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  1. Article: First experience with robotic pancreatoduodenectomy in Singapore.

    Low, Tze-Yi / Koh, Ye-Xin / Goh, Brian Kp

    Singapore medical journal

    2019  Volume 61, Issue 11, Page(s) 598–604

    Abstract: Introduction: Recent studies reported that laparoscopic pancreatoduodenectomy (LPD) is associated with superior perioperative outcomes compared to the open approach. However, concerns have been raised about the safety of LPD, especially during the ... ...

    Abstract Introduction: Recent studies reported that laparoscopic pancreatoduodenectomy (LPD) is associated with superior perioperative outcomes compared to the open approach. However, concerns have been raised about the safety of LPD, especially during the learning phase. Robotic pancreatoduodenectomy (RPD) has been reported to be associated with a shorter learning curve compared to LPD. We herein present our initial experience with RPD.
    Methods: A retrospective review of a single-institution prospective robotic hepatopancreaticobiliary (HPB) surgery database of 70 patients identified seven consecutive RPDs performed by a single surgeon in 2016-2017. These were matched at a 1:2 ratio with 14 open pancreatoduodenectomies (OPDs) selected from 77 consecutive pancreatoduodenectomies performed by the same surgeon between 2011 and 2017.
    Results: Seven patients underwent RPD, of which five were hybrid procedures with open reconstruction. There were no open conversions. Median operative time was 710.0 (range 560.0-930.0) minutes. Two major morbidities (> Grade 2) occurred: one gastrojejunostomy bleed requiring endoscopic haemostasis and one delayed gastric emptying requiring feeding tube placement. There were no pancreatic fistulas, reoperations or 90-day/in-hospital mortalities in the RPD group. Comparison between RPD and OPD demonstrated that RPD was associated with a significantly longer operative time. Compared to open surgery, there was no significant difference in estimated blood loss, blood transfusion, postoperative stay, pancreatic fistula rates, morbidity and mortality rates, R0 resection rates, and lymph node harvest rates.
    Conclusion: Our initial experience demonstrates that RPD is feasible and safe in selected patients. It can be safely adopted without any compromise in patient outcomes compared to the open approach.
    MeSH term(s) Humans ; Laparoscopy ; Operative Time ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Postoperative Complications/epidemiology ; Prospective Studies ; Retrospective Studies ; Robotic Surgical Procedures ; Singapore
    Language English
    Publishing date 2019-09-19
    Publishing country Singapore
    Document type Journal Article
    ZDB-ID 604319-7
    ISSN 0037-5675
    ISSN 0037-5675
    DOI 10.11622/smedj.2019119
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  2. Article: Initial experience with minimally invasive extended pancreatectomies for locally advanced pancreatic malignancies: Report of six cases.

    Low, Tze-Yi / Goh, Brian K P

    Journal of minimal access surgery

    2018  Volume 15, Issue 3, Page(s) 204–209

    Abstract: Background: Recently, there have been several reports on minimally-invasive surgery for extended pancreatectomy (MIEP) in the literature. However, to date, only a limited number of studies reporting on the outcomes of MIEP have been published. In the ... ...

    Abstract Background: Recently, there have been several reports on minimally-invasive surgery for extended pancreatectomy (MIEP) in the literature. However, to date, only a limited number of studies reporting on the outcomes of MIEP have been published. In the present study, we report our initial experience with MIEP defined according to the latest the International Study Group for Pancreatic Surgery (ISPGS) guidelines.
    Methods: Over a 14-month period, a total of 6 consecutive MIEP performed by a single surgeon at a tertiary institution were identified from a prospectively maintained surgical database. EP was defined as per the 2014 ISPGS consensus. Hybrid pancreatoduodenectomy (PD) was defined as when the entire resection was completed through minimally-invasive surgery, and the reconstruction was performed open through a mini-laparotomy incision.
    Results: Six cases were performed including 2 robotic extended subtotal pancreatosplenectomies with gastric resection, 1 laparoscopic-assisted (hybrid) extended PD with superior mesenteric vein wedge resection, 2 robotic-assisted (hybrid) PD with portal vein resection (1 interposition Polytetrafluoroethylene graft reconstruction and 1 wedge resection) and 1 totally robotic PD with wedge resection of portal vein. Median estimated blood loss was 400 (250-1500) ml and median operative time was 713 (400-930) min. Median post-operative stay was 9 (6-36) days. There was 1 major morbidity (Grade 3b) in a patient who developed early post-operative intestinal obstruction secondary to port site herniation necessitating repeat laparoscopic surgery. There were no open conversions and no in-hospital mortalities.
    Conclusion: Based on our initial experience, MIEP although technically challenging and associated with long operative times, is feasible and safe in highly selected cases.
    Language English
    Publishing date 2018-11-13
    Publishing country India
    Document type Journal Article
    ZDB-ID 2186884-0
    ISSN 1998-3921 ; 0972-9941
    ISSN (online) 1998-3921
    ISSN 0972-9941
    DOI 10.4103/jmas.JMAS_69_18
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  3. Article ; Online: Initial experience with laparoscopic and robotic surgery for the treatment of periampullary tumours: single institution experience with the first 30 consecutive cases.

