What is keyhole surgery?
Keyhole surgery, or laparoscopic surgery as it is also known, is a method of carrying out an operation without having to make a large incision. Many different types of operations can now be carried out using keyhole surgery. This type of surgery reduces the length of time a patient needs to stay in hospital and leaves little scarring.
How long does a keyhole operation take?
The operation time may be longer than conventional surgery - the length of time the patient spends away from the ward may be between one and a half and four hours.
What are the advantages of laparoscopic surgery?
Patients tend to recover more quickly after keyhole surgery and have fewer side effects. There is little scarring after keyhole surgery which is a boon to people who are self-conscious. One side effect of ‘open’ surgery - minimised with keyhole surgery - is ‘adhesions’. This is where internal organs stick together and form bands of scar tissue, which can be painful and cause obstruction. Adhesions have been proven to occur less often in adults after keyhole surgery, and the risk of adhesions in children after keyhole surgery is thought to be less as well.
Are there any risks?
Every anaesthetic carries a risk of complications but this is very small. All anaesthetists are experienced doctors who are trained to deal with any complications. After an anaesthetic, patients sometimes feel sick and vomit, may have a headache, sore throat or feel dizzy. These effects are short-lived. Any surgery carries a small risk of infection or bleeding.
After the operation, some patients may complain of shoulder pain. The patient may also feel some crackling under the skin because the carbon dioxide sometimes escapes into the tissue just under the skin. These side effects are usually short-lived and do not require any specialised care.
Are there any alternatives to minimal invasive surgery?
All operations carried out as keyhole surgery can also be carried out using ‘open’ surgery, that is, with a larger incision.
What does the operation involve?
The patient will be given a general anaesthetic and will be asleep during the operation. Once the patient is asleep, the surgeon inserts a small metal tube called a cannula into his/her tummy button. A telescope, with a miniature video camera mounted on it, is inserted into this tube to project a very high quality video image onto a television screen. The abdomen is then inflated with carbon dioxide to create space in which the surgeon can operate. The operation is performed by inserting specialised instruments which are passed through small hollow tubes which are inserted through separate very small incisions. There may be two or more small incisions required to perform the operation. Once the operation is over, the surgeon will stitch up the inside of the holes and the patient will be taken to the recovery room to wake up from the anaesthetic.
What happens after the operation?
After the operation, the patient will return to the ward to recover. He or she will always have some form of pain relief, which can include:
epidural which is given through a small space between the bones in the back;
nurse- or patient-controlled analgesia (NCA or PCA) which is given through a small plastic needle in the back of the hand. The amount of pain relief given is controlled either by the nurse or the patient.
Your child may also have a naso-gastric tube, which is a tube passed through the nose into the stomach, so that he or she can be given feeds or medicines easily. The patient may also have an intravenous (into a vein) infusion of fluids as he or she may not feel like eating and drinking after the operation.
You may be able to feel a few lumps under the skin by the wound sites, which are stitches inside the body. This is nothing to worry about and the stitches will dissolve on their own in about three months.
When you get home:
The patient may need some pain relief when you get home.
Intensive training in Basic and Advanced Laparoscopic Surgery starts on every 2nd Thursday.
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