Medical care and services

 

 

 

Division of General Surgery 

The Division of General Surgery at National Taiwan University Hospital (NTUH), led by Dr. Ming-Tsain Lin, has a workforce comprising board-certified surgeons practicing in distinct subspecialty areas such as breast surgery, gastric surgery, hepatobiliary surgery, endocrine surgery, liver transplantation, kidney transplantation, and pancreatic surgery. Modern general surgery comprises a constellation of highly specific subspecialties, each requiring several years of rigorous training for gaining expertise. These consist of the gastrointestinal tract, endocrine glands, abdominal wall, skin, and breasts. Through the several changes in modern medicine, general surgeons are the most broadly and thoroughly trained physicians. The deep skill set of a general surgeon is manifested with people’s frequent involvement in life-threatening situations and the fact that they remain entrusted by society to care for the patients who are injured or critically ill. The skilled surgeons of our hospital are trained fellows in various specialties, and many of them are renowned across the country as leaders in their respective disciplines. The Division of General Surgery seeks to create Asian leaders in health and science by providing the highest quality education for our trainees through our renowned residency and fellowship programs. Our faculty and research teams strive to optimize the existing technologies, along with the invention of the newer ones to bring the latest developments to our patients. The collaborative efforts of our clinical and research teams result in offering the best treatment options to help improve the quality of care and life for all our patients.

 

Pancreatic surgery

Currently, surgery is considered the best treatment for patients with tumors confined within the pancreas and not invading major blood vessels, where a tumor can be removed completely. Surgery for pancreatic cancer is a complex procedure. We are the most experienced pancreatic cancer surgery teams in the country and in Asia. High-volume pancreatic centers, in a previous study, have been defined as centers that perform more than 16 whipple procedures annually. In recent years, approximately 150 whipple procedures were performed at NTUH, with the mortality rate of less than 1%. Our surgeons are experts in complex open surgical techniques and have pioneered innovations for making pancreatic surgery a safe treatment for more people, unprecedently. Our goals in pancreatic surgery are to remove your tumor safely, limit the spread of cancer cells, and preserve your digestive function.

 

Breast cancer

At present, the treatment of breast cancer relies heavily on the cooperation of the multidisciplinary team. Our hospital has a complete breast cancer team that treats more than 1,000 newly diagnosed breast cancer patients annually. Breast surgeons in our hospital specialize in ultrasound examination, biopsy diagnosis, and various types of breast and axillary lymph node surgery. In recent years, oncoplastic breast surgery has also been developed. Drug treatments, such as chemotherapy, targeted therapy, hormonal therapy, and immunotherapy, have also been involved.

 

Benign breast disease

The common reasons for visits include lumps, abnormal mammography findings, breast pain, mastitis, and nipple discharge.

 

Endocrine surgery

We provide state-of-the-art surgical care for individuals who are diagnosed or living with endocrine disorders of the thyroid and parathyroid glands. Our experts work as multidisciplinary teams to provide patients with the goal of providing accurate diagnosis and customized treatment plans for the following conditions: 

Thyroid nodules, a disease that affects women three times more than it does to men, are growths or lumps in the thyroid gland. Thyroid cancer ranks seventh among the top 10 cancers in Taiwan and is a common cancer of the endocrine system. Surgical removal or other minimally invasive techniques are often effective. Hyperthyroidism is a disorder caused by an overactive thyroid that causes the body to speed up. Patients who fail to respond to anti-thyroid medicines may benefit from surgery. Hyperparathyroidism occurs when the body continues to produce parathyroid hormones although calcium levels are higher than normal. For primary and refractory renal hyperparathyroidism, surgery is the preferred choice of treatment.

 

Gastrointestinal tumor

Gastrointestinal tumors and cancers are common neoplasms in Taiwan, and surgery is the only curative treatment. NTUH provides endoscopic, laparoscopic, robotic-assisted, and traditional surgeries and a multidisciplinary team for patients with gastrointestinal tumors.

 

Functional and benign gastrointestinal diseases

Surgery is one of the treatments for several functional and benign gastrointestinal diseases, such as gastroesophageal reflux disease, hiatal hernia, achalasia, gastrointestinal hemorrhage, perforation, and ileus.