    Goh, Brian K P / Low, Tze-Yi / Kam, Juinn-Huar / Lee, Ser-Yee / Chan, Chung-Yip

    ANZ journal of surgery

    2019  Volume 89, Issue 4, Page(s) E137–E141

    Abstract: Background: Concerns have been raised about the safety of minimally invasive surgery (MIS) for pancreatoduodenectomy (PD) during the early learning phase. In this study, we present our initial experience with MIS for periampullary tumours.: Methods: ... ...

    Abstract Background: Concerns have been raised about the safety of minimally invasive surgery (MIS) for pancreatoduodenectomy (PD) during the early learning phase. In this study, we present our initial experience with MIS for periampullary tumours.
    Methods: Retrospective review of the first 30 consecutive patients who underwent laparoscopic (LS)/robotic surgery (RS) for periampullary tumours between 2014 and 2017.
    Results: Twenty-seven patients underwent PD, including three total pancreatectomies (TPs) and three underwent palliative bypasses. Twenty underwent LS, of which 18 were hybrid PDs, including two TPs and two bypasses. Ten patients underwent RS, of which nine were PDs, including one TP and one bypass. Five of 10 RSs were totally MIS procedures. There were four PDs with venous resection, of which three were by RS. There were four (13.3%) open conversions all in the LS cohort. There were five (16.7%) major (>grade 2) morbidities, including three pancreatic fistulas (two grade B and one grade C). There was no 30-day and one (3.3%) 90-day mortality. Comparison between RS and LS demonstrated that RS had a higher likelihood of being completed via totally MIS (five (50%) versus 0, P = 0.002), tended to have a shorter post-operative stay (eight (range 6-36) versus 14.5 (range 6-62) days, P = 0.058) but tended to be associated with a longer operation time (670 (range 500-930) versus 577 (range 235-715) min, P = 0.056).
    Conclusion: Our initial experience demonstrated that both LS and RS can be safely adopted for the treatment of periampullary tumours. The learning curve for RS seemed to be shorter than LS as we could transition more quickly from hybrid PDs to totally MIS safely.
    MeSH term(s) Adult ; Aged ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Incidence ; Laparoscopy/methods ; Male ; Middle Aged ; Pancreatic Neoplasms/mortality ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy/methods ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Singapore/epidemiology ; Survival Rate/trends ; Young Adult
    Language English
    Publishing date 2019-02-25
    Publishing country Australia
    Document type Comparative Study ; Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.15033
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  4. Article: Changing trends and outcomes associated with the adoption of minimally-invasive pancreato-biliary surgery: Contemporary experience of a 'self-taught' early adopter in Southeast Asia.

    Goh, Brian K P / Zeng, Gerald / Low, Tze-Yi / Chua, Darren W / Koh, Ye-Xin / Lim, Kai-Inn

    Journal of minimal access surgery

    2020  Volume 16, Issue 4, Page(s) 341–347

    Abstract: ... increased morbidity.: Conclusion: MIPBS can be safely adopted today with a low open conversion rate. ...

    Abstract Background: Minimally-invasive pancreato-biliary surgery (MIPBS) is increasingly reported worldwide. This study examines the changing trends, safety and outcomes associated with the adoption of MIPBS based on a contemporary experience of an early adopter in Southeast Asia.
    Methods: Retrospective review of 114 consecutive patients who underwent MIPBS by a single surgeon over 86 months from 2011. The study population was stratified into three equal groups of 38 patients. Comparison was also performed between minimally-invasive pancreato surgery (MIPS) and minimally-invasive biliary surgery (MIBS).
    Results: There were 70 MIPS and 44 MIBS. Sixty-three cases (55.3%) were performed using robotic assistance and fourteen (12.3%) were hybrid procedures with open reconstruction. Forty-four (38.6%) procedures were performed for malignancy. There were 8 (7.0%) open conversions and median operation time was 335 (range, 60-930) min. There were nine extended pancreatectomies including seven involving vascular reconstructions. Major morbidity (>Grade 2) occurred in 20 (17.5%) patients including 6 (5.3%) reoperations and there was no mortality. Comparison across the three groups demonstrated that with increasing experience, there was a significant trend in a higher proportion of higher ASA score patients, increasing frequency of procedures requiring anastomosis and increasing the use of robotic assistance without significant difference in key perioperative outcomes such as open conversion rate, morbidity and hospital stay. Comparison between MIPS and MIBS demonstrated that MIPS was associated with significantly longer operation time, increased blood loss, increased transfusion rate, longer hospital stay, increased readmission rate and increased morbidity.
    Conclusion: MIPBS can be safely adopted today with a low open conversion rate.
    Language English
    Publishing date 2020-01-12
    Publishing country India
    Document type Journal Article
    ZDB-ID 2186884-0
    ISSN 1998-3921 ; 0972-9941
    ISSN (online) 1998-3921
    ISSN 0972-9941
    DOI 10.4103/jmas.JMAS_94_19
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  5. Article ; Online: Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore.

