In hospitals, more and more you hear the terms laparoscopic or key-hole surgery but what does this mean to you as a patient. What are the advantages of surgery done this way and are there any disadvantages?
WHAT IS LAPAROSPIC OR KEY HOLE SURGERY?
'Laparoscopy' is a technique of performing a surgical operation using instruments inserted through narrow hollow tubes rather than through a larger incision, as in traditional surgery.
Although laparoscopy is termed 'key hole' surgery, the view obtained is much better than looking through a key hole. Modern equipment produces a wide, bright, clear and magnified view of the operation.
Laparoscopic surgery was first used to perform family planning operations more than 30 years ago by directly visualizing the fallopian tubes through a laparoscope (a sort of telescope). A more recent technological revolution occurred following the introduction of Video-laparoscopy. The development in technology allowed the removal of the gall bladder using a laparoscopic or 'key hole' technique. The first team in the world who removed a gallbladder by this way are the french team of Professor Dubois and Mouret in France in the mid eighties. These techniques have quickly spread all around the world and several major traditional open operations have now been replaced by keyhole surgery. This has now revolutionalised the field of general surgery, thoracic surgery, gynecology and more.
HOW IS THIS TYPE OF SURGERY PERFORMED?
The operation is performed by inserting a telescope of 1 cm diameter into the abdomen through a small hole and a trocar (hollow tube), at the navel. A microchip camera is attached to this telescope, which transmits the image of the internal organs on to a television monitor. The surgeon then introduces specialized instruments into the abdomen through 2 or 3 holes of no more than ½ cm. The Surgeon performs the operation whilst watching and guided by the image on the television monitor.
Similarly minimally invasive procedures are done on joints such as the knee using smaller instruments. This procedure and technique is known as 'arthroscopy'.
WHAT ARE THE ADVANTAGES?
There are several advantages with this type of operation:
1. Less Pain
Since a cut of several inches is reduced to one centimeter or less, pain is considerably reduced. Patients hardly need any painkiller injections beyond the first day after a major operation.
2. Less Bleeding
When there is less cutting, it naturally causes less bleeding. Only a very small amount of blood is lost during most operations.
3. Faster Recovery
With less pain and blood loss, patients recover much faster compared to open surgery. There is minimal damage to and faster recovery of the internal organs.
4. Decreased Hospitalization
Hospital stay is ½ day to about 2-3 days in most cases depending on the type of operation performed. Patients go home earlier as their requirements for drips and injections are reduced and they are able to have food much quicker than after an open operation.
5. Early return to work
A great benefit in today's busy and fast life is that patients can get back to normal activity within a few days after undergoing several types of major operations by key-hole surgery. All activities including lifting heavy objects and sports can be resumed earlier than with traditional open operations.
6. Decrease complications
As there are no large incisions, complications like wound infection, scar complications and hernias are rarely seen following key-hole surgery.
7. Economical
The amount of medicines required after surgery is considerably reduced. As patients go home early and return to work much sooner, indirect expenses and losses are significantly less. With decreased complications, recurring costs are not incurred.
8. Better Cosmetics
In today's world nobody wants an ugly scar & laparoscopy seems to be the answer. There is hardly a visible scar after a major operation.
DISADVANTAGES OF KEY HOLE SURGERY?
There are no disadvantages as such, but laparoscopic surgery has limitations. As a lot of sophisticated equipment and instruments are required, and as this type of operation requires specialized training and is difficult to perform, it is not available in all hospitals.
The operative procedure itself may be more expensive as sophisticated equipment and higher cost consumable are used.
All operations may not be possible by key-hole surgery as only small and limited instruments can be used. In some cases, it may be necessary to convert to an open operation during laparoscopic surgery due to either the severity of the disease or when bleeding cannot be controlled. Hence the possibility of open operation is there in every patient undergoing key-hole surgery and doctors are always prepared for it. However such an occurrence is rare.
WHICH ARE THE OPERATIONS PERFORMED BY LAPAROSCOPY?
Today most of the common abdominal operations can by performed by laparoscopy. These include operations for stones in the gall bladder, appendicectomy, release of adhesions, ulcer operation, repair of hernia, closing perforation in the intestines, removal of some organs from the abdomen like small and larger intestines, spleen etc.
Almost all gynaecological operations can be performed which includes operations for infertility, ectopic pregnancy, polycystic ovaries, ovarian cysts, hysterectomy and myomectomy.
Laparoscopy is of great benefit for diagnosing diseases in the abdomen causing abdominal pain, jaundice, ascitis and other problems. It is also used to assess the stage of cancer and also to check for any recurrence of cancer periodically
WHEN SHOULD LAPAROSCOPY BE PERFORMED?
Laparoscopic surgery can be performed at any time both as an emergency or as planned surgery. It requires trained personnel as they operate with sophisticated equipment and instruments, hence emergency laparoscopic operations are generally performed only in a few hospitals where large number of operations are being performed and where a dedicated laparoscopic unit is present
Muscat Private Hospital is fully equipped with state of the art equipment for laparoscopic surgery. Dr. Patrick Balquet has over 15 years extensive experience in laparoscopic surgery in both adults and children and was a leader in the development of laparoscopic surgery in children in Paris in Armand Trousseau Teaching Hospital.
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