More and more surgical procedures are being performed using minimally invasive surgical techniques. These are gentler than conventional surgery and shorten the hospital stay for patients after surgery.
What is minimally invasive surgery?
The term minimally invasive surgery, or keyhole surgery, is a collective term for various surgical techniques that use minimal incisions in the skin. The term minimally invasive surgery (MIS) or keyhole surgery is a collective term for various surgical techniques in which operations are performed via minimal skin incisions. Video cameras, light sources and surgical instruments are guided into the body through these small skin incisions in order to be able to operate under the view of a video camera. The great advantage of this method is that these small incisions protect the skin and soft tissues, there is hardly any wound pain after an operation because of the only tiny incisions, and patients recover more quickly from the procedures than with open operations. Since only tiny scars are produced, the risk of adhesions is also reduced. That’s why more and more surgeries are being performed using the keyhole method.
Function, effect and goals
Due to the great advances in minimally invasive surgery, more and more operations are being performed using minimally invasive techniques. However, the technical complexity and professional requirements for surgeons are much higher in these operations compared with conventional ones. Special skills are required to handle the special surgical instruments, including good spatial awareness and coordination skills. Most procedures are performed with special optics and delicate instruments that are inserted into the body at various points, such as through the abdominal wall, chest wall, or joint capsules. During laparoscopic surgery in the abdominal cavity, such as a laparoscopy, carbon dioxide is pumped into the abdominal cavity to create sufficient space for the operation. The magnification of the surgical field together with targeted lighting creates optimal conditions for visualization and visibility during surgery. For procedures such as arthroscopies on joints, water is used to expand the joint and protect the surrounding tissue. Because of advances in technology, keyhole surgery can now be performed for many conditions and orthopedic problems:
- Gall bladder removal
- Hiatal hernia, reflux
- Gastric band/bypass
- Appendectomy and other intestinal procedures
- Solution of adhesions in the abdomen
- Inguinal hernia surgery
- Umbilical hernia and incisional hernias
- Tissue biopsies
- Removal of superficial tumors
- Thyroid surgery
- Removal of abdominal cysts
- Testing the patency of the fallopian tubes
- Arthroscopy
- Meniscus surgery
- Carpal tunnel operations
- Spinal surgeries
In the future, more and more surgeries will be able to be performed minimally invasive. Laparoscopic bile removal has already become a standard procedure. The first minimally invasive procedure still took up to 9 hours, today uncomplicated procedures only take a maximum of one hour. The advantages of MIS are obvious and have been extensively researched scientifically in recent years:
- Minimal skin incisions
- Less risk of adhesions and scar fractures
- Less pain than with conventional surgery
- Faster recovery after operations
- Hospital stays shorter
- Aesthetic advantages due to minimal scars
For doctors, however, these procedures are technically no less complicated than conservative surgery and require at least the same amount of effort.
Risks, side effects and dangers
Minimally invasive surgery is still a relative branch of surgery that has undergone a great deal of technical development in recent decades, which has allowed it to be extended to many operations. Minimally invasive surgery has many advantages but also disadvantages and is not without risks. On the one hand, there are limits imposed by the technology due to the two-dimensional orientation on the screen. On the other hand, the surgeon cannot use the sense of touch as much during these operations.Patients cannot be sure before a minimally invasive procedure whether open surgery will be necessary after all due to complications or other necessities. They are therefore informed of these risks before anesthesia, since consent can no longer be obtained during surgery. In addition, some MIS procedures require special positioning of the patient, which also poses additional risks, especially for people with heart disease. For some operations using the keyhole method, the risk is even higher than for open surgery. For hernia surgery via laparoscopy, the risk is higher than for conventional surgery, which is why surgeons are increasingly returning to open surgery in certain cases. Although MIS is gentler for patients overall, physical discomfort increases for surgeons. Unlike conventional surgery, surgeons must work with their hands and arms in a very confined space and monitor their movements on a monitor for hours. In addition, the ergonomics of the operating tables are not adapted to these surgical procedures. Occupational diseases are on the rise among surgeons who frequently perform minimally invasive operations. Many suffer from shoulder/arm pain, carpal tunnel syndrome, back pain, headaches and eye problems. Overall, it can be said that minimally invasive surgery is a boon in many cases, especially for patients, but careful consideration should be given to when such surgery is appropriate, especially in light of potential complications. As technical capabilities are rapidly evolving, more procedures will certainly become technically feasible in the future.
