Donor Dies (killed) Doctors/Hospital Blames Tool...
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SURGICAL CLIPS IN THE SPOTLIGHT: Each surgeon has own preference, but...
Skill and safety count, say doctors
Clips that slipped and cost kidney donor Narinder Kaur her life are just one of the procedures that surgeons use to tie blood vessels
By Ng Wan Ching
March 06, 2007
METAL clips, staples, Hem-o-lok clips, special ties. These are all part of an arsenal of devices used by surgeons to close blood vessels during surgery.
Some of the devices surgeons use to close up blood vessels during surgery. -- CHOO CHWEE HUA
As surgical methods have advanced, so has the need for such devices.
Minimally invasive procedures such as laparoscopic (keyhole) surgery, is becoming more common.
The death of a kidney donor came after such surgery in 2005.
Compared with open surgery, these procedures are more delicate and call for more surgical skill.
MANIPULATION THROUGH INCISIONS
Instead of operating directly on an organ, surgeons have to manipulate instruments through small incisions to get to the organ.
One of the challenges with using laparoscopy is for surgeons to safely tie up or ligate blood vessels.
This would not be an issue with open surgery as surgeons would have space to tie up the blood vessels with sutures.
The Hem-o-lok clips, which are made of plastic, came in for particular scrutiny recently, when it was revealed that they had slipped after being used to close the left renal artery and vein of Madam Narindar Kaur.
She had undergone hand-assisted laparoscopic surgery at National University Hospital to remove her left kidney which she donated to her husband, Mr Surender Singh. (See report at top of facing page.)
The slippage resulted in sudden, internal bleeding in her abdomen. The 33-year-old woman died a few hours after the operation.
State Coroner Tan Boon Heng recorded a verdict of misadventure last Monday.
Surgeons The New Paper spoke to, say that slippage, through very rare, can happen.
And what each surgeon uses to tie up blood vessels is up to his own experience and personal preference.
If a surgeon feels that a certain device cannot do the job, he will choose another.
Take Associate Professor Eu Kong Weng, senior consultant and head of Singapore General Hospital's colorectal surgery department.
He uses laparoscopic methods for more than 80 per cent of his elective procedures. 'Sometimes we use clips, sometimes staples,' he said.
'Sometimes a clip can slip and bleeding occurs. If this occurs during the surgery itself, another clip can be easily re-applied.
BLEEDING
'Delayed slippage of clips is rare, though not unheard of. This can, of course, result in bleeding. Close post-operative monitoring and care is crucial to catch such an occurrence.'
Patients can then be brought back to the operating room to have the vessels ligated (tied up) again.
He prefers to use staples as he can apply three rows of staples in one shot.
'With the Hem-o-lok, which is made of plastic, you can clip only once. Then you have to remove the applicator, reload it with another clip, put it back into the patient's body and clip again. It's not so convenient,' he said.
SPEED
Another reason he chooses staples is speed.
'Staples are fast. Every minute counts in surgery. For example, you can use a special suture tie to close up the vessel, but that would take a few minutes, compared to seconds for the staple,' he said.
Dr T Ravintharan, a general surgeon in private practice, said he would usually put in two or three clips to close off one blood vessel.
'It depends on how comfortable I feel. Safety comes first,' he said.
About 95 per cent of his work involves laparoscopic surgery and he has been doing it since 1990. Currently he is the chairman of the Minimal Access Surgery Centre at Mount Elizabeth Hospital.
He usually uses large Hem-o-lok clips for larger blood vessels.
Metal clips and smaller Hem-o-lok clips are better for smaller vessels, he said.
'Clips generally can be applied in confined places,' he said.
Sometimes, he also adds sutures for safety.
COST
'But sutures require far more skill in application,' he said.
Cost may be a consideration too.
Sutures cost about $100. Staplers cost more than $360.
'If several staples are needed, it will sometimes drive up the cost. Staplers are better if there are lots of tissues and several vessels within to be tied off. But staplers require more space and therefore cannot be used in tight spaces,' he said.
Hem-o-lok is cheaper. It costs $42 per instrument and comes with six plastic clips.
