What is keyhole surgery?
Keyhole surgery, or minimally invasive surgery, is a surgical method used to access the interior of the body through a small incision, removing the need for open surgery. Generally, keyhole surgery is used to access the abdomen and the female pelvic organs in a procedure known as a laparoscopy. When used to access the thorax (chest), the procedure is known as a thoracoscopy.
During keyhole surgery, a thin telescope fitted with a light source and a camera – called a laparoscope – is passed through a small incision in the skin, giving doctors a magnified view of the inside of the body. Surgical instruments can also be passed through the incision, allowing surgeons to operate.
Keyhole surgery may be used to diagnose certain medical conditions, as well as to perform a variety of surgical procedures, such as the removal of damaged or diseased organs or parts of organs.
Keyhole surgery is a commonly performed procedure with a number of advantages over traditional open surgery. These include reduced recovery times after the surgery and reduced levels of pain, scarring and hemorrhaging. The procedure is generally safe, though possible complications do exist.
When is keyhole surgery needed?
Keyhole surgery can be used to diagnose and treat a range of conditions.
It is most commonly used in:
- Gastroenterology: To diagnose and treat conditions related to the digestive system
- Gynaecology: To diagnose and treat conditions related to the female reproductive system
- Urology: To diagnose and treat conditions affecting the urinary system
If non-invasive diagnostic methods like ultrasound or CT scans prove ineffective or produce no conclusive results, keyhole surgery may be necessary. Keyhole surgery may be used to help diagnose conditions including:
- Inflammation of the gallbladder/gallstones
- Pelvic inflammatory disease
- Ectopic pregnancy
- Ovarian cyst
- Female infertility
- Unexplained abdominal or pelvic pain
Keyhole surgery may also be used to obtain a tissue sample (in a procedure called a biopsy). This involves extracting a small amount of tissue from the relevant area, before sending it to a lab for analysis. The information collected by performing a biopsy can help diagnose and differentiate between various types of tumours, which may be non-cancerous growths, as well as cancer.
Keyhole surgery can also be used as a treatment option. It is commonly used to:
- Remove the appendix in cases of appendicitis
- Remove the gallbladder
- Remove sections of the intestine
- Treat hernias (when an organ or part of an organ protrudes through a weak spot in the abdominal wall)
- Treat problematic stomach ulcers
- Remove or partially remove organs affected by cancer, including the ovaries, kidneys, colon, liver, prostate and bladder
- Treat ectopic pregnancy
- Remove fibroids
- Remove the womb, in cases of pelvic inflammatory disease or endometriosis, for example
How is keyhole surgery performed?
Keyhole surgery is normally performed under general anaesthesia. While under general anaesthesia, the person undergoing surgery is put to sleep and woken up once the procedure is complete.
Once under general anaesthesia, first, the individual’s skin will be cleaned, before a number of small incisions (usually 2 to 3 incisions, 1-2 cm long) are made through the skin. Gas, usually carbon dioxide or nitrous oxide, is injected through one of the incisions, inflating the abdomen and allowing doctors to see more clearly. The laparoscope will then be inserted through the incisions, with the attached camera allowing doctors to see images from inside the cavity.
In most cases, multiple incisions will be necessary in order to allow different surgical instruments to be used during the procedure. A more modern technique called a single-port laparoscopy allows doctors to perform operations using a single incision.
After the procedure is complete, all instruments will be removed and the incision will be stitched up and dressed.
How to prepare for keyhole surgery
Before going under general anaesthesia, a period of fasting will generally be necessary, which will also involve refraining from chewing gum or smoking, for example. Doctors will give specific instructions on how to go about this, and these will need to be followed closely.
Recovering from keyhole surgery
After the procedure, people, who have undergone keyhole surgery, will be observed in hospital for a number of hours while having their vital signs monitored. The amount of time necessary for observation will depend on the condition of the individual and the type of anaesthesia used. In some cases, a hospital stay of 1-3 days, or, more rarely, of up to a week may be necessary.
In the hours and days following surgery, a person may feel mild to moderate pain in the area where the incision was made. As a result of the gas, pain may also be felt in the shoulder area and bloating may be experienced. These side-effects will usually subside in a number of days.
If keyhole surgery has been used to diagnose a condition, regular activities can normally be resumed in under a week. If used to treat a condition, recovery times will depend upon what kind of surgery has been undertaken, with recovery times usually ranging from 2 to 12 weeks.
Complications associated with keyhole surgery
Severe complications as a result of keyhole surgery are rare, while minor complications are more common but generally easily treatable.
Possible minor complications include:
- Nausea or vomiting (this is a non-serious reaction to the anaesthetic and affects roughly 20 to 30 percent of people who undergo keyhole surgery)
- Bruising or bleeding around the incision
- Infection of the incision area
Possible major complications include:
- Damaged organs, which could lead to organ failure
- Injured blood vessels/artery damage
- Complications associated with the use of carbon dioxide during the procedure – for example, gas bubbles entering the bloodstream
- Serious allergic reaction to general anaesthetic
- Blood clotting
- Infection of deeper areas beyond the incision, involving the entire abdominal wall or the lining of the abdominal cavity
Advantages of keyhole surgery over open surgery
There are a number of advantages of keyhole surgery over traditional open surgery.
Reduced physical impact: Operating through small incisions rather than large open wounds reduces the amount of blood that is lost, as well as the pain and discomfort that is felt by the patient after the surgery. Due to the small size of the instruments used during the procedure, tissue damage is also reduced. On the outside of the body, this will result in smaller scars, giving improved cosmetic outcomes after the surgery compared to open surgery.
Reduced risk of complications: After the procedure, the risk of complications such as infection, hernia and cellulitis (bacterial infection of the skin and tissues beneath the skin) is also lessened. Risks associated with the partially unavoidable cooling, drying and excessive handling of internal organs are also less likely in keyhole surgery as opposed to open surgery.
Reduced recovery time: The necessary recovery time after keyhole surgery is also shorter than that following open surgery, reducing the risk of conditions associated with extended periods of bed rest such as muscle atrophy, bone loss and pneumonia. Given the small size of the incision, scarring is also significantly reduced.
There are, however, disadvantages of keyhole surgery. The primary drawback is that, due to its complex nature, keyhole surgery can often take longer to perform than open surgery, therefore also requiring a longer period under general anesthesia.
Keyhole surgery FAQs
Q: Can I have keyhole surgery on the knee?
A: Yes, a type of keyhole surgery called an arthroscopy can be used to diagnose and treat problems in the knee. The technique can also be used on the ankles, elbows, shoulders, wrists and hips. An arthroscopy is generally considered to be a safe procedure, though, like any surgical procedure, it does come with some risks.
Q: What is the recovery time for keyhole surgery?
A: The recovery time for keyhole surgery differs from case to case, depending largely on the reason why the procedure has been carried out. If keyhole surgery has been used to diagnose a condition, a person will normally be able to recover within five to seven days. If keyhole surgery has been used to treat a condition, recovery can take between 2 and 12 weeks, depending on whether the surgery was minor or major.
NCBI. “Does laparoscopic surgery spell the end of open surgery?” November, 2003. Accessed August 31, 2017. ↩
MIBHS. “Advantages and Disadvantages of Minimally Invasive Surgery.” June 15, 2016. Accessed August 31, 2017. ↩