    Low, Tze-Yi / Hartman, Mikael / Chee, Corissa Yi Juan / Mohankumar, Bhuvaneshwari / Ang, Sophia Bee Leng / San, Moe Thu / Shabbir, Asim / Madhavan, Krishnakumar / So, Jimmy Bok Yan

    American journal of surgery

    2020  Volume 220, Issue 3, Page(s) 553–555

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/transmission ; Disease Transmission, Infectious/prevention & control ; General Surgery/organization & administration ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/transmission ; SARS-CoV-2 ; Singapore/epidemiology ; Surgical Procedures, Operative/standards ; Tertiary Care Centers
    Keywords covid19
    Language English
    Publishing date 2020-05-15
    Publishing country United States
    Document type Editorial
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2020.05.021
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  6. Article ; Online: Initial single institution experience with robotic biliary surgery and bilio-enteric anastomosis in southeast Asia.

    Goh, Brian K P / Low, Tze-Yi / Teo, Jin-Yao / Lee, Ser-Yee / Chan, Chung-Yip / Chung, Alexander Y F / Ooi, London L P J

    ANZ journal of surgery

    2019  Volume 89, Issue 4, Page(s) E142–E146

    Abstract: ... can be adopted safely with a low open conversion rate. Robotically constructed bilio-enteric anastomosis ... can be performed safely with a low anastomotic complication rate. ...

    Abstract Background: Presently, experience with robotic biliary surgery (RBS) is increasing worldwide although widespread adoption remains limited. In this study, we report our initial experience with RBS.
    Methods: Retrospective review of a single institution prospective database of 95 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2018. Of these, 27 patients who underwent RBS were included in this study. RBS was performed by three principal console surgeons of whom one surgeon performed 23 (85%) and supervised all cases. Additionally, to evaluate our initial outcomes with bilio-enteric anastomoses, eight consecutive pancreatoduodenectomies were included.
    Results: Of the 27 RBS performed, these included 10 hepaticojejunostomies with bile duct resections (including two concomitant pancreatoduodenectomies and one right hepatectomy) for choledochal cysts, bile duct strictures and biliary malignancies; five liver resections with hilar lymph node clearance for gallbladder cancer; four for Mirizzi syndrome; two cholecystectomies with cholecystoenteric fistula and two bile duct exploration after failed endoscopic treatment of choledocholithiasis. There were no open conversions, no 90-day mortality and four (14.8%) major (>Grade II) morbidities. The median post-operative stay was 6 (range 1-29) days and there was one (3.7%) 30-day readmissions. Of our first 18 robotically constructed bilio-enteric anastomoses, there was only one (5.5%) early anastomotic complication (bile leak requiring reoperation).
    Conclusion: Our initial experience demonstrated that RBS can be adopted safely with a low open conversion rate. Robotically constructed bilio-enteric anastomosis can be performed safely with a low anastomotic complication rate.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical/methods ; Bile Duct Diseases/surgery ; Bile Ducts/surgery ; Conversion to Open Surgery/methods ; Female ; Humans ; Incidence ; Intestine, Small/surgery ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Singapore/epidemiology ; Treatment Outcome
    Language English
    Publishing date 2019-03-18
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.15135
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  7. Article: Short-Term Outcomes of Extended Pancreatectomy: A Single-Surgeon Experience.

    Low, Tze-Yi / Koh, Ye-Xin / Teo, Jin-Yao / Goh, Brian K P

    Gastrointestinal tumors

    2017  Volume 4, Issue 3-4, Page(s) 72–83

    Abstract: Background/aims: The International Study Group of Pancreatic Surgery recently published a consensus statement on the definition of extended pancreatectomy (EP). We aimed to determine the safety profile and short-term outcomes of EP compared to standard ... ...