WARNING
During the hearing last Monday, It was revealed that the manufacturer for Hem-o-lok clips, US firm Teleflex Medical, issued a warning last year about their use on living kidney donors.
Since then, National University Hospital - where Madam Kaur and Mr Singh had their operations - has reinforced the clips with the use of sutures or metal clips. -
Costs becomes a priority when hospitals are required to operate on a positive bottom line.Originally posted by ShutterBug:COST
'But sutures require far more skill in application,' he said.
Cost may be a consideration too.
Sutures cost about $100. Staplers cost more than $360.
'If several staples are needed, it will sometimes drive up the cost. Staplers are better if there are lots of tissues and several vessels within to be tied off. But staplers require more space and therefore cannot be used in tight spaces,' he said.
Hem-o-lok is cheaper. It costs $42 per instrument and comes with six plastic clips.
WARNING
During the hearing last Monday, It was revealed that the manufacturer for Hem-o-lok clips, US firm Teleflex Medical, issued a warning last year about their use on living kidney donors.
Since then, National University Hospital - where Madam Kaur and Mr Singh had their operations - has reinforced the clips with the use of sutures or metal clips.
If the Hem-o-lok is cheaper at $42 each - (from a pack of 6), while sutures cost $100 and Metal Clips at $360 - does it make any sense if the use of the cheaper Hem-o-lok require an additional $100 suture or $360 Metal Clip to back-up the use of the $42 item ?
Somehow the maths do not add up to a positive bottom line.
Can we trust doctors to be administrators ? -
thing is this... the hemo-lock or whatever is put in the market.. you would trust the thing to be put through the paces..
just like you would trust your car not to blow up when you start the engine...
so to say that the doctor killed the patient is effing psychotic on your part...
costs may be a factor.. and all that.. but i ask you.. if the procedure was a success with all the most expensive procedures and tools used, would you be crying foul about the bill when it came to you?
things happen.. don't go around accusing doctors of killing patients..
ultimately, it affects something else you have been ranting and foaming at the mouth about: cost of medical care...
don't let it become like the US where doctors can barely work without being hit by malpractice suits every other time they try to save a person.. -
The next question is, are there means to test the effectiveness and quality of cheaper and new tools or equipment to ascertain their suitability, in the event that such items are being used as substitutes to the tried and trusted?
I can understand the need to reduce costs but at the end of the day, a balance must be met to ensure safety standards have not been compromised. Whether or not a doctor is directly responsible is no longer the issue. The critical aspect is whether it could have been prevented.
I'm sure doctors will feel the same way. -
off topic.. i like this from Billy's sig
Blind belief in authority is the single greatest enemy of truth~ Albert Einstein
however, the other extreme is also true.. the blind animosity against authority also ranks up there as one of the greatest enemies of truth..
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It's simply AMAZING, that hospitals are using CHEAP tools but charging patients through their noses and other orifices...
Of course, I would be GLAD to pay any amount if the docs in the hospital saves someone dear to me. It's priceless to me..!
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a poor worksman blames his tools
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It is profits that matter at the end of the day.Originally posted by ShutterBug:It's simply AMAZING, that hospitals are using CHEAP tools but charging patients through their noses and other orifices...
Of course, I would be GLAD to pay any amount if the docs in the hospital saves someone dear to me. It's priceless to me..! -
x2Originally posted by LinYu:a poor worksman blames his tools -
Atobe, I'm honored!Originally posted by Atobe:Costs becomes a priority when hospitals are required to operate on a positive bottom line.
If the Hem-o-lok is cheaper at $42 each - (from a pack of 6), while sutures cost $100 and Metal Clips at $360 - does it make any sense if the use of the cheaper Hem-o-lok require an additional $100 suture or $360 Metal Clip to back-up the use of the $42 item ?
Somehow the maths do not add up to a positive bottom line.
Can we trust doctors to be administrators ?
I agree with you, but I find that the article seems to uphold "preferences" of doctors' choice of tools...?
