Laparoscopic surgery – a cut above the rest

Awarded the Singapore Government Scholarship for Advanced Laparoscopic Surgery, Dr Anthony Siow is the first gynaecologist in Singapore to perform Single Incision Laparoscopy for Hysterectomy and Myomectomy. He is among a select few in the region to have performed more than 200 such cases, and is frequently invited to teach and demonstrate Single Incision Laparoscopic Surgery.

One of the most common conditions he has treated are fibroids and cysts, which he likes to term the ‘lumps and bumps’ of gynaecology. These are lumps found in the womb and ovaries. They are very common, turning up in 60 percent to 70 percent of women in health screenings, ranging from anywhere within half a centimetre to six centimetres. Close to sixty percent of fibroids do not cause any symptoms, and require no treatment. More than ninety-nine percent of fibroids are non-cancerous, ruling out concerns that lumps in the womb definitely point to cancer.

Lumps in the ovaries are termed cysts, and may contain fluids and tissue structures such as skin, bones and hair. The fluid in most cysts is blood or a clear fluid. If it is blood, the condition is usually endometriosis, which causes painful menstruation and difficulty with pregnancy. In women who are pregnant, fibroids larger than five centimetres need to be treated, as with cysts larger than four centimetres.

Dr Siow’s expertise in laparoscopy has seen him help patients achieve minimal trauma and swift recovery time after a surgery. It involves small incisions with quick recovery and minimal internal damage. As a micro-surgical technique where bleeding is controlled and chances of infection and post-operation scarring are greatly reduced, it is little wonder this procedure is popular among patients. Most gynaecological procedures have now moved towards laparoscopy.

Laparoscopy does have certain limitations, however. It is not well established that laparoscopy is effective in treating advanced cancer, for which doctors usually opt to perform open surgery. Despite that, early cancers have been treated very successfully with laparoscopy, and problems such as a history of repeated surgeries or a particularly large lump can be circumvented to still provide laparoscopic surgery for a patient. Laparoscopy is also suited for diagnosis, allowing doctors to gain a better view of the internal structure of the body, and better understand a patient’s condition.

On the topic of robots in surgery, Dr Siow thinks the use of robots presents benefits for patients with very deep-seated conditions, such as those of the prostate, which perpetuates far down the pelvis for men. The convergence of the pelvic bone makes laparoscopic surgery difficult, so the robot has the advantage of highly controlled motion. In gynaecological surgery, it is debatable whether it is applicable, as most gynaecological conditions don’t occur with such depth to warrant a robot.

Dr Siow is the first surgeon in Singapore to perform Single-Incision Laparoscopy for myomectomy and hysterectomy. Laparoscopic myomectomy involves the removal of fibroids, and hysterectomy involves the removal of part of or the entire womb. Laparoscopy for these procedures will usually involve three to four small cuts, so single-incision laparoscopy is a large upgrade with what Dr Siow likes to call “just one cut”. Following the skin crease of the belly button, the wound ends up shrinking into the fold of skin in the belly button, becoming difficult to see. Some call it ‘scar-less surgery’.

This was not possible until a few years ago, when advances in medical technology gave surgeons the multi-functional instruments, which can perform this type of procedure today. Cameras with a flexible tip now allow doctors to see 360 degrees inside the body without having to move the camera from the outside. The holding of tissue, making of incisions, and cutting and sealing of blood vessels can all be done with just one instrument, allowing surgery to be conducted with just one hand. Simple procedures like the removal of small fibroids can be done routinely with Single-Incision Laparoscopy with faster recovery compared to open surgery, and less scarring compared to usual laparoscopy.

An avid follower of medical literature, Dr Siow is waiting for single-incision laparoscopy to move to the robotic platform. The current state of robotic single-incision laparoscopy presents no benefits over manual surgery. In time to come, when laparoscopic technology advances far enough to move completely to the robotic platform, it will help a lot of surgeons who are still unclear of the aspects of laparoscopic surgery.

Dr Anthony Siow has a fierce passion for teaching because it helps translate his passion (in surgery) into knowledge his peers and juniors can use to continue helping patients. He understands that it is not easy; teaching requires experience and the ability to make knowledge simple for others to understand. He feels there is little point in being able to do a complex surgery if only one person can do it without being able to transfer the know how to others.

When asked about his advice for future doctors, Dr Siow said one has to take everything that comes with being a doctor. It is a glamorous job on the surface, but underneath it all there is a lot of hard work and long hours. Surgical skill comes from practice and reflection, all of which take time. Patients are not shown the gruelling process of getting to where the doctor is now, much like most ‘final products’. There are sacrifices to be made in terms of time with friends and family. Above all, it should always be about the patient, not about the doctor.

Dr Anthony Siow finds tremendous joy in guiding couples towards parenthood, and helping them over any bumps along the way. He attributes the ability to quickly respond to a patient’s condition to the multi-faceted centres of excellence in Gleneagles Hospital, his workplace. Easily being able to rope in colleagues from other medical centres in the same hospital, he can save precious time; giving patients the peace of mind he wants them to have.

Dr Anthony Siow has more than 15 years of institutional practice before setting up ASC Clinic for Women at Gleneagles Hospital, Singapore. He graduated from the Medical School of National University of Singapore, and obtained his Masters Degree (O&G) in Year 2000. He is a Fellow of the Royal College of Obstetricians & Gynecologists in United Kingdom as well as the Academy of Medicine, Singapore. He has a special interest in laparoscopic surgery and was awarded the Singapore Government Scholarship for Advanced Laparoscopic Surgery. He spent a year in Sydney Australia mastering the art of Laparoscopic Pelvic Floor Reconstruction and Severe Endometriosis Surgery.

ASC Clinic for Women
#05-04 Gleneagles Medical Centre,
Gleneagles Hospital,
Singapore 258499
T (65) 64799555 | F (65) 64754955
www.anthonysiow.com