Inside OT 手术台上 Episode 6

0:06 Wait, don’t move

0:08 This operation will take about six to seven hours

0:11 It’s quite a difficult operation

0:13 Take it slow

0:17 I often get stomachaches

0:19 Sometimes, I’ll get dizzy and vomit

0:23 The worry now is that…

0:24 your calcium levels may fall…

0:27 because now, your bones are very hungry

0:29 Patient’s 12th

0:30 She had an inflamed pancreas previously,

0:33 which resulted in a lot of internal scars

0:37 What if I don’t survive the surgery?

0:40 Whether my body withstand…

0:41 the long and major surgery?

1:03 (Ng Teng Fong General Hospital)

1:07 Ng Teng Fong General Hospital, which was opened in 2015,

1:11 covers an area of about 55,000 square metres

1:14 It has an emergency department, internal medicine department,

1:17 hepatobiliary and pancreatic surgery department and so on,

1:19 alleviating the strong demand for medical treatment in the West

1:24 No close contact

1:25 No

1:26 Tan Mei Ping, 50 years old,

1:28 is at Ng Teng Fong General Hospital today for an operation

1:33 She is independent and didn’t want to trouble her family,

1:36 so she came to the hospital to settle the admission procedures on her own

1:40 I often had stomach issues

1:44 Every time I went to consult the neighbourhood doctor…

1:47 and the company doctor,

1:49 they all said I had gastric

1:53 So, I thought that the gastric could be due to stress from work,

1:58 or from being too busy

2:03 Is it a bit low?

2:04 No

2:04 (Blood pressure) 146/96

2:08 Tan Mei Ping is a sales trainer,

2:11 She has always loved outdoor activities

2:13 From time to time, she would go out with relatives and friends,

2:15 or cycle around the island together

2:17 She is also a frequent marathon runner

2:20 Through her company’s annual medical check-up,

2:22 she only recently discovered that what she suffers from…

2:25 is not ordinary gastric pain

2:27 She actually suffers from what is known as…

2:30 primary hyperparathyroidism

2:36 It is the most common cause of hypercalcemia

2:42 Why does she have this issue?

2:44 That’s because in her neck,

2:46 there is a parathyroid tumour on the lower right side

2:53 (In Singapore, thyroid cancer is the eighth most common cancer among women)

2:58 (Between 2015 and 2019,)

2:59 (an average of 312 women in Singapore were diagnosed with thyroid disease per year)

3:06 Normally, parathyroid glands can’t be seen

3:10 We can’t even see them through an ultrasound scan…

3:13 because they are really small

3:14 They are smaller than a grain of rice

3:16 Usually, one of them may start to swell and become a tumour,

3:22 causing hormone hyperactivity

3:26 Too much parathyroid hormone can lead to high levels of calcium in the blood

3:32 Hypercalcemia could be life-threatening

3:36 So, in the long run, if we don’t resolve hyperparathyroidism,

3:43 the bones will become more and more porous

3:46 The probability of fracture would be higher

3:50 Also,

3:51 we know that long-term hypercalcemia affects other parts of the body

3:57 She may experience heart problems

4:00 Before this, I didn’t know why I always had stomach pain…

4:04 and backaches

4:06 I would go to TCM doctors for cupping…

4:11 and acupuncture

4:13 I also didn’t know why I kept feeling dizzy and vomiting

4:16 I wasn’t able to sleep after midnight

4:20 I would only be able to sleep for two to three hours

4:27 The scar will be very small

4:29 It would be somewhere along your neck here

4:31 Would it be big? Here?