If this is the case, if I'm in need of surgery, I would have to read up medical journals to know what tools are best for certain procedures and or surgeries, so that I can go around hospitals choosing surgeons who uses MY prefered tools...lol
What a friggin joke! YOu can trust them to come up with 'instant noodles' explanations on anything that went dreadfully awry.. delicious to eat, fast to cook, but doesn't fill your tummy and sure as heck NOT nutrtious!
hahahhahaaaaaaa.... -
Fully agreed!!!Originally posted by ShutterBug:It's simply AMAZING, that hospitals are using CHEAP tools but charging patients through their noses and other orifices...
Of course, I would be GLAD to pay any amount if the docs in the hospital saves someone dear to me. It's priceless to me..!
Cost vs life!!!of course life comes first which is priceless!!!
But by reading through those posts submitted by OM ,We r very worried 2 visit gov hospitals n polyclinics now!!!!especilally if the Doc is Indian Docs!!!
No races discrimination!!!
Do u know why??? -
nope.. you do not blame the best surgeon in the world if they are given faulty equipment..
sometimes, it is the tools..
it is easy to fall into using proverbs or whatever to lay waste to someone's reputation with a one-liner..
here's a contradictary one that throw everything into perspective..
he who hesitates is lost but fools rush in where angels fear to tread...
so, what now?
the doctor is to blame? - you think he wants to a woman to die??
the hospital is to blame? - you think if they don't use that, they'll not face criticisms about lowering costs? and i bet people like shutterbug will be all over the hospitals for not chosing something like the hemolock thing because it'll "reduce the costs for the patients"
the manufacturer is to blame? - for making things which have been used to save lives?
things happen.. unfortunate as it is..Originally posted by LinYu:a poor worksman blames his tools -
Blame us loh,sillyporeans!!!!!!Originally posted by the Bear:nope.. you do not blame the best surgeon in the world if they are given faulty equipment..
sometimes, it is the tools..
it is easy to fall into using proverbs or whatever to lay waste to someone's reputation with a one-liner..
here's a contradictary one that throw everything into perspective..
he who hesitates is lost but fools rush in where angels fear to tread...
so, what now?
the doctor is to blame? - you think he wants to a woman to die??
the hospital is to blame? - you think if they don't use that, they'll not face criticisms about lowering costs? and i bet people like shutterbug will be all over the hospitals for not chosing something like the hemolock thing because it'll "reduce the costs for the patients"
the manufacturer is to blame? - for making things which have been used to save lives?
things happen.. unfortunate as it is.. -
don't be an asswipe..
you are tailor-made to be a PAP person you know?
look for people to blame..
where there is something, look for others to blame... until you find that you yourself are to blame, then you say it's an "honest mistake" ?
there is NO ONE to blame here..
READ THE BLOODY STORY!!
the incident happened in 2005 when the clips were thought to be safe.. only last year did the manufacturer find the fault and then send out a caution...
and you idiots want to crucify the doctor?? the hospital??
sheesh!
looks like you are all sheep after all! led by someone like shutterbug to the slaughterhouse and thanking him for it..Originally posted by foomwee88:Blame us loh,sillyporeans!!!!!! -
U r very CB@!!@!!Originally posted by the Bear:don't be an asswipe..
you are tailor-made to be a PAP person you know?
look for people to blame..
where there is something, look for others to blame... until you find that you yourself are to blame, then you say it's an "honest mistake" ?
there is NO ONE to blame here..
READ THE BLOODY STORY!!
the incident happened in 2005 when the clips were thought to be safe.. only last year did the manufacturer find the fault and then send out a caution...
and you idiots want to crucify the doctor?? the hospital??
sheesh!
looks like you are all sheep after all! led by someone like shutterbug to the slaughterhouse and thanking him for it..
My C is bigger than yr mouth!!!
Come n suck it!!!! -
i rest my case...Originally posted by foomwee88:U r very CB@!!@!!
My C is bigger than yr mouth!!!
