On 2 June 2017, Dr Ng Ying Woo – our Obstetrics and Gynaecology Specialist from SBCC Women’s Clinic (Clementi), completed a Single Site Robotic System (SSRS) Salpingo-Oophorectomy – the first in Singapore and Southeast Asia.

With the da Vinci® Surgical System, Dr Ng performed the surgery through a single umbilical incision using the system’s robotic arms to remove a large ovarian tumour (10 cm in diameter).


What is Salpingo-Oophorectomy?

Salpingo-Oophorectomy refers to the removal of the fallopian tube (Salpingectomy) and ovary (Oophorectomy). Such surgery is usually performed to treat ovarian or other gynaecological cancers, or infections caused by Pelvic Inflammatory Disease.


SSRS vs Single Incision Laparoscopic Surgery (SILS)

Single Incision Laparoscopic Surgery has been around since 2009. The advancement in imaging enables SILS to gradually gain popularity in the surgical arena and now, it is recognised as a feasible and safe choice for most gynaecological procedures.

Similarly, in Single Site Robotic Surgery, all the surgical instruments have to transverse through a single small umbilical “hole”, making the surgical experience comparable to that of “dancing within a small circle”. However, the addition of the robotic arms in SSRS added a new dimension to gynaecological procedures. SSRS utilises robotics to overcome the technical constraints faced in SILS, such as the lack of triangulation, and the internal crossing and external clashing of surgical instruments. Using a robotic platform enables more precise surgical actions by increasing freedom of movement and restoring intuitive control of instruments.

Prior to attempting SSRS, the surgeon must possess skills and knowledge of SILS as the surgical skills required is different from that of the conventional multiple ports laparoscopic surgeries.


Benefits of SSRS for Patients

Female patients place great emphasis on the post-surgery cosmetic outcomes as they prefer not to have scars over their abdomens. SSRS is the right fit because of the following reasons:

  • Truly minimally invasive procedure as it employs the natural orifice of the body (i.e. the umbilicus)
  • Superior cosmetic outcome – a single “hidden” scar within the umbilicus
  • Reduced risk of infection and keloid scar formation
  • Decreased post-operative pain
  • Faster recovery, shorter hospitalisation, and minimal disruption to daily activities and quality of life
  • Improved patient satisfaction after the surgery


Advantages of SSRS for Doctors

The application of robotics makes SRSS procedures the preferred choice by surgeons for the following reasons:

  • More stable surgical platform
  • Excellent visualisation of surgical site (3D high definition vision)
  • Increased precision in tissue-handling and surgical dissection
  • Additional means for other surgeries should the tumour turn out to be malignant
  • Better ergonomics which reduce surgeon’s fatigue and discomfort level


Future Development of SSRS

The surgeon’s experience amassed through increased SSRS surgeries will greatly enhance its deployment in gynaecological procedures. Technical improvements to the robotic system such as additional wrist mobility, reduction of instrument size and higher resolution vision, will enhance SSRS’ performance and deliver better results to patients.


About our Doctor

Dr Ng Ying Woo is an experienced professional in all areas of general Obstetrics and Gynaecology, with special interest in minimally invasive surgery. He has pioneered the development of single incision laparoscopic approach for gynaecological procedures in Singapore since 2009. Since then, he has performed more than 300 cases of Single Incision Laparoscopic Surgery. With this recent case, he has initiated the addition of robotics in SILS procedures. He is currently practicing at SBCC Women’s Clinic (Clementi).