What is minimal access (keyhole) surgery?
Minimal access surgery utilizes the technology of telescopes video monitors and minaturized instruments to carry out operations without making large incisions. This is less traumatic for the patient and offers dramatically shortened recovery times. Because of magnification and miniaturized instruments, the surgery is often more precise and with less blood loss than traditional surgery. Gynaecologists began developing minimal access technology in the mid 1980s, and throughout the 1990s many procedures such as removal of ectopic pregnancy and hysterectomy became mainstream techniques. Progress is continuing in increasing the range of operations that can be carried out through minimal access surgery, and improving the outcomes of existing operations.
Do all surgeons carry out keyhole surgery?
Most gynaecologists in New Zealand are able to carry out a range of basic minimal access procedures such as the removal of ectopic pregnancies or ovarian cysts. However advanced procedures such as Total laparoscopic hysterectomy, Excision of deep infiltrating endometriosis, Laparoscopic pelvic floor repair, and Laparoscopic tubal microsurgery require specialized training. There is a steep learning curve associated with each procedure, and it may take many years to master the skills to carry out minimal access surgery safely and efficiently.
What operations can be carried out with keyhole surgery?
An increasing range of operations can now be carried out with keyhole surgery in both general surgery and gynaecology. Examples are:
- Gall bladder removal
- Appendicectomy
- Hiatus hernia repair
- Hysterectomy
- Ovarian cystectomy and oophorectomy
- Excision of endometriosis
- Pelvic floor repair
As technology develops, so does the range of operations we can accomplish with minimally invasive techniques.
Do complications occur?
Complications can occur with all forms of surgery. Once the surgeon has been fully trained and is over the learning curve for each operation, the incidence of complications is no greater than for traditional, open operations ( and for some operations is considerably less). The risk of complications depends on the type of surgery that is being carried out and obviously high risk operations such as excision of deep infiltrative endometriosis carry a much higher risk of complications than simple operations. At Endoscopy Manawatu we are registered as specialists by the New Zealand Medical Council and participate in recertification program administered by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. We keep an audit database of all operations so that we can monitor our rate of complications and ensure quality control.
Is minimal access surgery more expensive?
Minimal access surgery can take a longer time in theatre than conventional surgery and therefore theatre charges may be higher. There may also be additional charges for some disposable items of equipment. However the number of days in hospital is reduced significantly, which tends to balance out the increased theatre cost. In addition you may be able to return to work several weeks earlier, which may be a major saving to you, both in cost and convenience.