• Dr Peter Chew

Keyhole surgery

My daughter, 20, is going to have a 5 cm ovarian cyst removed by keyhole surgery. The doctor tells her that she can be discharged the same day. May I know more about keyhole surgery? What are the complications? What should I look out for should complications occur?


Keyhole surgery or laparoscopic surgery is also known as minimally invasive surgery (MIS). It is a recent surgical technique in which operations are performed through small cuts, usually between 0.5 cm to 1.5 cm, on the tummy.


For removal of the ovarian cyst, your daughter will be put under general anaesthesia and her tummy inflated with carbon dioxide through a fine needle. When her abdomen is sufficiently distended, a fine 5- 10mm diameter telescope is inserted inside the abdomen via a tiny cut at the belly-button to allow for magnified views of the reproductive organs. Additional instruments are then introduced to remove the cyst.


There are a number of advantages to the patient using laparoscopic surgery compared with the usual open method. They are as follows:


· Pain and bleeding are less due to smaller cuts.

· Recovery times are shorter.

· The hospital stay is shorter and the patient can go back to work earlier.

· The internal organs are less exposed to the air thus reducing the chances of infections.


But there can be complications too though they are very rare, usually less than 1 %.

These include:


· Injuries from the trocar, an instrument used to pierce the tummy. This sharp pointed tool, which stabs into the tummy blindly could cause large amount of bleeding from the blood vessels in the abdominal wall. The small and large bowels can also be damaged during the process. This can be serious and life threatening if it is not recognised and treated early. The urinary bladder can also be injured resulting in urinary infection or leakage.


· Adhesion formation in the abdominal organs remains a major, unsolved problem. Adhesions are tough bands that bind tissue to organ after surgery. They can lead to chronic tummy pain and blockage of the bowels resulting in repeated vomiting and abdominal distension. Surgery has to be done to overcome the obstruction.


· Umbilical hernia and wound infection


The risk of injuries is increased in patients who have blood clotting problems, are either too fat or too thin or have prior abdominal surgery such as caesarean section or appendicetomy.

After the ovarian cyst is removed, your daughter may feel pain and fullness in her tummy and aches over the shoulders. This should improve in a day or two.


You should watch out for the following signs or symptoms and call the doctor immediately if she has:


· Heavy bleeding from the incisions

· Fever or chills

· Problems with urination or bowel movements

· Heavy vaginal bleeding

· Severe or increasing abdominal pain

· Vomiting

· Redness or discharge from the skin incisions

· Shortness of breath or chest pain



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