• Dr Peter Chew

What is key -hole surgery (laparoscopy)?

“Doc, it is really amazing how the surgery went so smoothly. I could hardly feel any pain today," she remarked, pointing to the three puncture wounds on her abdomen. She was smiling and sitting up in bed, and enjoying her breakfast when I saw her the next morning after the operation. I had removed her womb by key-hole surgery.

Key-hole surgery or minimally invasive surgery is a surgical procedure in which the surgeon can access the inside of the abdomen and pelvis using a tiny lighted telescope (laparoscope)through a small cut instead of a large one in the abdomen as in conventional open surgery.

The operation is carried out under general anaesthesia. The abdomen is first inflated with carbon dioxide which will push the pelvic organs away from the abdominal wall. A small cut about 0.5 to 1 cm is usually made in the umbilicus and the laparoscope inserted into the abdomen. The laparoscope, which is connected to a camera, will then relay images of the pelvic organs to a television monitor. The operation is then performed using surgical instruments which are placed inside the abdomen via other small incisions.  After the procedure, the gas is let out and the incisions closed with sutures. The patient can go home on the same day or stay a day or two in the hospital.

This procedure has been used by gynaecologists for years in the diagnosis and treatment of various conditions.

The advantages of key-hole surgery are as follows:

1. Less adhesions: As the incisions are small, chances of abdominal organs like intestines sticking to the abdominal wall by scar tissues and adhesions are reduced.  Adhesion bands can cause persistent abdominal cramps and discomfort, intestinal obstruction and infertility.

2. Less post-operative pain and disability: Since there is less trauma to the skin and muscles, patients require less painkillers and can ambulate earlier. As a result, the recovery time is faster and the hospital stay shorter. Most patients are able to return to normal activities in 1 to 2 weeks.

3. Less risk of infection. This is because pelvic organs are not exposed to the air of the operating room over long periods of time as in conventional operation.

4. Better dissection of the diseased tissues and less damage to the surrounding organs:  Video magnification offers surgeons better exposure of the diseased organ and its surrounding structures. As a result, delicate manoeuvres can be performed.

However, there are disadvantages too. They include the following:

1. The equipment is more expansive and they are usually disposable.

2. The surgeon needs to be trained. The learning curve, the skills and experience vary from person to person.

3. Safety issues:

Minor complications such as infection or minor bleeding and bruising around the incision can occur.

Serious complications are not common. They are estimated to occur in 1 out of every 1,000 operations. They include:

• Damage to the surrounding organs such as bowel or bladder. This   could result in the loss of organ function

• Damage to major blood vessels which may result in serious internal haemorrhage.

• Deep vein thrombosis or DVT, in which a blood clot develops in a vein in one or both the legs. The clot may break off and block the blood flow in one of the blood vessels in the lungs. This condition is called pulmonary embolism and can be life-threatening.

As my patient recovered well post-operatively, she was discharged home the next day.

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