The Sundaytimes Sri Lanka

The BrainSuite: A one-stop OR at Singapore General Hospital

Kumudini Hettiarachchi reports on a first in the world, with state-of-the art equipment

It is not a run-of-the mill Operating Room (OR), where men, women and children with brain problems are wheeled in for surgery with scans taken elsewhere accompanying them.

This is different. It is a BrainSuite at the Singapore General Hospital (SGH) – a first in the world. With state-of-the-art equipment and all other facilities, simply put the BrainSuite is a one-stop OR for the patient.

Prof. Ivan Ng Pic by Ranjith Perera

“We are able to do complex brain procedures much more accurately because we have all the information we need at our fingertips,” stresses Prof. Ivan Ng, Chairman of the Departments of Neurosurgery at SGH and National Neuroscience Institute, Duke-NUS Graduate Medical School.

In this setting, when Neurosurgeons are engaging in minimally-invasive procedures, they have a “panoramic, bird’s eye view” in real-time allowing them to change strategy and also trajectory in the best interests of the patient, MediScene learns.

The old and the new, nay the newest is compared and contrasted by him as he tells MediScene that earlier ORs were not organized  ergonomically. The proof lies in photos not so old of “how they used to be”.

Those days we used to have a lot of operating theatre clutter, a proliferation not only of equipment but also of instruments, he says, smilingly adding that surgeons were only interested in operating, not organizing or bringing about order in the OR.

However, MediScene learns that by the late 1990s, the thinking at SGH had changed significantly.Giving “our experience”, Prof. Ng says that it was to build six operating suites dedicated to the brain, spine and trauma surgery with various intra-operative options, within a major OR complex with 24 ORs. A Radiosurgery Centre as well as an IT system that links information transfer completed the picture.
An Integrated Neuroscience Centre includes the operating theatres of the future, he says going into detail about optimized workflow, intra-operative imaging and a digital information management system.

The key of Operating Suite Design being Intra-operative Modality inclusion, the facilities incorporated are optimal ‘siting’ of imaging; allowing better workflow of surgeons, anaesthetists, nursing and ancillary staff; ergonomics; sterility; safety; IT linkage; and display options encompassing navigation, neuro-imaging and surgical procedure, MediScene understands. The imaging includes MRI, CT and 3D C-arm.

Our concept was an integrated centre, he stresses, aimed at lining-up special scanning facilities within, so that the patient does not have to move. Those days scanning was done separately. The ORs in the BrainSuite are also larger and brighter.

Referring to the “ergonomic design”, he is quick to point out that the “scene has changed” drastically – where earlier there would have been tubes and lines snaking across the floor, now everything is suspended from the ceiling. “There is nothing on the floor,” he adds. “It was an ambitious project not done elsewhere in the world at that time.”

That was why the Neurosurgeons themselves were very much a part of the process of setting up the centre, it is learnt, getting involved from scratch, planning and working with engineers.

With not only radiation oncology being brought by linking up with the Novalis radiosurgery suites and also outpatient clinics and offices to facilitate pre-surgical review, planning as well as treatment plans on a common interface via the BrainSuite net, the work done within the BrainSuite has become seamless, says Prof. Ng.

According to him this all-in-one facility enhances a Neurosurgeon’s surgical planning and exploration experience, particularly for complex operations. “Looking at the precise images of a patient’s brain before, during and right after surgery, allows us to decide whether further procedures are required and translates to better outcome for patients.”

With Prof. Ng’s “speciality interests” including vascular neurosurgery, skull base surgery and neuro-trauma he knows what he is talking about.

Citing an example of a resection of a brain tumour, Prof. Ng says that due to the accurate systems available in the BrainSuite, there is no need for a big opening in the head. Minimally-invasive surgery can be performed. His focus turns to multi-slice CT scanning as he explains that its value may be measured by the fact that any Formula 1 driver involved in an accident is rushed to SGH, the formal hospital for them.

It is not only the brain that benefits from all these advances but also the spine, with Orthopaedic Surgeons finding the images using 3D of complex spine structures invaluable to perform bone resections, it is learnt.

Dealing with the inclusion of radiosurgical facilities, Prof. Ng says that traditionally for radiation there was a field view, with both brain tissue and cancer tissue having to be targeted resulting in loss of memory, headaches and somnolence. Now doctors are able to zero-in only on the tumour.

The radiosurgery system is a quantum improvement on standard treatment, according to him. Earlier the patient’s head had to be put into a frame, now only a face mask is needed. The BrainSuite has seen more than 2,000 patients going in as of January 2012, with the oldest being 85 and the youngest a boy of just two years.

Paediatric Neurosurgeons resected the boy’s tumour, he says, adding it was a “nice resection” and the child is doing well. Underscoring the fact that the BrainSuite with its advanced imaging facilities allows Neurosurgeons to perform significantly complex surgery with a lot of confidence, he also points out that even the patients get confidence because they are able to see scans immediately after surgery. Unlike what the doctors tell them, they are reassured because “scans don’t lie”.

Acknowledging that for Neurosurgeons too it’s a constant learning experience, this eminent Professor says in all humility that “it makes us realize our inadequacies and correct them there and then during the operation and not later. I have personally grown a lot – for it allows me to correct errors of judgment, before the patient comes out”.

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