 

Obesity surgery

Bariatric surgery is the only effective treatment for people with severe obesity to achieve long-term weight loss and improve type 2 diabetes and several metabolic disorders. Common bariatric procedures include laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. The Center for Obesity, Life Style, and Metabolic Surgery in NTUH provides people with obesity with multidisciplinary and integrated healthcare.

 

Hernia

Hernia is derived from the Greek word hernios--bud, which means that the structure of the human body is loose, causing the structure of the body to bulge outward. The possible cause is that connective tissues, which constitute the muscles and ligaments, have pathological changes due to connective tissue diseases or aging, causing the abdominal wall or groin structure to loosen. In addition, if the intra-abdominal pressure rises (such as severe constipation, chronic cough, massive ascites), the peritoneum and its contents protrude out of these loose structures, forming the abdominal wall or inguinal bulge, known as ventral hernia or inguinal hernia. If an abdominal wall bulging occurs near the wound after the previous operation, it is called an incisional hernia. The possible treatment option could be conservative treatment or surgical repair. Repair methods include tissue repair and tension-free repair with mesh via an open or minimally invasive approach, which need to be thoughtfully discussed with the surgeons.

 

Liver and biliary disease

Surgical treatment for liver and biliary disease includes removal of neoplasms of the liver, gallbladder, bile ducts, or spleen; gallstone extraction; liver abscess drainage; managing complications of portal hypertension such as esophageal or gastric varices that fail to respond to internal medicine treatments, and liver transplantation. There is a high incidence of liver cancer in Taiwan because of the high prevalence of chronic viral hepatitis B and C.

 

Kidney transplantation

The services include: 1. pre-operative evaluation of patients with end-stage renal disease and for both living and deceased donors, 2. organ procurement from the deceased donor, 3. nephrectomy of the living donor, and 4. long-term follow-up after kidney donation and transplantation.
 

Division of Colorectal Surgery

Surgeons in the Division of Colon and Rectal Surgery at National Taiwan University Hospital are well-versed in the diagnoses and the surgical and nonsurgical treatment of both benign and malignant diseases of the colon, rectum and anus. Every year, they perform more than 1000 colorectal surgeries and 500 anal surgeries, making the practice the largest in Taiwan. Surgeons also cooperate with colleagues in gastroenterology, oncology, radiation oncology, urology and other specialties to ensure that patients receive multi-disciplinary, comprehensive, innovative treatment.

Colon and rectal surgeons at National Taiwan University Hospital have completed 5-year training in general surgery as well as followed by 1-year advanced specific training in the treatment of colon rectal and anal problems. We apply the state-of-the-art technology to the treatment various anocolorectal diseases, as following:

 

Colorectal cancer

Colorectal cancer is the third most common malignant disease and the fourth leading cause of cancer-related death worldwide. In Taiwan, the incidence of colorectal cancer has increased recently, with around 14,000 new cases and 5,000 mortalities per year. The exact cause of colorectal cancer is unknown, but some factors, such as age, family history, personal history of inflammatory bowel diseases, colon polyps or personal history of breast, uterine or ovarian cancer, can increase the risks of colorectal cancer.

Colorectal surgeons at National Taiwan university hospital are experts in prevention, diagnosis and treatment of colorectal cancer. We provide clinical service ranging from colonoscopy for the detection of benign and malignant polyps to radical surgery for the treatment of advanced colorectal cancer. Remarkably, most of the colorectal cancers diagnosed at National Taiwan University hospital are treated by the minimally invasive surgery(MIS), including laparoscopic or robotic surgery.

 

Diverticular diseases

Diverticula are small pouches or sacs on the colon wall. The term diverticulosis refers to having diverticula within the colon. Most people with diverticulosis will not have symptoms. But complications, such as diverticulitis, perforation, stricture, fistula and bleeding, can arise from the presence of those sacs. Surgery for diverticular disease is indicated when the complications occurred and cannot be properly managed non-surgically.