Come n suck it!!!! -
I m afraid 2 say u r not even know wat we r talking about!!!!Originally posted by the Bear:nope.. you do not blame the best surgeon in the world if they are given faulty equipment..
sometimes, it is the tools..
it is easy to fall into using proverbs or whatever to lay waste to someone's reputation with a one-liner..
here's a contradictary one that throw everything into perspective..
he who hesitates is lost but fools rush in where angels fear to tread...
so, what now?
the doctor is to blame? - you think he wants to a woman to die??
the hospital is to blame? - you think if they don't use that, they'll not face criticisms about lowering costs? and i bet people like shutterbug will be all over the hospitals for not chosing something like the hemolock thing because it'll "reduce the costs for the patients"
the manufacturer is to blame? - for making things which have been used to save lives?
things happen.. unfortunate as it is..
Pls tell me wat is the issue here???
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U better suck my c in yr mouth!!!!Originally posted by the Bear:i rest my case...
Dont open yr mouth again!!!99999 or not dont tell others!!!oh!!! -
How typical! I am beginning to think that PAP paid you lot to oppose them. With folks like you supporting the Opposition parties, who with an ounce of sanity would risk being associated with you?Originally posted by foomwee88:U r very CB@!!@!!
My C is bigger than yr mouth!!!
Come n suck it!!!!
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Originally posted by oxford mushroom:How typical! I am beginning to think that PAP paid you lot to oppose them. With folks like you supporting the Opposition parties, who with an ounce of sanity would risk being associated with you?
I m a pig but not a dog like u post here to earn $$$$$
How much I need 2 pay u as a dog????
Dogs like 2 lick my C !!!how about U,OM???? -
well, even if you are swearing i will explain
if you read properly, the procedure was carried out in 2005.. the doctor thought the thing was safe.. so he used it.. the woman died because the clip failed..
that was 2005...
then in 2006, the manufacturers of the clip sent out an advisory saying the clip may fail if used for that very procedure the woman died in...
that's 2006...
so.. the question is.. why is it that the shutterbug dares to accuse the doctor or the hospital KILLED the patient??
and the next question begs to be asked... how come without knowing the whole thing, would you jump on the bandwagon and agree with shutterbug? condemning the doctor and the hospital of KILLING a patient??
buhbye.. i'm not visiting this place anymore because the whole topic reeks of a person poisoned by his own hatred -
I think u owe me an apology!!!Originally posted by the Bear:well, even if you are swearing i will explain
if you read properly, the procedure was carried out in 2005.. the doctor thought the thing was safe.. so he used it.. the woman died because the clip failed..
that was 2005...
then in 2006, the manufacturers of the clip sent out an advisory saying the clip may fail if used for that very procedure the woman died in...
that's 2006...
so.. the question is.. why is it that the shutterbug dares to accuse the doctor or the hospital KILLED the patient??
and the next question begs to be asked... how come without knowing the whole thing, would you jump on the bandwagon and agree with shutterbug? condemning the doctor and the hospital of KILLING a patient??
buhbye.. i'm not visiting this place anymore because the whole topic reeks of a person poisoned by his own hatred
I m not an asswipe and AN PAP'S DOG , I HATE TO BE CALLED AS A DOG !!!!
I m a retiree n I m neither a supporter of PAP nor opposition parties!!!
I hate PAP now,cauz ,they r cheating sillyporeans for what they had said n done!!!
Pls dont hit me b4 u know who I am n called me as a PAP's gods -
I see you are not trying to answer any of Bear's points.Originally posted by foomwee88:I think u owe me an apology!!!
I m not an asswipe and AN PAP'S DOG , I HATE TO BE CALLED AS A DOG !!!!
I m a retiree n I m neither a supporter of PAP nor opposition parties!!!
I hate PAP now,cauz ,they r cheating sillyporeans for what they had said n done!!!
Pls dont hit me b4 u know who I am n called me as a PAP's gods
Blindly shooting away isn't going to do you any good. One of those rounds may just end up going through your foot.
Oh well... happy shooting, then. -
don't oppose for the sake of opposing. you have the ability to think.
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2 c this bunch of dogs here which r of std-std really making me vomitting blood!!!!Originally posted by SevenEleven:don't oppose for the sake of opposing. you have the ability to think.
We think we had made a right decision!!!
SINKAPORE!!!!