Dr Nara's Thoracic Surgery

28/07/2025

A young patient with mediastinal Ewing sarcoma underwent excision of the mediastinal mass and left upper lobectomy 3 weeks ago.

She was very happy with the outcome and gifted me a beautiful card accompanied by a wallet...very thoughtful of her. Thank you for being a good patient.

24/07/2025

Honoured to be part of the conference.

The Inaugural Global Chest Wall Surgery Conference, co-hosted by the Institute of Chest Wall Surgery (ICWS) and the International Chest Wall Surgery Organization (ICWSO), was grandly convened on July 19, 2025, in Guangzhou, China. Nearly 100 doctors from 13 countries and regions gathered to explore....

19/07/2025

Prof Wenlin Wang is a renowned chest wall and pectus surgeon in Guang Zhou, China. He founded the International Chest Wall Surgery Organisation (ICWSO). He has performed more than 15000 chest wall reconstruction to date. I am humbled to be invited to talk in the 1st Global Chest Wall Surgery Conference on our experience in the management of chest wall tumors, organised by ICWSO.

Very insightful discussions and exchange of ideas from speakers across the globe (US, UAE, Romania, Armenia, India, Pakistan, Thailand and Malaysia). I am very pleased to see great interest is shown for chest wall work. Many thanks to Prof Wang for having us in Guangzhou.

14/07/2025

It's always nice to be appreciated by patients, especially after challenging surgeries.

Ferrero Rocher from a patient who underwent right lower bilobectomy for destroyed lung due to aspirated chicken bone 8 years ago.

Ban Heang tau sar peah from a patient that underwent uniportal vats right upper sleeve lobectomy for carcinoid tumor.

Nice desserts...;)

05/07/2025

Sleeve resection in lung prevents pneumonectomy. Not many are performing it by minimally invasive manner (uniportal approach). We performed a sleeve right upper lobectomy in a young lady with hemoptysis and completely collapsed right upper lobe due to carcinoid tumor occupying the right upper lobe bronchus into the main bronchus. Pulmonologist debulked the tumor and referred for surgery. She was without any decision for surgical intervention for around 8 months before being sent to me for resection. Below is the post op CXR. Thank you Dr Arvind Alaga for the referral.

Surgery video
https://youtu.be/tsiMWPhwXao?si=vMX7Pq29LRRhWLX6

24/06/2025

An appreciation from a patient we operated for thymic squamous cell carcinoma. She flew all the way from Sibu, Sarawak to get the surgery done in HKL. Now she will continue with the adjuvant treatment in Kuching, Sarawak.

22/06/2025

It was an eventful Saturday. Started off with a left uniportal VATS upper lobectomy in a lady with a 3cm nodule at the hilar, very near the left common PA. She underwent anterior resection 3 years ago for re**al cancer, and the single lung nodule, presumed to be a metastasis without any biopsy, was subjected to radiotherapy about a year ago. Upon realising the progression of disease (1cm to 3cm), she was sent for surgery. Lobectomy after radiotherapy was very challenging. Patient is doing well on room air after completion of surgery by minimally invasive manner.

The lesson to be learnt here is that no lung lesion should be radiated before a biopsy and discussion with a Thoracic Surgeon about the resectability of the lesion

After that, a webinar on NiVATS to a group of Thoracic Surgeons and Anaesthetists from MGM Medical College & Hospital from Navi Mumbai. It was an engaging crowd with many questions asked. Great discussions and thank you for the invite Nikhil Rane.

12/06/2025

A happy patient makes a happy surgeon. Despite still having his drain on Day 2 of surgery, he wants the picture taken to express his gratitude. Tq for trusting me.

09/06/2025

Double sleeve lobectomy, which involves resecting the lobe along with the main pulmonary artery and bronchus, reconstructing the remnant artery and bronchus to prevent a pneumonectomy. This procedure is indicated when the tumor involves the main pulmonary artery and bronchus at the same time. Conventionally, this patient would have undergone a pneumonectomy or a definitive (palliative) chemoradiotherapy.

This lady presented with mass at the left secondary carina, and the CT showed involvement of the left main PA and main bronchus. She underwent neoadjuvant chemo-immuno and then the surgery. We started off with uniportal VATS, but I converted to open thoracotomy just before cutting the PA, the reason being not having a suitable PA clamp to control the artery by VATS and also because not familiar with VATS reconstruction of PA. Blood loss was about 500cc, mainly from the lung after cutting the PA.

The patient was extubated immediately and doing well.

Surgical video
https://youtu.be/VLOpnWJ1SL8?si=CNm63YCJOvaZGcI5

30/05/2025

Today, we were fortunate to host fellow thoracic surgeons from Japan and Thailand in HKL, engaged in exchange of ideas on complex lung cases and constructive discussions on immunotherapy and tki for lung cancer.

They also walked around HKL, visiting the wards and operating theatre.

Thanks to JnJ for ensuring smooth logistics, in conjuction with the launching of the Echelon 3000 stapler.

29/05/2025

I was asked this question many times by oncologists, surgeons and respiratory physicians. "How difficult is it to do surgery after immunotherapy or TKI in lung cancer?" My answer is 'VERY DIFFICULT'.

Below are two videos of the surgery, which demonstrate how challenging it can be.

1st case is of a patient with NSCLC stage IIIB, after chemo/IO
https://youtu.be/ZS89bI3ITIA?si=25c0VuCqhYBS44uk

2nd case is of a patient with NSCLC stage IIIA, ALK mutated, post alectinib.
https://youtu.be/eOyZScLy7ak?si=Mt4lCIQndoGdD24S

These types of surgeries are more easily performed in a minimally invasive manner due to the intricate and delicate dissection required to achieve oncological clearance. The future of lung cancer treatment will demand such surgical acumen.

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50 Yr old man with Stage IIIB poorly differentiated adenocarcinoma underwent left upper lobectomy after 4 cycles of chemotherapy and immunotherapy (pembro).T...

28/05/2025

Sweaty palms (palmar hyperhidrosis) can be very disruptive in a person's day to day life. There are many ways one can try to control the sweat, but the only proven effective way is by doing bilateral sympathectomy.

I perform nonintubated (no tube in the throat) bilateral endoscopic sympathectomy and in my series, the complication rate of unrelated site sweating (compensatory hyperhidrosis) after surgery is around 20%, lower than the average rate of 70 to 80%. The satisfaction rate of my patients were >90%.

The patient gets admitted on the day of surgery, around 7am. The surgery is completed in around 20 minutes and the patient may go home the same evening, or the next morning.