Interview by Roshini Anthony of www.medicalgrapevineasia.com
According to Senior Consultant Endovascular Surgeon Dr Benjamin Chua, the concept of “unsalvageable” with regards to endovascular surgery is one of the biggest myths pertaining to this field. In fact, vascular disease can be prevented if dealt with early and properly. Dr Chua talks to Medical Grapevine about the inspirations behind his decision to become a vascular surgeon and the exciting developments that are constantly occurring in this fast-paced field.
Q: What inspired your career in medicine and why the specific interest in vascular surgery?
My parents introduced me to the idea of being a doctor and the importance of caring for other people. My mum was very well cared for by her obstetrician (as a matter of fact, I was named after her obstetrician) and she thought pursuing a career in medicine would be a very interesting profession for me. I feel fortunate to have had the opportunity to train to become a doctor.
I started my training as a general surgeon. Along the way, I had the opportunity to work with very good vascular surgeons and over time, I grew to appreciate the specialty. I like the fact that we work with blood vessels. Not only are they very delicate, but I get to work with different parts of the body and my work involves making sure these vessels function well and are disease-free.
I trained in the area of endovascular surgery which uses a lot of minimally-invasive catheter techniques. I was privileged to train with one of the pioneers of the field, Professor Michael Denton, when I was in Australia. With that sort of training and exposure, how could I not be interested in vascular surgery?
Q: Please share with us some of the biggest highlights of your career.
I think there have been several interesting landmarks in my career.The first was when I had the privilege of going over to Duke University to train in medical research. I spent two years there where I got the chance to work with some of the brightest people in clinical research. Another landmark is when I went to Melbourne, Australia to do my Fellowship in advanced vascular surgery. I had the opportunity to work with many outstanding Australian and American surgeons who were doing their Fellowships as well.
Perhaps the most significant highlight of my career occurred two years ago when I helped set up the Department of Vascular Surgery at SGH. It is Singapore and the region’s first independent department of vascular surgery, dedicated specifically to care for patients with vascular diseases. It now has six full-time surgeons who have completed about 10,000 operations. Now that I am in private practice, thinking of the achievements of the Department always puts a smile on my face.
Q: What are the biggest challenges you have faced in the course of your career and how did you overcome them?
You want to do the best for your patients and this is always
a challenge as judgement, skill and technique all come into play. It is important to always understand and tailor your care to the patient. It is a challenge in the sense that you want to ensure that your patient has the best outcome. It can also be challenging working with limited resources or with different personalities as patient care is a team effort.
Q: What do you think are the most exciting developments in the field of vascular surgery?
Vascular surgery is actually one of the fastest changing fields in surgery with many new technologies and techniques available. I believe the most significant change has been the switch from traditional, open surgery to minimally-invasive endovascular surgery. About 80% of my work now is minimally-invasive. For example, complex aortic aneurysms that were once only treated with open surgery and had a high morbidity rate can now be dealt with through a minimally-invasive procedure. Patients can now go home two days after surgery as opposed to staying a week in the ICU which used to be the case with major surgeries.Technology has allowed us to treat many vascular diseases with minimally-invasive procedures. I feel this has had a major impact on patients as there is a reduced morbidity risk, a quicker recovery time and there is option for a repeat attempt using a different technique should the first procedure fail.
I believe the most significant change has been the switch from traditional, open surgery to minimally-invasive endovascular surgery. About 80% of my work now is minimally-invasive.
Technology has allowed us to treat many vascular diseases with minimally-invasive procedures. I feel this has had a major impact on patients as there is a reduced morbidity risk, a quicker recovery time and there is option for a repeat attempt using a different technique should the first procedure fail.
Q: What improvements in your field would you like to see?
I would like to see better devices so that many vascular surgeries can be performed using less-invasive techniques.Taking for example an aortic aneurysm repair, patients still need to stay at the hospital for two to three days. With newer and smaller devices, we aim to be able to discharge the patient on the same day.This is something which I hope to achieve in the next six months.
I would also like to see newer imaging techniques which require less exposure to radiation for both patient and doctor. Intravascular ultrasound technology is an example of this, as is infrared technology.
Q: What spurred on your interest in research? Could you enlighten us on some of your research projects?
Due to the fast-changing nature of vascular surgery, we find there are always better ways of doing things. For instance, not all the devices that we use are perfect. My research interest began with looking into methods of improving these devices. I have filed a few patents and we have several grant funded research projects that look at novel stents to treat aortic aneurysms and peripheral vascular disease.These projects are being done with the aim of improving efficiency of the surgery and outcomes for the patient.
Q: How do you stay informed about developments in your field?
I attend major conferences to learn from my peers and colleagues. I also travel the region
to help fellow colleagues develop techniques that I know and use.These interactions help keep me up-to- date with developments in my field.
Q: What are the biggest misconceptions about your field?
One of the major misconceptions is that patients with vascular diseases are high-risk and can be too difficult to treat.This could not be farther from the truth as many cases with diabetes and hypertension, if treated well, can be prevented from progressing into other diseases. Therefore, the concept of “unsalvageable” is not true.
There are many vascular diseases that can be treated effectively and patients can return to their normal activities if they are treated well. For a patient, it is important not to wait to visit a vascular doctor. For example, diabetics should visit a vascular doctor if they are suffering from leg pain or if they have cuts that don’t heal as this could prevent the need for major amputations.
Q: Who are/were your role models?
I have had the pleasure of working with a few people who have inspired me in my career. I worked with Dr William Owen, then a nephrologist at Duke University, who taught me about research in diabetes and renal failure, and Professor Michael Denton who I worked with in Melbourne, Australia, from whom I learned a lot about endovascular surgery including the key skills in judgement. For instance, surgery may not always be necessary as sometimes, watchful waiting and observation of the patient and conservative treatment may be sufficient. Professor Denton remains a very dear friend today after previously being a boss. My peers and colleagues have also been role models as I have learned a lot from them.
On a personal note, my wife has been very supportive and has helped guide me in making the right decisions.
Q: How would you best sum up your career?
It is a very rewarding career but appreciating your patients and taking good care of them is of utmost importance as vascular disease can sometimes be difficult to treat.
Vascular surgery in private practice is a relatively new field. Many may not understand what the field encompasses as it covers a wide range of diseases. I spend a lot of time taking care of patients with diabetes with leg problems and my goal is to prevent the need for a major amputation. I also treat a lot of patients with varicose veins as well as aortic aneurysmal disease and carotid disease with the aim of preventing stroke.These diseases affect a large number of people; therefore, we try to get people to understand what the field of vascular surgery is all about.
The low points are the long hours and long surgeries. However, if you have positive outcomes, there is a sense of satisfaction and happiness. Nothing gives me more pleasure than a happy patient who can return to their daily functions.