• What is keyhole surgery?
• Benefits of laparoscopic surgery
• Limitations of laparoscopic surgery
• The operations
• The instruments

What is keyhole surgery?

The term keyhole surgery is widely used and generally refers to any surgical technique that uses very small incisions to gain access to the target organ. Examples include laparoscopic surgery which treats intra-abdominal disease, thoracoscopic surgery the chest, transurethral-the urinary tract, arthroscopic-joints and endoscopic hollow organs including the gut and sinuses and lungs.

This web site is dedicated to information about laparoscopic abdominal surgery of the gastrointestinal tract and relevant endoscopy including colonoscopy and gastroscopy. The site is system orientated and divided into 4 main areas gallstone disease, bowel (colorectal) disease, acid reflux and hernias. These are the areas of my personal experience and expertise.

Laparoscopic surgery is made possible by a combination of advances which have come together to deliver a new era of safer and more effective surgery with minimal patient trauma. These advances include the following

1. High grade digital camera systems which give sharp well lit and magnified views of even the most inaccessible areas of the abdominal cavity. These views allow surgeons to see clearly areas of the abdomen which in open surgery are hidden down a deep hole full of shadows of the sweating assistant. Keyhole surgery in the obese patient is often much easier than the open equivalent. With the patient completely asleep the abdomen is inflated with CO2 gas to provide space to operate
2. Specialised instruments, many of which are for single patient use, extend the surgeons reach and allow dexterous movements. Single patient use is the ultimate protection from cross infection with viruses and prions such as HIV, hepatitis and new variant BSE.
3. Advanced cutting and coagulation technology affording bloodless surgery and reducing or eliminating blood transfusion requirements.
4. Stapling technology facilitating division and reconnection of gut in single movements.
5. Training opportunities on a global scale and of the highest calibre have accelerated spread of new skills and ideas. In the last year alone I have visited experts in Paris, Edinburgh, Colchester and Birmingham often to operate with other specialists. Even after 14 years of specialist experience in laparoscopic surgery I am still excited by the pace of advance. I have always taken every opportunity to learn more and have made trips to the United States and Europe on a regular basis to ensure that my patients benefit from the latest advances.

Back to top

Benefits of laparoscopic surgery are well recognised
Smaller incisions give less pain.

Patients need fewer pain killers and suffer fewer side effects of painkillers such as nausea and drowsiness.

Nausea and gut paralysis after open surgery prevents patient eating. After keyhole surgery patients nutrition is rapidly restored giving them the strength to heal and recover.

Less pain leads to early mobilisation. Not only do patients leave hospital earlier they recover quicker at home and return earlier to normal activity and if employed, their work.

Less time immobile hospital means less chance of a DVT (clot in the leg), pressure sores. Hospital acquired infections and general debility are avoided. Patients having keyhole surgery are less prone to MRSA and clostridium difficile infections. Ultimately this translates into lower death rates after surgery.

Clearly small wounds mean small wound problems. Less infection, less haematoma and critically, few debilitating hernias and chronic wound pains which may require further surgery.

Chronic wound pain after laparoscopic groin hernia surgery is 5 times less common than with open surgery. This includes the local anaesthetic techniques as practiced by the mass market hernia centres advertised on the radio and in newspapers.

Older patients may need nursing home care after open surgery. This is less common after keyhole surgery.

The immune system is suppressed by the insult of open surgery. Keyhole surgery has less impact on the immune system. There is some evidence that this may translate into better cancer outcomes after keyhole surgery as well as fewer infections.

Finally intestinal obstruction due to adhesions to big incisions is a major problem after open surgery. Some patients who survive open cancer surgery subsequently die from adhesion related intestinal obstruction. Keyhole surgery causes fewer adhesions.

Certainly this is likely to be the surgery of tomorrow as well as today.

Back to top

Limitations of laparoscopic surgery

Gross problems may require gross solutions: big cancerous and inflammatory masses and huge hernias may be best dealt with by open surgery if at all. I will always tell you if I feel that I should do open rather than keyhole surgery.
Abdominal keyhole surgery generally requires general anaesthetic so the patient must be passed fit for general anaesthesia.
Finally open surgery has healed many patients and will do so in the future. If cost is a major consideration or appropriately trained surgeons and support staff and facilities are not available then open surgery may be necessary

Back to top

The operations.
Common procedures performed

• Laparoscopic Cholecystectomy
• Laparoscopic bile duct exploration
• Laparoscopic anti-reflux surgery
• Balloon dilation of an oesophageal stricture
• Lap groin hernia repair
• Lap incisional hernia repair
• Open sublay incisional hernia repair
• Gastroscopy
• Laparoscopic colon resection.
• Colonoscopy

Less common laparoscopic procedures

• Heller’s cardiomyotomy
• Splenectomy
• Biliary and gastric bypass surgery
• Rectopexy