Department of
Introduction Hepatobiliary
and Pancreatic
Breast Surgery,
Head and Neck
(Cluster Based)
Green Team - Colorectal Surgery

L to R: Dr. Karen Ho, Dr. Alex Leung, Dr. Lau Chi Wai (Team Head), Dr. Karen Tung, Dr. Chan Wai Hong, Dr. Joseph Yuen, Dr Christina Chan

Fig. 1

Under the vision and leadership of Mr Michael Li, the colorectal team has started laparoscopic colorectal surgery as early as 1992. The unit is one of the pioneers in laparoscopic colorectal surgery, not only in Hong Kong, but is also recognized internationally. By now, we routinely performed laparoscopic colorectal resection of all kinds (up to 90% of our patients), even in the most difficult pathology and most challenging patient. Our excellent results were reported in various world renowned journals.

Laparoscopic Total Mesorectal Excision-The Corner Stone

We firstly performed laparoscopic sphincter-saving TME in March 1999, and we were the first centre worldwide to report on the technique and results in the literature. As reported in the Annals of Surgery in 2006, we had zero operative mortality, and with a mean follow-up of 26.9 months, the actuarial 5-year cancer-specific survival and local recurrence rates were 81.3% and 8.9%. The incidence of sexual dysfunction was 13%.

Simultaneous Laparoscopic Abdominal and Transanal Excision (SLATE)

Tumors located at or below the levator ani is traditionally treated with sphincter-ablating surgery. The concept of intersphincteric dissection for selected patients has been described in the literature with success. In view of this, the team developed an innovative approach, called Simultaneous Laparoscopic Abdominal and Transanal Excision (SLATE) for treatment of ultra-low rectal cancers, defined as those located within 4 cm from anal verge. We performed intersphincteric dissection from the perineal side while the laparoscopic abdominal and pelvic dissection is carried out simultaneously, until the two surgeons meet at the pelvic floor. The specimen is delivered per anally. This even avoids any laparotomy wound for specimen retrieval, making the operation really minimally invasive. A hand-sewn colo-anal pull through anastomosis is then fashioned. The technique and the initial results were again published in peer review journal.

Endo-Laparoscopic Approach for obstructing colonic tumors

Since January 2002, we have explored the feasibility of endoluminal stenting in obstructing cancer. By relieving the obstruction, emergency operation can be avoided in an unprepared colon. It allows full pre-operative work-up so that futile operation can be avoided in disseminated cases. For curative situation, the operation would become a laparoscopic colectomy with primary anastomosis on an elective basis. We conducted the first randomized controlled trial in the literature comparing this Endo-Laparoscopic Approach versus conventional emergency surgery for obstructing colonic tumors which was published in the Archives of Surgery in 2009.

Endosopic Submucosal Dissection (ESD) & Endo-Laparoscopic Approach for flat and sessile colonic lesions

Large sessile or flat polyp might require surgical resection previously. With the development of endoscopic skills and instruments, Endoscopic Submucosal Dissection (ESD) offers a better en bloc resection for early neoplasm in lower GI tract, but the risk of perforation and full thickness thermal injury is high. This leads to the concept of endoscopic dissection under laparoscopic monitoring. Any accidental perforation can be repaired immediately with endoscopic suturing. The colon can also be manipulated or mobilized to facilitate endoscopic procedure. With the maturation of skills, we start to perform ESD of selective cases in endoscopic centre in 2016.

Hybrid-NOTES endo-laparoscopic colectomy for left-sided colorectal cancers

Inspired by the development of Natural Orifice Transluminal Endoscopic Surgery (NOTES), we have managed selected left-sided colorectal cancers with a combined laparoscopic and transluminal technique by using the TEO device. Patients are thus saved from a mini-laparotomy for specimen extraction, as tumour retrieval and subsequent anastomosis are carried out transanally via the TEO device. It is proven to decrease wound related complication and wound pain when compared to conventional laparoscopic technique, which was published in the World Journal of Surgery in 2013.

Towards The Era of Robotic surgery ………

With time and experience surgeons started to realize the intrinsic limitations of laparoscopic surgery. The introduction of the robotic surgical system with its excellent dexterity, vision, and ergonomics, may offer potential solutions for complex procedure in difficult anatomical position. Since the installation of the Da Vinci Robotic System in our endo-lap OR on 19 May 2009, we have performed more than 225 cases of robotic assisted colorectal surgery. With better visualization and pelvic nerve preservation, we believe patients may benefit from robot assisted total mesorectal excision in terms of urological and sexual function outcomes.

