Team Surgeons

 

A/Prof Jeffrey Low

A/Prof Jeffrey Low

Senior Consultant and Head
Division of Gynaecologic Oncology

Dr Fong Yoke Fai

Dr Fong Yoke Fai

Senior Consultant and Head
Division of Benign Gynaecology

Dr Ng Soon Yau Joseph

Dr Ng Soon Yau Joseph

Senior Consultant
Division of Gynaecologic Oncology


Team Advisors

 

Prof PC Wong

Prof PC Wong

Senior Consultant and Head
Division of Reproductive Endocrinology & Infertility

A/Prof A Ilancheran

A/Prof A Ilancheran

Senior Consultant
Division of Gynaecologic Oncology


Robotic Surgery - GRACES

Robotic surgery is surgery or an operation that is performed by a human surgeon using the robot as a tool. The characteristics of the robot allow the surgeon's own skill to be amplified thus resulting in a better clinical outcome for the patient. The use of robots in medicine and specifically in surgery is unlike how robots are used in industry. We often have mental images of robots in an assembly line. These industrial robots are used to carry out repetitive tasks that do not change over time. In surgery, each patient and even each surgical event in the same patient is different and the surgeon has to make decisions on how to approach the surgical situation to achieve the best possible outcome for the patient whilst keeping the safety of the patient paramount.

The da Vinci® surgical robotic system is the most comprehensive and most advanced robotic surgical system in use today. It is widely regarded by surgeons to be the ONLY robotic surgical system in clinical practice. So when your surgeon mentions robotic surgery, he or she is almost certainly referring to performing surgery with the help of the da Vinci® robotic surgical system from Intuitive Surgical, Inc.

The way robotic surgery is performed is similar to laparoscopy in many ways. Ports or tiny tubes are introduced into the patient's body. The robotic instruments or arms are then placed into the patient's body through these ports. Once the robotic instruments are in the body cavity, they are are controlled by the surgeon who is able to then perform very complex surgery easily and safely because the robotic instruments act more like human hands than surgical instruments. This form of surgery is less tiring for the surgeon and is more “intuitive” which means that the surgeon is able to perform even very difficult surgeries comfortably and naturally which results in cleaner, safer surgeries that are associated with less pain and less blood loss.

...

Gynaecologic robotic surgery can help women living with non-cancerous gynaecologic conditions such as fibroids, endometriosis or ovarian cysts. These gynaecologic conditions may limit a woman's quality of life by causing heavy menstrual bleeding, debilitating pain or uncomfortable abdominal bloating. Gynaecologic robotic surgery is also designed to help women living with cancer of the endometrium and cervix.

Traditional forms of surgical treatment for these gynaecologic conditions involved the use of laparoscopy for mild disease and opening the abdomen surgically for complex or difficult cases. Often, conditions such as endometriosis and cancer create a difficult operating environment that makes open surgery necessary. Unfortunately, open surgery is often associated with a more painful recovery from an open wound and greater blood loss.

With gynaecologic robot-assisted surgery, complex and difficult operating environments can easily be negotiated and overcome in a minimally-invasive fashion. The same surgical outcomes are achieved, but there is much less pain since a large abdominal wound is completely avoided and the overall blood loss from the procedure is less. This all translates into a recovery process that is minimally disruptive with our patients getting back to the business of living their lives normally without interruption.

Please consult a GRACES team specialist today to see if gynaecologic robotic surgery is right for you.

  • 1985 - First “robotic” surgery with PUMA 560 which involved a robot controlling a needle introduced into the brain to obtain a tissue sample
  • 1988 - Probot. Urological application of robot-assistance
  • 1992 - Robodoc. Orthopedic application
  • 1994 - AESOP (Automated Endoscopic System for Optimal Positioning). First FDA approved robot-assisted system for intra-abdominal use
  • 2001 - AESOP incorporated into ZEUS which was an integrated surgical robot
  • 2000 - da Vinci® introduced the whole concept of “robotic telepresence”

The da Vinci® robotic surgical system began life as a DARPA (Defense Advanced Research Projects Agency) military project. The initial goal was to have a robot controlled by a surgeon that could perform surgery on soldiers on the battlefield many miles or even many hundreds of miles away. This initial concept of surgery by remote control is known as robotic telepresence or the surgeon projecting his presence in the form of the robot with the aid of telecommunications many miles away from his physical location.

