Endoscopic ultrasound (EUS) is basically similar to an upper endoscopy (which requires mild sedation and can be performed as in a day care unit) but allows the endoscopist to scan beyond the wall of the gastrointestinal tract. Structures such as the lymph nodes around the lungs, in the chest, and the pancreas and bile duct can be studied carefully and if necessary biopsied at the same time.
Thus, EUS can be used to stage Gastrointestinal cancers, lung cancers, pancreatic cyst drainage and also investigate unexplained abdominal pain.
The Endoscopic Ultrasound would be carried out by Dr Ryan Ponnudurai at Prince Court Medical Centre

MB BCh, LRCP & SI (NU Ireland), BAO, Board Certification Int. Med and Gastroenterology (USA), AM (Mal)

Head of Medical Services & Director of Endoscopy Services,
Prince Court Medical Centre, Kuala Lumpur

After completing his specialization in Internal Medicine in Cleveland, Ohio (Board Certification USA, 1996) Dr Ryan underwent extensive training in the subspecialty field of Gastroenterology and passed the American Board Certification (Gastroenterology) in 1999.
He returned to Malaysia to provide a new service in the main tertiary referral centre in Kuala Lumpur. There he built up the endoscopic ultrasound component of the endoscopy unit and after three years it became the largest and highest volume centre in South East Asia. As this expertise was non existent before his return, he set out to train fellow gastroenterologists, and has succeeded in training 10 endosonographers in Malaysia. He regularly has gastroenterologists from Holland, India, Australia and Thailand coming for learning attachments to acquire this skill.
Dr Ryan has spent the last six years travelling to different countries teaching and demonstrating this relatively new technology. Due to the interest generated, he decided to form an EUS club called the Asia Pacific EUS club which was launched last year at the Asia Pacific Digestives Week. This has links with the European equivalent (EURO EUS).

What is Vaginal Rejuvenation Surgery?

Vaginal rejuvenation surgery involves a combination of two main procedures, which are vaginoplasty and labiaplasty. Laser is now used during these procedures to perform precise incisions in order to give the best surgical results.

Vaginoplasty is a surgical procedure that involves the reshaping and tightening of the vagina to its normal anatomical shape and diameter. This is done by removing excess vaginal lining and tightening the surrounding soft tissues and muscle.

Labiaplasty is a cosmetic genital surgical procedure that will reduce the size or change the shape of the small lips on the outside of the vagina (the labia minora).

What are the indications for these procedures?

Vaginoplasty and labiaplasty are performed for two main reasons: firstly is the correction of anatomical and structural distortion of the female external genitalia and the vaginal wall. This can arise as a result of congenital defect or due to the process of childbirth. Secondly, it is also performed for the enhancement of sexual gratification. Most women who desire vaginoplasty often complain of feeling “loose”. This can decrease the sensation during intercourse, resulting in lower levels of sexual satisfaction for both partners.

How does it work?

The laser vaginoplasty procedure corrects the anatomical defects due to various causes and at the same time, enhances the tone and the strength of the vaginal muscle. It will reduce the internal and external diameter of the vagina, leading to a higher level of sexual enjoyment.

Women who have abnormally shaped labia may complain of discomfort, pain or lack of self esteem. Chronic labial irritation leading to pain or discomfort can sometimes develop if the women wear tight clothing or during sex, sports or other physical activities. In such cases, labiaplasty provides an aesthetic enhancement of the external appearance of the genitalia, resulting in better comfort and sensation. Women whose labia become irritated and painful will often find relief after surgery.

Why is laser used for these procedures?

The laser used in the procedure is pinpoint, precise and delicate. It also minimizes blood loss and swelling. This would promote excellent wound healing, resulting in minimal or no scarring at all. Pain will also be minimized with the use of laser.

How long does the Vaginal Rejuvenation Surgery take?

The surgical time depends on the extent of the procedure, which may range from 30 to 60 minutes.

Do I need to be admitted for these procedures?

No. These procedures are done as daycare. The procedures are usually performed under general anaesthesia. You will be under observation for a few hours before being allowed home on the same day.

Post Operative Period

Adequate pain relief is given during and after the procedures. Women usually report mild to moderate discomfort for a few days following the procedures. This can easily be relieved by oral painkillers and cold packs to the area. Many women can return to their usual daily activities after a few days of rest.

What are the Risks Associated with the surgery?

As with any surgery, there can be complications (both surgical and anaesthetic). However, complications are rare and may include bleeding, infection and scarring. Proper surgical techniques and the use of laser will significantly reduce these risks. Antibiotics may be given during the procedure to prevent infection

The Fertility Management Programme was first initiated at our Centre in 1986. It coincided with the setting up of the first IVF laboratory in Malaysia and was soon rewarded with a series of “firsts” – the first IVF baby in Malaysia was born that year and was followed by successes with GIFT, PROST, TEST procedures.

From 1996, ICSI was introduced into the Programme and was met with a “first” Malaysian success soon after.

Since its inception the Programme has now evolved into a Comprehensive Infertility Management Programme which includes full investigative protocols with Fertility Consultation and Counseling, Reproductive Endocrinology, Laparoscopic Surgery, Tubal Microsurgery and associated Assisted Conception procedures.

The Assisted Conception procedures include:
• Semen Analysis
• Anti Sperm Antibody Screening
• TESA/MESA
• OVULATION INDUCTION
• IUI
• IVF-ET
• ICSI
• Gamete and Embryo Freezing and Storage
• Antenatal Screening programmes
• Genetic Screening (CVS, Amniocentesis)

The programme is run by a team of Clinicians, Coordinators, and Scientists with 21 years of experience in Fertility Management and IVF. There is a dedicated Fertility Centre housed within the Clinical Facility with a state-of- the-art IVF Laboratory Facility within the Operating Theatre Complex adjacent to the Daycare Facility.

Subang Jaya Medical Centre carries a reputation of being the most advanced private medical care facility in the country with comprehensive programmes in all Medical, Surgical, Paediatrics, Obstetrics and Gynaecology disciplines with full support facilities for Adult and Paediatric intensive care and rehabilitation.