Technique

Abdominal surgery can be done with a large cut – a “laparotomy”, or small cuts using a camera (laparoscope) and other instruments to work inside – laparoscopic surgery.

What a lot of people don’t realise is that there is huge difference in how laparoscopic surgery can be performed for the very same operation.

Let’s face it – every cut hurts and leaves a mark. The bigger the cut, the more the pain and scarring.

Wouldn’t it be great to have no pain or scarring?

Medical technology hasn’t quite taken us there yet, but that hasn’t stopped Dr Gan from striving for these goals with every operation. He has adopted a wide range of advanced laparoscopic techniques with the aim of doing each operation using the fewest and smallest cuts. Instead of relying on strong pain-killers, he focuses on techniques that greatly reduce the need to take them in the first place. For example, it is not uncommon for his gastric bypass and bowel cancer resection patients to avoid opiate pain-killers after surgery, and to go home after one to two days in hospital. Many gallbladder and hernia surgery patients are happy to go home with minimal discomfort as a day case where appropriate.

Dr Philip Gan and his wife, Dr Ping Fung

The nerve supply of internal organs (autonomic nervous system) is different to that of the abdominal wall and skin (somatic nervous system). Internal organs are more sensitive to pressure (like a blockage), whereas the abdominal wall feels sharp pain when cut and stretched. By reducing the size and number of incisions, and locating those incisions strategically, pain and scarring can be dramatically reduced.

Before elaborating, it is important to explain some terminology. Laparoscopic or “key-hole” surgery is performed by inserting “ports”, which are cylinders that usually have a one-way gas valve, into the abdominal cavity and inflating the abdomen with carbon dioxide gas to create a space. A special camera called a laparoscope is inserted and the image projected on a screen. Other long instruments are inserted through other ports to move organs around and operate on them, which may involve cutting, sealing, stitching or stapling. Organs such as the liver can get in the way and need to be lifted using a retractor. Some retractors are inserted through another laparoscopic port, and others through a cut without using a port. There are different sized ports, which allow a range of different sized instruments to be inserted. The larger the port, the more pain! Also, if an organ needs to be removed, then at least one of the incisions needs to be large enough to remove that organ.

Dr Gan doesn’t use one approach for all operations, but rather tailors what he believes is the best one for each individual patient.