Minimally-invasive surgery (MIS) (also known as “key-hole surgery”) has been proven to be associated with numerous advantages over the traditional open approach such decrease pain, faster recovery, decreased blood lost and lower wound infection rates. However, many surgeons and centers today still prefer to perform major HPB operations via open surgery (long open incisions) due to the complexity of these procedures. Several members of our department are highly adept in all aspects of MIS HPB surgery.
The department is a global and regional thought leader in the field with its vast experience in performing MIS (laparoscopic and robotic surgery) for complex liver, pancreatic and biliary procedures and is well-recognized internationally for its expertise. Presently, it is one of the highest volume centers in the field for MIS HPB surgery in the region. Since starting its MIS program for liver and pancreatic resections in 2006, it has performed about 1500 MIS procedures for major HPB surgeries including over 950 MIS liver resections and 350 MIS major pancreatic resections as of 2022.
It is also the pioneer of robotic HPB surgery in the region, starting its formal program in 2013 and has performed over 160 robotic major HPB procedures as of 2022. Presently, robotic surgery is used selectively to complement conventional laparoscopy allowing more complex procedures to be completed successfully via the minimally-invasive approach.
Its surgical results (open conversion rate, morbidity and mortality) for MIS are on par with the very best centers worldwide and has been published in numerous prestigious international journals [1-7]. At present, its 30-day mortality rate for major HPB procedures performed via MIS is less than 0.5 %.
Today, with its extensive experience with MIS, virtually all types of major HPB procedures can be performed routinely via the MIS approach including major hepatectomies, major pancreatic surgeries including pancreatoduodenectomies (Whipples procedure) and hepaticojejunostomies. The MIS approach is now also performed frequently for recurrent cancers after previous open surgeries, very large tumors (> 10-15 cm) and tumors involving major blood vessels. Due to its expertise, the department is also a global thought leader in the field and has lead numerous international multicenter studies and has been part of several international expert consensus guidelines [8-13].
Complete surgical resection remains the only curative treatment for most HPB cancers. However, frequently, these cancers are considered inoperable due to involvement of major blood vessels or adjacent critical organs. The department is experienced in treating these cancers using highly sophisticated surgical techniques to enable complete surgical removal for cancers considered inoperable by most surgeons. It currently performs highly complicated and innovative surgical procedures such as associating liver partition and portal vein ligation (ALPPS), cold in-situ perfusion and complex vascular reconstructions [14] to ensure the best chance of complete oncology clearance.
The department is one of handful of centers in the region experienced in all aspects of liver transplantation and performs complicated transplants such as ABO incompatible liver transplantation and small-for-size graft living donor liver transplantation. Due to its extensive experience in MIS-HPB surgery, it is also one of a small number of transplant centers routinely performing pure laparoscopic donor hepatectomy for adult living donor liver transplantation. It also pioneered several complicated transplant procedures in the region such as the first combined heart-liver transplant in Asia and the first ABOi liver transplant in the region.
Major hepatectomy/ liver resection (right/ left/ extended/ central hepatectomy)
Minor hepatectomy/ liver resection
Sectionectomies and anatomical segmentectomies
Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS)
Two staged hepatectomy after portal vein embolization/ ligation
Liver cyst fenestration
Intraoperative ablation (Microwave/ radiofrequncy)
Pancreatoduodenectomy (Whipples procedure/ pylorus-preserving)
Total pancreatectomy
Subtotal/ distal pancreatectomies (spleen-saving)
Enucleation
Central pancreatectomy
Pancreatectomy with arterial or venous reconstruction
Necrosectomy
Pancreatojejunostomy
Duodenum preserving pancreatic head resections for chronic pancreatitis
Pseudocyst drainage
Bile duct exploration for stones
Hepaticojejunostomy and bile duct resection
Radical cholecystectomy for gallbladder cancer
Major hepatectomy with bile duct resection for cholangiocarcinoma (Klatskin tumor)
Surgery for Mirizzis Syndrome and cholecystoenteric fistulas
Completion cholecystectomy
Cholecystectomy/ subtotal cholecystectomy
Splenectomy
Gastric, duodenum and small bowel resections for tumors
Adrenalectomy
Retroperitoneal tumors
Intra-abdominal tumors
The department is presently one of the highest-volume and most experienced subspecialty departments in Southeast Asia currently performing about 400 major subspecialty HPB surgeries per annum (including > 200 major liver surgeries and > 100 major pancreatic surgeries per annum).
Find out more about our Clinical Outcomes here >
Center for Digestive and Liver Diseases and M Clinic, Singapore General Hospital
Mon
Tues
Wed
Thurs
Friday
Morning (AM)
PC Cheow
EK Tan
JY Teo
A Chung
P Chow
YX Koh (M)
YX Koh
B Goh
A Chung (M)
Afternoon (PM)
P Raj (M)
L Ooi
P Raj
B Goh (M)
PC Cheow (M)
Comprehensive Liver Cancer Clinic, National Cancer Centre Singapore
Enquiring patients and referring physicians, please email: hpbsurgery@sgh.com.sg
Providing information regarding diagnosis/condition and treatment/surgery required would be useful.
