​Pushing Boundaries In Lung Surgery

All-in-one keyhole

PULSE Issue 41 | July 2023

“What is easy for the surgeon can be hard on the patients,” said A/Prof John Tam Kit Chung, Head and Senior Consultant, Division of Thoracic Surgery, Department of CTVS, NUHCS, as he looked back on his journey as a thoracic surgeon for the past 25 years. 

Patients at NUHCS with lung conditions are usually in their 60s, 70s, and even their 80s. This makes open-chest or multiple-incision surgeries riskier for older patients, as they not only take a longer time to heal but tend to have other conditions that may complicate the surgery. In his pursuit to reduce post-operative pain for lung surgery patients, A/Prof Tam looked to find a better technique that would be safe, reduce surgical risks and have better outcomes for patients. 

This led to the development of a new surgical technique – Uniportal Video-Assisted Thoracic Surgery (UVATS). Compared to the conventional multi-portal Video-Assisted Thoracic Surgery (VATS) which uses a few small incisions on the patient's torso to access the lungs, UVATS uses only one small cut and is currently the least invasive technique for lung surgery. The surgical technique is performed through a single cut of about 3cm, at the side of the chest. Through this cut, a small telescope is inserted into the body to magnify the insides of the thoracic region on a video monitor. Surgeons then proceed with the operation using specially made minimally invasive instruments which are small, thin and chopstick-like, in order to perform the surgery. 

In 2009, A/Prof Tam led his team to perform the first UVATS in Singapore. He has since gone on to mentor a generation of thoracic surgeons in this single-incision surgery technique, developing the NUHCS Lung Surgery Centre to its current pinnacle of excellence. Apart from lung surgery, thoracic surgeons also perform surgeries in the chest area involving organs such as the chest wall (ribcage and breast bone), the pericardium (fluid-filled sack that surrounds the heart), the sympathetic chain (structure of nerve fibres spanning from the base of the skull to the base of the spinal column), and the diaphragm. The team is also trained to manage airway emergencies involving the trachea and bronchus (windpipe). Committed to providing the highest standard of care for patients and advancing the field of thoracic surgery, A/Prof Tam and his team continue to pursue innovative solutions through cutting-edge research and education.

CONDITIONS THAT MAY REQUIRE LUNG SURGERY 

• Collapsed Lung (Pneumothorax) – When air leaks into the area between the lungs and the ribcage, this leads to the lung collapsing. Drainage tubes are used to suction the air out and re-expand the lung while the lung is repaired to prevent it from collapsing again. 

• Fluid around the Lungs (Effusion or Empyema) – Fluid may build up in the chest area around the lung as a result of an infection or illness such as Pneumonia. Surgery is performed to remove all the fluid and infected material from the area to help the lungs heal. 

• Lung Nodule or Lesion – An abnormal growth that forms in a lung usually after an infection or inflammation. Most lung nodules are benign and do not require treatment. However if the growth presses against the airway, it may cause chest pain. Surgery can be performed to remove the nodule. 

• Lung Mass – An abnormal growth in the lung area that is more than 3cm in diameter. Lung masses could be benign or malignant and are determined by surgery to remove a lobe of the lung and the neighbouring lymph nodes for further tests.

DID YOU KNOW? LUNG CANCER IS THE #1 CANCER KILLER IN MEN AND #2 IN WOMEN IN SINGAPORE.

Unfortunately, most patients die of lung cancer due to late detection. If detected and treated early, lung cancer can be treated with more than 90% survival rate of patients in five years. Aggressive treatment of early lung cancers has also shown excellent survival outcomes with minimal long-term side effects. Studies have shown that UVATS offers faster recovery for patients who detect lung masses early. With advanced medical technology, later stages of lung cancers are now amenable to targeted therapy with good long-term disease control. For more information, please visit www.nuhcs.com.sg.

NUHCS LUNG SURGERY CENTRE

Established in 2007, NUHCS Lung Surgery Centre today carries out more than 400 lung surgeries each year. It is the first centre in Singapore to perform UVATS in 2009 and is the only centre in Singapore with a full team of experienced UVATS thoracic surgeons supported by a team of specialty care nurses and case managers. In addition to the wide range of lung conditions, the Centre also manages rarer conditions such as Hyperhidrosis (excessive sweating), Pectus Chests (pigeon or funnel chests), and Rib Fractures.