 

Inflammatory bowel diseases

Inflammatory bowel diseases consist of two similar but distinct disease entities, Crohn’s disease and ulcerative colitis. Both are characterized by chronic inflammation of the gastrointestinal tract and cause persistent diarrhea, abdominal pain, rectal bleeding/bloody stools, weight loss and fatigue.

Medical treatment is always the first option for inflammatory bowel disease unless emergency surgery is required. Several treatment strategies are used at onset and for long-term to help patients control the diseases. Surgery may be needed when patients develop complications, such as bowel stricture, perforation, bleeding or fistula formation.

 

Hemorrhoids

Hemorrhoids are bulging blood vessels in and around the anus and lower rectum. The exact cause of hemorrhoids is unknown. Due to our upright posture, a lot of pressure is put on human rectum, which can potentially cause bulging. Other contributing factors include aging, chronic constipation or diarrhea, pregnancy, heredity, straining during bowel movements, overuse of laxatives or enemas and spending long periods of time on the toilet. The main symptoms of hemorrhoids are bleeding and/or protruding of skin during bowel movements, itching and/or pain in the anal area and sensitive lumps.

The treatments of hemorrhoids usually begin with nonsurgical methods. With nonsurgical treatment, pain and swelling usually decrease in 2-7 days. The firm lump should recede within 4-6 weeks. If symptoms do not resolve after conservative treatment, surgical procedures are indicated. In addition to traditional hemorrhoidectomy, the Division of Colon and Rectal Surgery at National Taiwan University Hospital provides many advanced treatment methods to treat certain type of hemorrhoids with far less pain than before, such as procedure for prolapse and hemorrhoids(PPH).

 

Anal abscess and fistula

An anal abscess is a painful condition in which a collection of pus develops near the anus. Most anal abscesses are a result of infection from small anal glands. An anal fistula is a small tunnel that develops between the anus and the nearby skin. It usually results from a previous or recurrent anal abscess. In fact, as many as one third of patients with an abscess get a fistula. Cancer, trauma, Crohn’s disease and radiation can increase the risk of anal abscess and anal fistula.

The most effective treatment of an anal abscess is surgical drainage. And, surgery is almost always needed to treat an anal fistula. We colorectal surgeons are expertise in this area.

 

Chronic constipation

Constipation is one of the most common complaints. Usually it is easy to prevent and simple to treat. However, it may be a sign of a more serious problem that requires medical attention. Please schedule an appointment if constipation is recurring and persistent, long term but more severe and frequent, uncontrolled even under prevention procedures, associated with a change in normal bowel habits or associated with significant weight loss or rectal bleeding. Constipation is usually treated with medication but in some severe conditions, such as colonic inertia or slow transit constipation, surgery may be of help.

 

Fecal incontinence

Fecal incontinence is the impaired ability to control the passage of gas or stool. Most patients with fecal incontinence are embarrassed to seek medical help and the symptoms may cause social isolation and a negative impact on quality of life. Fecal incontinence may result from injury, disease and age. The most common causes include childbirth-related injury, trauma to anal muscles, age-related loss of anal muscle strength or neurological diseases. Some tests, such as ultrasound or manometry, may be needed to confirm the diagnosis. There are nonsurgical or surgical treatment options that vary based on the cause and severity of the problem. We colorectal surgeons also provide the best personalized approach for the treatment of this clinical conundrum.

 

Division of Cardiovascular Surgery

Cardiovascular surgeons at National Taiwan University Hospital diagnose and surgically treat diseases of the heart, aorta and peripheral vessels. Each year, they perform more than 1,000 cardiac and major aortic operations. In this regard, the Division is on the leading edge of treating cardiovascular conditions, including those that are rare and complex. They use the latest innovations in cardiovascular surgery, such as off-pump coronary artery bypass, minimally invasive cardiac surgery, robot-assisted cardiac surgery, and endovascular surgery. They treat the following conditions  :

 

Coronary artery diseases (coronary artery bypass surgery)

Coronary artery disease (CAD) frequently has certain risk factors including old age, male sex, high blood pressure (hypertension), high blood lipids (hyperlipidemia), and high blood sugar (hyperglycemia). CAD results mainly from the build-up of cholesterol-containing deposits (plaques) that lead to hardening of blood vessels (atherosclerosis) and obstruction of blood vessels. As a result, the insufficient supply of oxygen and nutrients to the heart would cause cardiovascular symptoms such as chest pain and shortness of breath. 