4:34 It’ll be a small scar

4:36 The patient had gastric ulcers 10 years ago,

4:39 which could have been due to hypercalcemia

4:41 Some patients may also feel easily fatigued

4:45 These are very common symptoms

4:48 For long-term symptoms, hypercalcemia could lead to osteoporosis

4:52 This patient had a slight fall two years ago,

4:56 which caused a fracture in her foot

5:06 Also awaiting surgery in the hospital this day…

5:09 is 56-year-old Rosna, who suffers from pancreatic cancer

5:14 Okay, it’s better

5:15 37.1

5:17 Accompanied by her husband, she was admitted to the hospital…

5:20 for a seven-hour Whipple operation

5:28 Apparently, the ship is not anchored…

5:30 in the uncertain sea

5:32 Rosna is an English teacher…

5:34 and has a history of hypertension, hyperlipidemia and diabetes

5:40 She has been using medication to keep these conditions under control

5:44 But this time, the symptoms were unexpected

5:48 I noticed that the white of my eyes…

5:50 were turning yellow

5:51 But again, I didn’t visit the doctor

5:55 And I had diarrhoea for two weeks straight

5:59 I still didn’t see the doctor

6:01 I self-medicated

6:03 I tried to take charcoal pills…

6:05 and stuff like that

6:07 I know it’s wrong of me

6:09 I was being stubborn…

6:10 and sticking to my own medication

6:13 Then, I came to a point…

6:15 when I told myself that this cannot be

6:17 Because my eyes were turning yellow

6:19 And my diarrhoea kept recurring

6:22 It came to a point where my son…

6:24 encouraged me to see a doctor

6:29 So, I went, and I was warded that very day

6:33 After many checks,

6:38 X-rays, CT scans and an endoscopy,

6:42 the doctors found out that…

6:43 there were problems with my pancreas

6:47 Okay, breathe in, breathe out

6:50 Breathe in, breathe out. Slow, deep breaths

6:55 The scan showed that there was a blockage in the bile duct

6:58 The main reason for this bile duct blockage is because she has pancreatic cancer,

7:03 which blocked the bile duct

7:05 So, we did other scans first to make sure that the cancer hasn’t spread

7:10 Then, we arranged for a surgery

7:12 (Pancreatic cancer has the 7th-highest cancer mortality rate globally,)

7:16 (and ranks 5th in Singapore)

7:19 (Pancreatic cancer is more common among males,)

7:22 (with patients averaging 71 years old and above)

7:28 Pancreatic cancer is one of the most difficult cancers to cure

7:33 But for early pancreatic cancer,

7:35 if the pancreas is removed surgically,

7:38 and the surrounding lymph glands are cleared,

7:40 the survival rate of the patient can be improved

7:44 The first thing that came to my mind…

7:47 when I was told…

7:48 that I had to go through this surgery was…

7:50 Obviously, I was scared and anxious

7:54 Because I’ve never gone through this before

7:58 A lot of things were going through my mind

8:01 All the negative feelings and thoughts,

8:04 like, what if I don’t survive the surgery?

8:07 Whether my body can withstand…

8:09 the long and major surgery?

8:12 I want everything to go well

8:14 I just want to wake up alive…

8:17 after the operation

8:19 In the face of his wife’s worries,

8:21 Rosli, as a husband,

8:22 felt that the best solution was to be by her side

8:27 She’s actually just a bit scared and nervous

8:31 But as a family, we always encourage her,

8:33 and tell her not to worry,

8:34 because all of the doctors are professionals

8:37 They will take care of you

8:49 (Ng Teng Fong General Hospital)

8:54 Nurse, open the ligature

8:57 Rosna, who suffers from pancreatic cancer,

8:59 is at Ng Teng Fong General Hospital today for a Whipple operation

9:04 Can I have the power clip, please?

9:06 After Rosna received general anaesthesia,

9:08 the doctors immediately began the operation, which was expected to last up to seven hours

