Minimally Invasive Surgery

What is Minimally Invasive Surgery?

• Traditionally, Surgery involved cutting the body wall to reach for an organ inside the tummy or chest to perform surgery on that organ. With Minimally invasive surgery- this cutting is not done, instead specialized instruments are inserted through either puncture holes or natural opening to perform the surgery. So ACCESS trauma, i.e. trauma caused to body while getting to the organ is avoided and this seems to be the logical approach.

What are the types of minimally invasive surgeries?

• Laparoscopy: Laparoscopy involves placing instruments through small puncture holes in the belly for doing surgeries on intra-abdominal organs such as gall bladder, appendix, kidney, stomach, intestine etc. As a first step- an inert gas like Carbon Dioxide is placed to insufflate the belly. This gives the working space for moving the instruments. Then other small hole are made- 3mm-5mm in size to put in telescope and working instruments to perform the surgery.
• Thoracoscopy: Same principle is applied for chest surgery such a lung resection/ biopsy or some selected cardiac surgeries.
• Hysteroscopy: Hysteroscopy is specialized Endogynecological procedure whereby a telescope is inserted into uterus through vagina for performing intra-uterine procedures such as check-up for infertility, fibroid, abnormal menses, septate uterus etc.
• Cystoscopy: Involves placing a special fine telescope through urinary opening into the urinary bladder to check the urinary passages. This is most commonly done as first step for most of the urological surgeries, prostates surgery, bladder tumours, bladder stones etc. In kinds it is done for managing block in the urethra such as posterior urethral valves.
• Ureterorenoscopy (URS): Is a valid extension of concept of cystoscopy. In URS a specialized instrument called Ureterorenoscope is passed through the bladder into the ureter (pipe which connects kidney & bladder). This is an expensive and delicate instrument and URS is primarily used in managing stones stuck in the ureter.

What are the benefits of Minimally Invasive Surgery?

• Less access trauma- so less painful. Though no surgery can be painless (regardless of doctor telling you that it will be painless), with current techniques pain is less.
• Faster healing and less chance of infection.
• Shorter hospitalization- back to work faster.
• Cosmesis is good as there is no major cut/ stitch mark on the belly.

What are the disadvantages of Minimally Invasive Surgery?

• For some of the surgeries, anesthesia required is more extensive than open surgery. As such it may not be possible to do extensive prolonged laparoscopic surgery in patients who may have heart disease, lung disease or are of old age.
• Expensive: Since Minimally Invasive Surgery requires lot of specialized equipment, it is an expensive proposition. But a part of the cost is offset by shorter hospitalization and lesser use of medicines.
• Feasibility: All surgeries may not be possible with Minimally Invasive techniques.

Is Minimally Invasive Surgery possible in kids?

• Yes, we have miniaturized equipment for Minimally Invasive Surgery in kids. These instruments have a diameter of 3mm and no stitches are required at key hole. Common Minimally Invasive Surgeries in kids include Orchiopexy (for undescended testis), hernia repair, surgery for kidney blocks, kidney removal, appendicectomy, cholecystectomy, diagnostic laparoscopy, Anti-reflux surgery for gastro-esophageal reflux, cystoscopy for posterior urethral valves or ureterocele and many others. In short the scope of Minimally Invasive Surgery is limited only by Surgeon’s mind.