 

Valvular heart disease

Valvular heart disease (VHD) is characterized by damage to or a defect in the four heart valves: mitral valve, the aortic valve, the tricuspid valve and the pulmonary valve. Possible causes of VHD include rheumatic heart disease, infective endocarditis, heart valve degeneration, ischemic injury, and certain inflammatory diseases. These conditions lead to valvular regurgitation (insufficiency) or stenosis.

 

Aortic diseases

Aortic diseases include dissecting aortic aneurysm (DAA), thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA).

 

Congenital heart disease/defects (CHDs)

CHDs are classified into two broad categories: acyanotic and cyanotic lesions. The most common conditions are atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (ToF), transposition of the great arteries (TGA), patent ductus arteriosus (PDA), and complex congenital heart disease. National Taiwan University Hospital is Taiwan’s leading medical center in treating congenital heart diseases.

 

Peripheral vascular diseases (PVDs)

Surgical options include arteriovenous (AV) fistula placement for dialysis and the surgery for peripheral arterial occlusion, deep vein thrombosis and varicose veins.

 

Heart failure

Heart failure occurs when the heart does not function normally for certain reasons, and does not pump sufficient blood to the tissues and organs of the entire body.  The most common causes of heart failure are cardiomyopathy (dilated, ischemic, hypertrophic, or restrictive) and myocarditis. If the condition does not improve after active treatment with medication, the patient may undergo further evaluation for a heart transplant.

 

Other special treatments

If acute or chronic heart failure endangers the life of the patient, surgeons need to offer special care such as a ventricular assist device (VAD) or extra-corporeal membrane oxygenation (ECMO). The use of these advanced technologies must be closely monitored in an intensive care unit (ICU). 

 

Division of Pediatric Surgery

Common pediatric surgical conditions

Such conditions include inguinal hernia, swelling in the scrotum (hydrocele), undescended testis, inflammation of the foreskin (posthitis), hypospadias, tongue-tie (ankyloglossia), polydactyly, hemangioma, lymphangioma, wry neck (torticollis), funnel chest (pectus excavatum), pigeon chest (pectus carinatum), umbilical granuloma, umbilical hernia, etc.

 

Neonatal surgery

Disorders that require surgical intervention include imperforate anus (anal atresia); esophageal atresia and tracheoesophageal fistula; diaphragmatic hernia; intestinal atresia and stenosis; intestinal malrotation and intestinal obstruction; meconium peritonitis; hypertrophic pyloric stenosis; gastroschisis and omphalocele, etc.
 

Abdominal surgical emergencies in infants and young children

These include acute appendicitis, intussusception, incarcerated inguinal hernia, etc.

 

Pediatric tumors

Examples include subcutaneous soft tissue tumors, liver tumors, kidney tumors, neuroblastoma, teratoma, etc.

 

Other digestive system disorders

Such disorders include biliary atresia; choledochal cyst; megacolon; diverticulitis and diverticular bleeding (hemorrhage); perianal abscess and anal fistula (fistula-in-ano), etc.

 

Other urinary system disorders

Such disorders include ureteropelvic junction (UPJ) malformation and obstruction; vesicoureteral reflux (VUR), etc.

 

Thoracic/abdominal trauma and soft tissue injuries (STIs) in children

 

Division of Thoracic Surgery

This Division treats diseased organs in the chest (thoracic) cavity that require surgery. To this end, we offer minimally invasive, precise and high-tech surgical options. These include endoscopy and other medical techniques such as non-intubated single-port thoracoscopic surgery, computerized tomography-guided stereotactic surgery, and da Vinci robotic-assisted surgery. Thoracic surgery is indicated for lung diseases (lung cancer, pulmonary nodule, metastatic lung lesion, pathological changes of the lung with unknown origin, pneumothorax, pulmonary empyema, etc.); mediastinal diseases (mediastinal tumor, myasthenia gravis, thymoma, and surgical treatment for palmar hyperhidrosis, or sweaty palms); and esophageal disorders (esophageal cancer, esophageal diverticulum, achalasia, esophageal stricture, etc.).