Transanal TME

In performing laparoscopic or even robotic TME for bulky mid-rectal tumors or in narrow male pelvis, we may encounter problems like difficult dissection, angulation of the staple during distal transection resulting in multi-firing, which might affect the clinical outcomes. Therefore, in 2016, we embark the two-team transanal approach for TME, aiming to ensure adequate distal resection margin, to facilitate distal dissection and to shorten operation time. Transanal retrieval of specimen avoids a minilaparotomy, thus minimizing wound complications.


Key Members

Prof. Li Ka Wah, Michael MBBS (London), MRCS, LRCP, FRCS Ed, FRCS (England),FCSHK, FHKAM (Surgery)
Honorary Consultant

Prof. Li Ka Wah, Michael, is an Honorary consultant in Department of Surgery at Pamela Youde Nethersole Eastern Hospital, Hong Kong. He received his medical education at St Bartholomew’s Hospital University of London.

He was involved with the early development of laparoscopic surgery in Hong Kong in the early 1990’s and continued to develop a Department of Surgery with a special interest in the advancement of laparoscopic surgery.

His honorary appointments include : (1) Professor of Surgery in University College London, (2) Advisor of Minimal Access Surgery Training Centre, PYNEH, (3) Adjunct Associate Professor in Surgery, Prince of Wales Hospital, CUHK, (4) Honorary Clinical Associate Professor in Surgery, Queen Mary Hospital, UHK, (5) International Advisory Committee, the American Society of Colon and Rectal Surgeons, (6) Examiner in General Surgery, Royal College of Surgeons of Edinburgh, (7) Examiner in General Surgery, College of Surgeons of Hong Kong, (8) Honorary Consultant in Surgery, Queen Elizabeth Hospital, London, UK, (9) Honorary Consultant in Laparoscopic Surgery, Guangzhou Medical College First Affiliated Hospital, (10) Honorary Consultant, Shenzhen Hospital of Beijing University. (11) Visiting Associate Professor of Laparoscopic Surgery, Sun Yat Sen University of Medical Sciences, Guangzhou, PRC. Prof. Li was appointed as a Hunterian Professor at the Royal College of Surgeons of England in 2010.

Dr. LAU Chi Wai MBChB (CUHK), FRCS(Edin), FCS(HK), FHKAM(Surgery)

Dr. Lau is currently Consultant of the Department of Surgery, Pamela Youde Nethersole Eastern Hospital.  He graduated in the Chinese University of Hong Kong in 1988.  He have  worked in PMH and YCH before joined our department in 2016.  He got overseas training in Cleveland Clinic Florida  in 1997 and was subspecialized in colorectal surgery since then.

Dr. Leung Lik Hang, Alex MB BS, MRCS(Edin), FRCS (Edin), FHKAM, FCSHK
Associate Consultant

Dr. Leung Lik Hang, Alex, is currently an Associate Consultant in the colorectal team. He graduated in the University of Hong Kong in 2004 and received surgical training in PYNEH since 2005. After obtaining his specialist qualification, he chose to pursue his professional interest in endo-laparoscopic and robotic colorectal surgeries. In 2015, he has undergone his training in endoscopic submucosal dissection (ESD) in Kobe, Japan. He actively participates in clinical research of minimally invasive and robotic surgeries of colorectal pathologies. He received the Best Paper Award of the Joint Annual Scientific Meeting, Hong Kong Society for Coloproctology and Hong Kong Society of Minimal Access Surgery in 2011. He received the Best Original Paper Award, The College of Surgeons of Hong Kong in September, 2013. He is also an honorary Clinical Assistant Professor in the Department of Surgery, the Chinese University of Hong Kong.

Dr. NG Chung Kei Daniel MB BS, MRCS(Edin), FRCS (Edin), FHKAM, FCSHK
Associate Consultant

Dr. Ng Chung Kei, Daniel, is the associate consultant of colorectal team, Department of Surgery, PYNEH. He graduated from the University of Hong Kong in 2005 and received his surgical training in PWH and NDH, Hong Kong. He joined the colorectal team in PYNEH in 2012. He has special interest in robotic and laparoscopic colorectal surgery, endo-luminal surgery including transanal endoscopic operation (TEO), proctology and advanced colonoscopy.