    Abstract Background/aims: The International Study Group of Pancreatic Surgery recently published a consensus statement on the definition of extended pancreatectomy (EP). We aimed to determine the safety profile and short-term outcomes of EP compared to standard pancreatectomy (SP). To mitigate surgeon bias, only pancreatectomies performed by a single surgeon were included.
    Methods: Ninety consecutive patients who underwent pancreatectomy by a single surgeon over a period of 5 years and who met our study criteria were classified into an SP or an EP group. Sixty-two patients underwent pancreaticoduodenectomy (PD), including total pancreatectomy, and 28 patients underwent distal pancreatectomy.
    Results: The 25 patients who underwent EP had significantly increased operation time, estimated blood loss, postoperative intensive care unit (ICU) transfer, and postoperative stay compared to the 65 patients who underwent SP. There was 1 (1.1%) 30-day mortality and 4 (4.4%) in-hospital mortalities. Postoperative morbidity and mortality were similar between both groups. Subgroup analysis of the patients who underwent PD demonstrated that the EP group (
    Conclusion: Although patients who underwent EP experienced significantly increased operative time, blood loss, and postoperative stay, they did not experience significantly higher postoperative morbidity or mortality compared to patients who underwent SP.
    Language English
    Publishing date 2017-11-30
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2735769-7
    ISSN 2296-3766 ; 2296-3774
    ISSN (online) 2296-3766
    ISSN 2296-3774
    DOI 10.1159/000484523
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  8. Article ; Online: Initial experience with robotic pancreatic surgery in Singapore: single institution experience with 30 consecutive cases.

    Goh, Brian K P / Low, Tze-Yi / Lee, Ser-Yee / Chan, Chung-Yip / Chung, Alexander Y F / Ooi, London L P J

    ANZ journal of surgery

    2018  Volume 89, Issue 3, Page(s) 206–210

    Abstract: ... showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures ...

    Abstract Background: Presently, the worldwide experience with robotic pancreatic surgery (RPS) is increasing although widespread adoption remains limited. In this study, we report our initial experience with RPS.
    Methods: This is a retrospective review of a single institution prospective database of 72 consecutive robotic hepatopancreatobiliary surgeries performed between 2013 and 2017. Of these, 30 patients who underwent RPS were included in this study of which 25 were performed by a single surgeon.
    Results: The most common procedure was robotic distal pancreatectomy (RDP) which was performed in 20 patients. This included eight subtotal pancreatectomies, two extended pancreatecto-splenectomies (en bloc gastric resection) and 10 spleen-saving-RDP. Splenic preservation was successful in 10/11 attempted spleen-saving-RDP. Eight patients underwent pancreaticoduodenectomies (five hybrid with open reconstruction), one patient underwent a modified Puestow procedure and one enucleation of uncinate tumour. Four patients had extended resections including two RDP with gastric resection and two pancreaticoduodenectomies with vascular resection. There was one (3.3%) open conversion and seven (23.3%) major (>Grade II) morbidities. Overall, there were four (13.3%) clinically significant (Grade B) pancreatic fistulas of which three required percutaneous drainage. These occurred after three RDP and one robotic enucleation. There was one reoperation for port-site hernia and no 30-day/in-hospital mortalities. The median post-operative stay was 6.5 (range: 3-36) days and there were six (20%) 30-day readmissions.
    Conclusion: Our initial experience showed that RPS can be adopted safely with a low open conversion rate for a wide variety of procedures including pancreaticoduodenectomy.
    MeSH term(s) Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy/methods ; Pancreaticoduodenectomy/methods ; Retrospective Studies ; Robotic Surgical Procedures ; Singapore ; Splenectomy/methods ; Young Adult
    Language English
    Publishing date 2018-05-24
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 2050749-5
    ISSN 1445-2197 ; 1445-1433 ; 0004-8682
    ISSN (online) 1445-2197
    ISSN 1445-1433 ; 0004-8682
    DOI 10.1111/ans.14673
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  9. Article: Restructuring the surgical service during the COVID-19 pandemic: Experience from a tertiary institution in Singapore

    Low, Tze-Yi / Hartman, Mikael / Chee, Corissa Yi Juan / Mohankumar, Bhuvaneshwari / Ang, Sophia Bee Leng / San, Moe Thu / Shabbir, Asim / Madhavan, Krishnakumar / So, Jimmy Bok Yan

    Am J Surg

    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #753986
    Database COVID19

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  10. Article ; Online: Restructuring the surgical service during the COVID-19 pandemic

    Low, Tze-Yi / Hartman, Mikael / Chee, Corissa Yi Juan / Mohankumar, Bhuvaneshwari / Ang, Sophia Bee Leng / San, Moe Thu / Shabbir, Asim / Madhavan, Krishnakumar / So, Jimmy Bok Yan

    The American Journal of Surgery

    Experience from a tertiary institution in Singapore

    2020  Volume 220, Issue 3, Page(s) 553–555

    Keywords Surgery ; General Medicine ; covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2020.05.021
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