Patients with benign lung diseases may develop severe cardiopulmonary dysfunction, resulting in irreversible respiratory failure that does not respond to medication. Disorders include severe emphysema, pneumoconiosis, silicosis, pulmonary fibrosis, bronchiolitis obliterans (due to drug toxicity, e.g. induced by excessive consumption of Sauropus androgynus for weight loss), and bronchiectasis. As a surgical solution, lung transplant surgery may be performed to save the lives of such patients. 

 

Division of Neurosurgery

The Division of Neurosurgery treats disorders of the nervous system, including the central, peripheral, and autonomic nervous systems, by surgery. Neurosurgeons specialize in the treatment of all neurological diseases that can be surgically managed or cured.

Common central nervous system (CNS) diseases include brain or spinal cord tumors (brain cancer, meningiomas, pituitary tumors, medulloblastoma, metastatic tumors, neurofibromas, etc.); trauma (traumatic brain injury, cerebral concussion, cerebral contusion, intracranial hemorrhage, spinal cord injury, vertebral column fracture, spinal cord contusion, etc.); stroke (hemorrhagic stroke, subarachnoid hemorrhage, ruptured cerebral aneurysm, arteriovenous malformation, carotid atherosclerosis, Moyamoya disease, cerebrovascular stenosis, etc.); infection (brain abscess, spondylitis, etc.); degenerative movement disorders (Parkinson's disease, chorea, etc.); epilepsy; and congenital diseases (hydrocephalus, myelomeningocele, diastematomyelia and other congenital anomalies, etc.). Neurosurgeons are experts on the treatment of all CNS disorders.

The peripheral nervous system (PNS) consists of 12 pairs of cranial nerves and 31 pairs of spinal nerves. PNS disorders include tumors (neurilemmoma), nerve compression (median or ulnar nerve compression, facial spasm, trigeminal neuralgia, herniated disc, or bone spur on the spine leading to neck pain, back pain or sciatica), neurotmesis and repair, etc. All of these require neurosurgical treatments.   

The most common autonomic nervous system (ANS) disorder is sweaty palms (palmar hyperhidrosis).

 

Division of Plastic Surgery

Reconstructive surgery

• Facial trauma repair (face fracture reduction and fixation; facial nerve repair)
• Hand trauma repair (hand fracture reduction and fixation; hand nerve and tendon repair; finger reattachment; limb replantation; reconstruction after brachial plexus injury)
• Emergency and reconstructive treatment of burns (including burns covering a large total body surface area; functional and aesthetic revision of scars)
• Correction of craniofacial congenital anomalies (congenital head and neck malformation; congenital craniofacial anomalies; cleft lip and palate repair)
• Correction of congenital hand deformities
• Treatment of varicose veins, hemangioma, and vascular malformations
• Reconstruction after surgical resection of head and neck tumors
• Reconstruction after surgical resection of breast cancer (mastectomy/lumpectomy)
• Reconstruction of trunk and limb tissue defects
• Surgical management of chronic non-healing wounds (diabetic foot ulcer; pressure ulcer; stasis ulcer caused by poor venous return; ischemic ulcer; non-healing wound caused by radiation therapy or cancer)

 

Burns — emergency and reconstructive treatment

• Emergency and reconstructive treatment of burns (including burns covering a large total body surface area; functional and aesthetic revision of scars)

 

Cosmetic suyrger

• Eye plastic surgery (double eyelid surgery; blepharoplasty for droopy upper eyelid and eye bag)
• Nose plastic surgery (rhinoplasty for nose augmentation and reduction)
• Facial plastic surgery (forehead lift; face lift; neck lift; facial bone contouring; skull contouring)
• Breast plastic surgery (augmentation and reduction; correction of inverted nipples; treatment of gynecomastia, or enlarged breasts in men)
• Body shaping (liposuction; abdominoplasty, or tummy tuck surgery)
• Scar revision