If you have a drain through one of your wounds, it will be removed once minimal. I will see you each day in hospital till your discharge – and will see you a few days after that. There is usually no need to inspect the wounds/s till then.
There is no scientific basis for dietary restrictions but, if you believe certain foods delay healing, eg seafood, heaty food, by all means avoid them for a few weeks. Vitamin C, fruits and vegetables are helpful.
Lysis of Adhesions
Minimal Access Surgery (MAS)
(“minimally invasive”, “keyhole”, “laser”, “laparoscopic”, “hysteroscopic” surgery)
By not using large cuts and not exposing internal organs to air/excess handling, MAS allows faster recovery and improved long term benefits. An instrument with a light source and camera is passed into the abdomen via a small incision or into the uterus via the cervix. In the former, a few more small incisions are usually required.
Most non-cancerous surgeries can be performed by MAS - cystectomy, myomectomy, hysterectomy, tuba/ectopic pregnancy, tubal repair, prolapse repair, appendicectomy, neurectomy, adhesiolysis, vaporization of endometriosis and hysteroscopic polypectomy, myomectomy, endometrial resection. Your informed consent will include discussion on choice of approach - MAS or laparotomy.
For technical reasons or to secure the objective for surgery, it may be necessary to revert to a traditional incision (laparotomy) in the course of any MAS. It is implicit that consent for a MAS approach includes that for laparotomy. Also, during surgery, other conditions not earlier apparent may be found and further or alternative procedures/approaches may be needed. Another surgeon may be asked to assist in the surgery or postoperative care.
Pictures or video may be taken during surgery and used to show you what was seen and done. They may be used for teaching purposes but there will be no disclosure of your identity. Often, other surgeons or nurses will be present to observe techniques.
fibroids, cysts, uterus
Please remember that, though your recovery is fast and there are none or only a few small scars, you have had major surgery and you must have adequate rest for about 1-3 weeks (2-6 weeks for laparotomy). Finish all antibiotics if given but take the analgesics given only as necessary.
Common post-operative complaints include shoulder pain, bloating, vaginal bleeding, sore throat and nausea. Relief will be given. Ask if you need something to help sleep.
Possible complications are those for any surgery and include bleeding, urinary retention, infection, anaesthetic problems and damage to adjacent organs such as ureter, bladder or bowel. Immediate or delayed further surgery may be required.
Feel free to clear any queries you may have with me. Being well-informed will help you have a successful surgery, be more relaxed and have a good outcome.
DR ALEX K H OOI – MBBS, MMED [O&G], FRCOG, FAMS, FICS, MBA
Gynecologic Minimal Access Surgeon
3 Mount Elizabeth, #11-07 Mount Elizabeth Medical Centre, Singapore 228510
T +65-67388331 F +65-67348896 www.obgyndr.org www.liposuction.com