Dr Nara's Thoracic Surgery

07/06/2026

A 60 year old man with upper esophageal carcinoma, post chemo radiotherapy, complicated with tracheoesophageal fistula, presented with severe aspiration pneumonia. The fistula was located 3cm from carina, measuring 0.5cm. In the esophagus, it was located around 20cm from incisors, and only a slim scope can pass through the upper esophageal sphincter. Decision was made for SEMS Y-stent insertion in the trachea.

Conventionally, this stent is inserted with fluoro guidance, using a rigid bronchoscope, under GA, using 2 guide wires.

I inserted with the assistance of flexible bronchoscopy, single guide wire under deep sedation in the OT, without fluoro guidance. This avoids GA related complications in a patient who is already fragile with ongoing infection after chemo and of course reduces radiation exposure.

Post procedure chest x-ray showed perfect stent placement and the patient was sent back to the ward to continue antibiotics and physiotherapy.

05/06/2026

Attended CARINA 2026 in Hospital Sultanah Bahiyah, Alor Star. The symposium was organised by Chest Alor Star under the leadership of Dr Arvind Alaga and was attended by well known pulmonologist from India along with their fellows.

I presented 2 talks on airway tumors and lung cancer, and was tasked to judge 11 oral and video presentation. The cases discussed were of high quality with strong clinical relevance. It was tough judging them.

Thank you for the great hospitality and congratulations on a wonderfully crafted symposium.

04/06/2026

Was invited to participate in the Asia Pacific Policy Review and Engagement for Lung Cancer (ASPIRE) along with the Lung Health Initiative by MOH. This was co organised by Lung Cancer Network Malaysia (LCNM) that got all the stakeholders together for this round table meeting.

Many important and pertinent points were highlighted regarding lung cancer screening in Malaysia. Hopefully, after a few more meetings, a policy brief can be forwarded to relevant parties.

Thank you Dr Anand and ASPIRE team for the invite.

24/05/2026

19/05/2026

IgG4 related lung mass that may mimic tuberculosis or malignancy is rare. We had a patient that underwent VATS right upper lobectomy and one of the surgical postgraduate student, Dr Shan, published a case writeup. Well done.

https://www.cureus.com/articles/481809-igg4-related-lung-disease-presenting-as-an-indeterminate-pulmonary-mass-in-a-young-woman-with-prior-tuberculosis-a-case-report #!/

19/05/2026

Another day to create awareness, away from my usual surgeries. This time, I spoke about surgical safety and it's importance in the Patient Risk Management Symposium 2026 organised by the Development Division of the Ministry of Health.

18/05/2026

After the completion of the chest wall workshop, I had to assist in the conjoint board postgraduate surgical exit examination for 3 days in University Malaya.

To all the candidates that made it, congratulations! The real life of a surgeon just started for all of you, and it almost never gets easier. For those who didn't get through, keep trying and never give up. It's always about how strongly you get up after falling down.

16/05/2026

The International Chest Wall Surgery Workshop was concluded successfully yesterday.

The 1st day of lectures and cadaveric workshop witnessed high level of quality discussions pertaining to chest wall surgeries and we were lucky to have the authorities of such procedures in Asia to guide us, namely Prof Wang, Dr Sira, Dr Aneez and the other experienced surgeons from Malaysia and Indonesia.

In the 2nd day, we performed 6 surgeries in HKL. They were 3 pectus corrections, 2 pectus bar removals, and a partial sternectomy, thyroidectomy, reconstruction with pectoral flap, plating and tracheostomy (join venture with endocrine surgeon, Dr Raflis) for a huge thyroid ca infiltrating the manubriosternum.

Thank you to all the committee members, participants and sponsors for making this workshop a memorable one.

09/05/2026

In between a tracheal injury sent for repair all the way from Penang and a posterior chest wall resection for a paraspinal chondrosarcoma, I managed to deliver a talk on 'Early Lung Cancer Surgical Management' at the NTCC 2026.

The talk emphasised mainly on how to manage if an early lung nodule is detected, which includes

1. Surgical planning with AI assisted 3dCT reconstruction to identify the nodule precisely for accurate margin of resection.

2. Single incision (4cm) access VATS surgery.

3. Use of ICG dye localisation with infrared telescope for intraoperative nodule identification.

4. Usage of cryoablation for minimal post op pain.

5. Usage of digitally monitored negative pressure thoracic drainage for effective post op drain management.

These measures ensure a complete package of solving the dilemma of managing a small,

03/05/2026

Three chest wall surgeries encompassing tumor and trauma were performed by final year thoracic surgery fellow, Dr Dinesh and 1st year fellow, Dr Dexter in the last 10 days.

A case of metastatic tumor to lower sternum, resected and reconstructed. 2 cases of traumatic rib fractures requiring ventilation were fixed along with other fractures at the clavicles and scapula.

This could be the prelude to our International Chest Wall Surgery Workshop scheduled in less than 2 weeks.