Contents 23RD MAY 2014, FRIDAY PLENARY 1 Mentoring A Modern Malaysian Surgeon: Challenges And Solutions 9 P Kandasami PLENARY 2 Minimally Invasive Surgery: Is Open Surgery A Pre-Requisite? – Min Byung Soh SYMPOSIUM 1 Training In Minimally Invasive Surgery, Expectation Of A Modern Surgeon 1.1 Gastrointestinal Surgery: From Conventional Laparoscopy To SILS 10 Michael Li 1.2 Training In Urology: From Open To Robotics 11 Rohan Malek 1.3 Vascular: From Open To Endovascular 12 Zainal Ariffin Azizi 1.4 Thyroid: From Open To Endoscopy 13 Rohaizak Muhammad SYMPOSIUM 2 Surgical Care 2.1 Nutrition In Malnourished Surgical Patients 14 Jesus Fernando Inciong 2.2 Modern Concept Of Intravenous Fluid Resuscitation In Surgical Patients – Lum Siew Kheong 2.3 Principles And Practice Of Early Recovery After Surgery (ERAS) – Mark Smithers 2.4 VTE In Surgical Patients 15 Pankaj Kumar Handa 1 Contents 23RD MAY 2014, FRIDAY PLENARY 3 Evolution Of Minimally Invasive Surgery: Conventional Laparoscopy To Robotics 16 Michael Li SYMPOSIUM 3 Managing Post-Operative Complications 3.1 Management Of Ischaemic Colitis 17 Luk Tien Loong 3.2 Managing Intra-Abdominal Sepsis After Colorectal Surgery 18 Michael Li 3.3 Managing Voice Change After Thyroid Surgery 19 Abdullah Sani Mohamed 3.4 Managing Jaundice Post Laparoscopic Cholecystectomy 20 Tan Wee Jin SYMPOSIUM 4 Patient Safety And Education 4.1 Prevention Of Surgical Site Infection – Elizabeth Wick 4.2 Surgical Audit 21 David Galloway 4.3 Managing Surgical Misadventures 22 P Kandasami 4.4 Evidence Based GI Practice – Mark Smithers 2 Contents 24TH MAY 2014, SATURDAY PLENARY 4 Genetic Predisposition In Cancers – Targeting The High Risk Surgical Patient 22 Gareth Evans PLENARY 5 Surgical Treatment Of Achalasia Since The Advent Of Laparoscopy 23-24 Carlos A Pellegrini SYMPOSIUM 5 Breast Surgery 5.1 Breast Cancer Genetic Predisposition And Management In Malaysia 24 Teo Soo Hwang 5.2 Genetic Counselling And Testing In Ministry Of Health 25 Ch’ng Gaik Siew 5.3 Hereditary Breast Cancer Services – Models Of Care 26 Gareth Evans 5.4 Challenges In The Surgical Management Of Young Breast Cancer Patients – S V S Deo SYMPOSIUM 6 Surgery In Trauma 6.1 Chest Trauma: Updates In Management – Mohamed Ezani Md Taib 6.2 Decision Making In Blunt Abdominal Trauma 27 R Krishnan 6.3 Managing Polytrauma 28 Oliver Hautmann 6.4 Managing Trauma In Children – Anne John Rachel 3 Contents 24TH MAY 2014, SATURDAY PLENARY 6 Venous Disease: Advances In Endovenous Therapy 29 Joh Jin Hyun PLENARY 7 Metabolic And Bariatric Surgery: From The Past To The Present – Huang Chih Kun SYMPOSIUM 7 Advanced Laparoscopic Surgery 7.1 Laparoscopic Oesophagectomy – Mark Smithers 7.2 Comparison Between Open Versus Laparoscopic Gastrectomy For Early 30-31 And Advanced Gastric Cancer: The Preliminary Experience From University Malaya Medical Centre Chin Kin Fah 7.3 Laparoscopic Colectomy And Total Mesocolic Excision – Min Byung Soh 7.4 Laparoscopic Vs Retroperitoneoscopic Adrenalectomy 32 Normayah Kitan SYMPOSIUM 8 Metabolic And Bariatric Surgery 8.1 Bariatric Surgery In Asia And Malaysia 33 Nik Ritza Kosai 8.2 Risks And Benefits Of Bariatric Surgery: Current Evidence – Asim Shabbir 8.3 Metabolic Surgery In The Treatment Of Type 2 Diabetes Mellitus 34 Tikfu Gee 8.4 Endobarrier: A New Treatment For Obesity? 35 David Galloway 4 Contents 24TH MAY 2014, SATURDAY SYMPOSIUM 9 Advances In Oncology 9.1 Targeted Therapy: Principles And Practice – Tho Lye Mun 9.2 Managing GIST 36 Chin Kin Fah 9.3 Hormonal Therapy In Breast Cancer – Leong Yu Khong 9.4 Chemoradiotherapy In Colorectal Cancer – Tho Lye Mun 5 Contents 25TH MAY 2014, SUNDAY PLENARY 8 Safe Surgery Saves Lives – Elizabeth Wick PLENARY 9 Prostatic Disease: A Modern Surgeon’s Challenge 37-39 Teh Guan Chou SYMPOSIUM 10 Critically Ill Surgical Patients 10.1 Early Identification Of Critically Ill Surgical Patient 40 Ng Char Hong 10.2 Septic Care Bundle 41 April Roslani 10.3 Managing Urosepsis 42 Selvalingam Sothilingam 10.4 Management Of Mycotic Abdominal Aortic Aneurysm 43 Naresh Govindarajanthran 6 Contents 25TH MAY 2014, SUNDAY SYMPOSIUM 11 Advances In Urology 11.1 Imaging Of Cancers In Urology 44 Ong Teng Aik 11.2 Robotic Prostatectomy – Lim Meng Shi 11.3 Managing Urolithiasis 45-46 Clarence Lei 11.4 Radiation Cystitis – Chan Siew Hong HOW I DO IT SESSION 1. Thoracoscopy In Chest Trauma – Tikfu Gee 2. Laparotomy In Liver Injury – Manisekar Subramaniam 3. Management Of Oesophageal Perforation – Michael Griffin 4. Arteriovenous Fistula 47 Lim Beng Kiat 7 Contents ETHICON PRIZE Presentations 48-52 FREE PAPER Presentations 53-63 POSTER Presentations 64-268 8 PLENARY 1 MENTORING A MODERN MALAYSIAN SURGEON: CHALLENGES AND SOLUTIONS P Kandasami Department of Surgery, International Medical