The da Vinci® robotic surgical system is the most comprehensive robotic surgical system, but is by no means the only robot ever developed for use in an operating room. You can see from the brief timeline above that different systems have come and gone over the years and most if not all of them are no longer in use clinically today.

The da Vinci® robotic surgical system is still in use today, many years after it was introduced, and still growing in the number of conditions that can be effectively treated using this surgical technology, this is testament to its effectiveness and power as a comprehensive surgical robotic system.

The Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery programme was launched in at the National University Hospital to capitalize on the growth of gynaecologic robotic surgery worldwide. The objective of the core group of founding gynaecologic surgeons was to bring this leading surgical technology to the women of Singapore.

Singapore has one of the most developed and sophisticated healthcare environments in the world, this is evident from the high standard of care that is ubiquitous in this island state and in the expectations that Singaporean patients have of healthcare providers, institutions and governing authorities. It was into this environment that GRACES was introduced to “raise the bar” on healthcare delivery to women who require gynaecologic surgery. The GRACES programme was introduced to provide Singaporean women with a mode of surgical treatment that can best be described as minimally disruptive surgery.

The whole care concept revolves around the idea that with robotic surgery, women's lives need not be disrupted just because they need gynaecologic surgery. Having gynaecologic surgery and not breaking one’s routines were mutually exclusive with more traditional forms of surgery. With the introduction of robotic surgery, women now have the option of having even very complex surgery done and still recovering rapidly enough to keep living their normal everyday lives with little or no disruption.

To emphasize our commitment to bring the benefits of this wonderful technology to our patients, the GRACES programme was launched in September 2008 by helping a patient living with endometrial cancer be the first woman in Southeast Asia to benefit from robot-assisted cancer surgery. Since that very first patient in 2008, the GRACES programme has continued to a volume leader in gynaecologic robot-assisted surgery, helping countless women benefit from this cutting-edge surgical technology by getting the surgery that they need without disruptive and prolonged recoveries.

The GRACES programme is committed not only to delivering the very highest standards of surgical care but also to innovation and study. The GRACES programme is involved in research programmes that study how humans interact with machines to produce a more seamless interface between surgeon and robot resulting in even better surgical outcomes and patient experiences.

The GRACES programme also actively trains surgeons from around the region who are interested in offering the benefits of robot-assisted gynaecologic surgery to their patients. Through the GRACES Surgical Partners Programme, regional partner surgeons and their centers are trained, and have to maintain a certain level of proficiency and caseload complexity to ensure that they are delivering the standard of robotic surgical care worthy of a GRACES center.

Benign Gynecology

 

Dr Fong Yoke Fai

Dr Fong Yoke Fai

Senior Consultant and Head
Division of Benign Gynaecology


Gynaecologic Oncology

 

A/Prof Jeffrey Low

A/Prof Jeffrey Low

Senior Consultant and Head
Division of Gynaecologic Oncology

 

A/Prof A Ilancheran

A/Prof A Ilancheran

Senior Consultant
Division of Gynaecologic Oncology

 

Dr Ng Soon Yau Joseph

Dr Ng Soon Yau Joseph

Senior Consultant
Division of Gynaecologic Oncology


Reproductive Endocrinology & Infertility

 

Prof PC Wong

Prof PC Wong

Senior Consultant and Head
Division of Reproductive Endocrinology & Infertility


Monday, 25 July 2011
  Robotic surgeon 'can ease bed crunch'
(The Straits Times)

 

Sunday, 11 October 2009
  Robotic surgery removes gynae and colorectal cancer - more agile and safe
(ZbWellness, Lianhe Zaobao) - in Chinese language