9:14 The Whipple operation is an extremely complex operation…

9:18 because the pancreas is located in the deepest part of the abdominal cavity

9:23 It is located behind the stomach…

9:26 and in front of the aorta and spinal cord

9:30 Rosna’s tumour is near the head of the pancreas,

9:33 which caused her to have jaundice

9:39 Retractor

9:41 After removing the pancreas,

9:43 many other parts need to be connected, so it takes a long time

9:48 In the final part of the operation,

9:50 Dr Thng must reconnect the small intestine…

9:53 with the remaining pancreas, stomach and bile duct

9:57 This makes the surgery even more complicated

10:01 Wait, don’t move

10:08 Another pair of forceps for Dr Joel, please

10:10 In the other theatre,

10:11 Tan Mei Ping,

10:13 who was diagnosed with primary hyperparathyroidism two weeks ago,

10:18 is about to start surgery after receiving general anaesthesia

10:22 We usually use two scans…

10:26 to detect which parathyroid gland has a tumour

10:30 The first scan is the ultrasound

10:32 The ultrasound will show…

10:34 which of these four parathyroids are swollen,

10:37 Normal parathyroid glands…

10:40 can’t be seen on the ultrasound…

10:41 as they’re less than one centimetre

10:43 The second scan is what we call Sestamibi or Parathyroid scan

10:48 This scan shows which parathyroid gland is hyperfunctioning

10:54 For this patient, both scans show that…

10:56 she only has one tumour, in the bottom right

10:59 This allows us to do a smaller and less invasive surgery

11:06 3-0 tie

11:07 Dr Oh performed an open surgery on Tan

11:12 He first made a small incision of about two centimetres…

11:16 in the low curved collar on the sternal notch,

11:19 and removed the parathyroid glands with manual retractors…

11:22 and the help of a headlamp

11:25 Most cases of thyroiditis are quite small

11:28 So, we want to make sure that we’re able to locate the tumour and remove it

11:35 We need to get to the plain…

11:36 between the thyroid and the parathyroid

11:40 The advantages of this type of operation is that the operation distance is short,

11:43 the operation time is short,

11:45 and the area that could be damaged is relatively small

11:49 In addition, the incision marks can easily be covered up after the operation

11:55 However, such an operation also presents certain challenges

11:59 For this surgery, the scar won’t exceed two centimetres

12:03 So, as you can imagine, a small scar…

12:06 would mean that we have to be more careful and use smaller tools…

12:11 to remove the tumour

12:19 (Two hours into the Whipple operation)

12:22 Give me the medium clip

12:24 I’ll need two

12:26 Rosna’s surgery has been going on for two hours

12:30 One more clip

12:31 In the 1960s and 1970s,

12:33 the mortality rate for such complex operations was 33 percent

12:38 However, with the rapid development of medical research,

12:40 the mortality rate for this operation has been reduced to about 2 to 3 percent

12:46 Take your time

12:51 Patient’s 12th

12:55 The biggest risk of this surgery is bleeding

12:59 When a patient bleeds, we can usually stop the bleeding in the operation theatre

13:04 The second risk is at the connection sites

13:07 Sometimes, if the patient isn’t able to heal well,

13:12 there may be signs of a leak

13:14 This would cause the patient to show signs of inflammation…

13:19 and to develop a fever

13:21 Their white blood cell count would rise, and they would need antibiotics

13:25 New tubes may need to be inserted to remove the dirty fluids,

13:29 or another surgery may be required

13:45 (Ng Teng Fong General Hospital)

13:48 It’s actually bigger than what we saw…

13:50 on the ultrasound

13:52 Tan’s operation has been going on for an hour and a half

13:57 Dr Oh Han Boon is carefully removing her parathyroid gland

14:03 During the operation, Dr Oh was most worried about…

14:06 accidentally injuring the recurrent laryngeal nerve

14:09 This would cause the patient to lose the ability to breathe normally

14:13 It will be difficult to live a normal life even if salvaged

14:18 The patient has quite a lot of symptoms

14:20 But she is also worried that the surgery would affect her quality of life

14:27 Her job requires her to use her voice to communicate with many people

14:33 Hence, we have to ensure the safety of the operation

14:36 We also hope to reduce the risk of damage to her voice and vocal cords

14:43 She felt that the symptoms were affecting her very much

14:46 Hence, we hope that her symptoms will start to disappear after the surgery

14:51 Her bones would also be stronger, so she might be able to…

14:56 do activities such as mountain climbing and so on

15:01 How high was the pre-excision?

