Key Hole Surgery

Minimal Access (keyhole) surgery

Whenever surgery is indicated, Saad strongly advocates the minimal access (keyhole) approach for most gynaecological procedures including total hysterectomy. This modern surgical approach, which requires special skills, offers several advantages over the traditional open surgery such as shorter hospital stay and a quick return to normal life activity. In addition, keyhole surgery leaves a tiny abdominal scar with a much reduced risk of wound infection.

What is keyhole (minimal invasive) surgery and how is it performed?

Keyhole surgery involves the insertion of a laparoscope, which is a medical telescopic camera, through a small incision in the navel. This laparoscope is connected to a screen that gives the surgeon a good view of all pelvic and abdominal organs. The abdomen is distended with carbon dioxide gas to separate the organs so that a clear view is maintained throughout the procedure. This allows diagnosis and treatment of many gynaecological diseases such as endometriosis, adhesions and ovarian cysts. Further tiny skin incisions (between 2 to 3) in the lower abdomen will be required to introduce instruments into to perform various procedures.

Advantages of keyhole surgery over open surgery

Keyhole surgery offers many advantages over the traditional open surgery such as:

1. Shorter recovery: usually laparoscopic operations are performed as day-case procedures allowing the patient to go home with 24 hours after operation.
2. Quick return to normal life activity after major operations such as hysterectomy
3. Tiny skin incisions cause much less discomfort after surgery
4. Tiny skin incisions minimise reduced risk of wound infection
5. Tiny abdominal scars give a better cosmetic outcome.
6. Gentle handling of tissues with fine instruments avoiding hand manipulations and exposure of the organs to the outside environment. This significantly reduces the risks of infection and adhesion (scar tissue) formation after surgery.
7. Video magnification allows more accurate diagnosis and a more precise surgery.
8. Video magnification of tissues also allows detection and control of small bleeding vessels minimising the risk of haemorrhage during or after the surgery.

Are there any disadvantages to laparoscopic surgery?

There are four main disadvantages to laparoscopic surgery including:

1. It does not allow palpation of tissues with the surgeon's hand, which can sometimes be necessary for the diagnosis especially in deep-seated diseases.
2. It requires special surgical skills, which require many years of training to acquire hand eye co-ordination with the 2-D view on the monitor.
3. It requires expensive equipments and a more complex setup than open surgery.
4. The first part of the procedure involving the insertion of instruments into the abdomen carries a small risk of injury to organs such as the bowel and the bladder. However, in experienced hands and with careful patient selection, this risk is minimal.

What are the complications of keyhole surgery?

Like all other surgical procedures, laparoscopic surgery carries a small risk of complications such as:

1. Rarely, laparoscopic surgery may cause injury to organs such as bowel, bladder and ureter (tube running from the kidneys to the bladder). This can be greatly minimised by paying attention to safety guidelines and by proper patient selection.
2. Injury to blood vessels leading to haemorrhage
3. Surgical emphysema defined as escape of the gas used during the procedure under the skin. This is not a serious complication and usually resolves spontaneously.

What to expect after surgery?

Following laparoscopic surgery, the patient should expect to go home within 24 hours. She will have two to four small skin incisions sutured with dissolvable materials. She can remove the wound dressings and have a shower the day after the operation. She should keep the small wounds clean and dry. Dressings are only needed if the wound is oozing or uncomfortable next to the clothing. If not dissolved within two weeks, the sutures will need to be removed by the practice nurse.

It is common to experience some abdominal pain after the procedure. Shoulder pain is also common as a result of the presence of gas in the abdomen (under the diaphragm), but this will gradually disappear over the next 24 - 48 hours. The Anaesthetist will prescribe good pain killers that will help control the after-pains.

Returning to work will depend on the individual and on the type and extent surgery performed. Most patients will require at least two days for complete recovery from the effects of the anaesthetic. However, some patients undergoing extensive laparoscopic surgery such as hysterectomy may require at least two weeks of work.