 

Wednesday, 22 October 2008
  NUH Uses 'Da Vinci' for Gynaecological Cancer Surgery Which Reduces Pain and Leaves No Scar
(Lianhe Zaobao) - in Chinese language

 

Wednesday, 22 October 2008
  Robot Performs Surgery on Woman Suffering from Endometrial Cancer
(Shin Min Daily News) - in Chinese language

Introduction

The GRACES surgical programme is a care concept centered on the philosophy of helping women receive the surgical care they need without having to put the business of living their lives on hold.

At the heart of the GRACES programme is the da Vinci® robotic surgical system. We at GRACES aim to help gynaecologic surgeons achieve a consistent quality of surgical healthcare delivery to patients who need gynaecologic surgery through the use of robot-assisted operative technology.

Our vision is for women across Asia to easily access minimally-disruptive gynaecologic surgery that is safe and timely and that leverages on robot-assisted operative technology to achieve the best clinical outcomes possible.

If you are a gynaecologic surgeon who is interested in offering robot-assisted surgery to patients who require gynaecologic surgery, we at GRACES can help. We are committed to bringing your plans to offer the benefits of robot-assisted gynaecologic surgery to your patients from conception to bedside.

Being a GRACES-accredited surgical program means that you and your team will join an elite gathering of gynaecologic surgeons and healthcare providers who are committed to the use of cutting-edge technology in achieving only the very best clinical outcomes for their patients. It also means that you become part of a surgical network that gives you unlimited access to resources in the form of expertise, sub-specialty domain knowledge, patient support and research and development and the backing of a major international academic medical center.

Finally, it means that you are part of a network of dedicated professionals who are thoroughly committed to helping women lead healthier, more productive lives.

 

The Accreditation Process

The journey to becoming a GRACES-accredited surgical program is a 3 step process:

 

Step One. da Vinci® robotic surgical training at the Khoo Teck Puat Advanced Surgery Training Centre. This state of the art surgical training facility is the venue for 2 days of hands-on course where you become familiar with the da Vinci® robotic surgical system and begin to experience the potential of this surgical technology in wet and animal laboratories.

 

Step Two. Proctored Surgical Experience.

This should follow systems training by no more than a month. We have found that surgeons are better able to leverage on their systems training experience when they follow in short order with live clinical surgery. The daunting prospect of live surgery so shortly after systems training is overcome with active proctoring by a GRACES Team Expert who will be on-site.

The GRACES Team Expert will walk you and your team through pre-operative preparation of the operating suite and on the day of surgery, helps direct your team in their preparation for surgery. Our Team Expert will walk you through patient examination, port selection and placement and systems docking procedures. Your very first tentative steps at the Surgeon's Console will also be gently guided to provide a comfortable environment in which to acclimate and operate with the da Vinci® robotic surgical system in a clinical setting that is familiar to you.

Our Team Expert will also help you and your bed-side operative assistant synergise as surgeon partners, a critical part of any successful robotic surgical programme.

 

Step Three. Maintaining Excellence.

After you and your team have completed proctored sessions and achieved accreditation as a GRACES-certified surgical programme, we at GRACES will continue to monitor your progress and your clinical outcomes with a progressively complex caseload. Part of maintaining your centre's excellence in robot-assisted surgery will be upgrading your skill set through regular exchanges where you may opt to visit GRACES @ NUH to observe and operate with our team of experts on more complex benign and oncology cases.

Alternatively, you may opt to invite a GRACES Team Member to operate with you and your team at your center or even have one of our Nurse Experts visit to upgrade your nursing and surgical technical team.

Finally, we at GRACES believe in supporting your efforts to bring robotic surgical technology to your patient base because we believe that collaboration is the best way to consistently improve women's health in Asia.

To find out more about the  GRACES Surgical Accreditation Programme and the GRACES network of surgical programs, please feel free to contact a GRACES Team Member.