15:03 Two hours later, Dr Oh successfully removed Tan’s parathyroid

15:09 After removing it, we can see that…

15:12 the tumour is bigger than what we saw from the ultrasound

15:16 That could also explain…

15:18 why the parathyroid hormone levels were so high before the surgery

15:22 Okay, the blood has been taken

15:24 We can take a look at it

15:26 Forceps, please

15:27 When we tested the blood…

15:29 in about 10 minutes after the gland was removed,

15:32 her index levels were already returning to normal

15:36 It was down to about 10, 12

15:53 Your voice is very good

15:55 The operation went very well

15:57 The scar is very small

16:00 After we took out the tumour,

16:03 the parathyroid hormone levels dropped a lot

16:07 It’s almost normal now

16:08 Now, the worry is that…

16:09 your calcium levels may fall…

16:13 because now, your bones are very hungry

16:15 They are trying to suck all the calcium back

16:18 We may give you some calcium pills

16:21 If everything goes well,

16:22 you can go back tomorrow

16:26 After this, you can eat and drink…

16:27 anything you want

16:29 Thank you, doctor

16:30 No problem

16:32 I will see you tomorrow morning

16:34 Okay, bye-bye

16:42 5-0

16:45 No, new line

16:47 (Four hours into the Whipple operation)

16:49 Forceps

16:50 Rosna, who suffers from pancreatic cancer,

16:52 is still undergoing surgery on the operating table

16:55 In addition to resecting the head of the pancreas, where the tumour is located,

16:59 Dr Thng also has to resect the duodenum surrounding the head and neck of the pancreas

17:05 T Breaker

17:06 The difficulty is that…

17:07 the duodenum is connected to the stomach and the small intestine

17:10 In the process of removing the duodenum,

17:13 a part of the stomach often has to be removed as well

17:16 The end of the bile duct…

17:18 passes through the head of the pancreas to connect to the duodenum

17:22 Therefore, the bile duct and gallbladder must also be removed during surgery

17:30 Suction

17:31 Dr Thng has been working continuously for nearly five hours,

17:35 but he is still completely focused on the operation

17:39 As the pancreas is surrounded by a complex network of large blood vessels,

17:43 during the operation, if the angle or distance is not precise,

17:47 massive bleeding may occur at any time

17:52 (Six hours into the Whipple operation)

17:56 Finally, Dr Thng successfully removed…

18:00 all the tumours six hours into the operation

18:06 This is the pancreas, and this is the duodenum

18:09 This is the patient’s gallbladder

18:12 The cancer is probably around here

18:16 We have removed the cancerous tissues

18:18 This operation took about seven hours

18:23 It was a difficult operation because she had an inflamed pancreas previously,

18:27 which resulted in a lot of internal scars

18:32 Hence, the surgery took a little longer

18:35 Of course, I do feel a little tired

18:38 However, what’s most important is that the operation was successful…

18:41 and the patient recovers

18:45 But even after removing the tumour, the operation is not over

18:50 Dr Thng has to rebuild the continuity and integrity…

18:53 of the intestinal tract, bile duct and pancreatic duct for Rosna

18:58 This is another major undertaking

19:01 Hold the top, please

19:03 Of these, reconnecting the pancreatic duct to the intestine is the most difficult

19:08 This is because the diameter of the pancreatic duct…

19:09 is only about 0.2 to 0.5 centimetres,

19:13 so the doctor has to spend some time to connect the intestines

19:19 (The Whipple operation ended after eight hours)

19:20 The surgery was a success

19:22 The patient went home five days after surgery

19:25 This morning, I saw the patient in the outpatient department

19:29 She has recovered and has gone back to work

19:34 (A month after the surgery)

19:37 Nobody likes to go through an operation,

19:38 but if it’s for your own good, why not?

19:40 Just put all these negative thoughts aside

19:44 You must remember that…

19:45 there are so many people supporting you,

19:47 so you just have to go for it

19:51 Pancreatic cancer is 20 percent genetic…

19:55 and 80 percent sporadic

19:58 It’s caused by some genetic mutation

20:04 For now, we’re not able to prevent it

20:07 If you experience jaundice, fever or persistent stomach pain,

20:13 you should seek medical attention immediately

20:16 (A month after surgery)

20:18 After surgery, Tan has also returned to the daily life she longed for

20:24 She goes to the gym in her condominium to exercise almost every day,

20:28 hoping to return to her pre-illness state of health as soon as possible

20:33 I feel that my life has improved

20:36 I’m not as tired as before

20:39 I don’t have issues sleeping any more

20:41 I go to bed earlier,

20:43 and get up earlier

20:46 I will encourage my friends and relatives…

20:51 to go for annual medical check-ups

20:53 This way, any issues can be treated sooner and the risks will be lower

21:26 Subtitles: CaptionCube