University, Seremban, Negeri Sembilan, Malaysia In the past, surgical training was an apprenticeship. Mentoring played a crucial role in shaping trainees. Mentors not only passed on knowledge, wisdom and technical skills, they were role models of professional and personal integrity. Trainees derived tremendous benefit from their counseling, moral support and career guidance. The old ways were good; however the practice of surgery has changed in recent years. New technologies, changing demographics and disease patterns, increased consumerism, patient empowerment and autonomy have revolutionized health care. Surgical Education has changed; the modern surgeon is expected to acquire a broad range of technical, interpersonal, administrative, and research skills. There has been a dramatic shift in the approach to technical training and knowledge acquisition. The modern surgeon is different from his or her predecessor. There is evidence to suggest that mentoring is still hugely beneficial to the modern surgeon. This paper will reflect on the challenges and solutions in mentoring a modern Surgeon in Malaysia. 9 SYMPOSIUM 1 | Training In Minimally Invasive Surgery, Expectation Of A Modern Surgeon GASTROINTESTINAL SURGERY: FROM CONVENTIONAL LAPAROSCOPY TO SILS Michael Li Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Over the last two decades, conventional laparoscopic approach been applied in the treatment of almost all gastrointestinal conditions due to the associated definite short term benefits. However, these minimal access approaches still necessitate a number of ports and a mini-laparotomy wound for specimen retrieval. Despite the small skin and fascial incisions, patients still experience pain and wound related complications. In an attempt to pursuit excellence and reduce wound-related complications, investigators have recently introduced to use of single port access device such that the number of trocar sites can be minimized. The single port device is introduced via a natural ‘orifice’ the umbilicus, in an attempt to produce ‘scarless surgery’. The technique, known as single incision laparoscopic surgery (SILS), was first reported in simple procedures like laparoscopic cholecystectomy and laparoscopic appendectomy. More recently SILS was also reported for laparoscopic colectomy. Initial experience suggests while SILS colectomy is feasible. However, Single Incision Laparoscopic Surgery (SILS) still poses a major technical challenge even for the most experienced laparoscopic surgeons. The difficult maneuverability of instruments in the single port platform and the frequent clashing of working instruments would result in limited operating fields. On the other hand, robotic surgery is yet another surgical advance being launched at the turn of the millennium. Robotic arms movement is driven by surgeon’s digital movement, with the signal transmitted and digitalized after anti-tremor filtration from the console. Initial experiences shows that robotic surgery provides a better magnified view and better retraction as compared to conventional laparoscopy. More recently, robotic single port surgery has been reported with success. The dexterity and freedom of the robotic endowrist helps overcome the ergometry of single port surgery, making it technically simpler and easier to perform. Meanwhile, it is unclear whether single port colectomy confers any additional advantages compared to standard laparoscopic colectomy, apart from the unproven benefits of fewer scars and scar related complications. Since only the surgical access itself has been modified, it is even doubtful if the oncological or clinical outcomes will be better than those in standard laparoscopic colectomy. Nonetheless, with further advancement in technology lead by our industrial partners, single port colectomy may become technically less challenging and more acceptable to surgeons in future. 10 SYMPOSIUM 1 | Training In Minimally Invasive Surgery, Expectation Of A Modern Surgeon TRAINING IN UROLOGY: FROM OPEN TO ROBOTICS Rohan Malek Department of Urology, Hospital Selayang, Selangor, Malaysia Minimally Invasive surgery is firmly established in Urology and majority of Urological procedures are now performed via minimally invasive approaches through endoscopic (natural orifice), percutaneous, laparoscopic and robotic assisted laparoscopic surgery. However, there is still a need for some training in open surgical approaches especially with trauma and reconstructive and complex uro oncological procedures. There is variation in the expectations of training in each country depending upon the patient burden, number of Urologists and degree of subspecialisation. In the US and most Western European countries, Urologists are initially trained as generalists