Minimally Invasive Surgery

More and more surgical interventions are carried out with minimally invasive surgical procedures. These are gentler than conventional operations and shorten the hospital stay for patients after an operation.

What is Minimally Invasive Surgery?

The term minimally invasive surgery or keyhole surgery is a collective term for various surgical techniques in which surgery is performed through minimal skin incisions.

The term minimally invasive surgery (MIC) or Keyhole surgery is a collective term for various surgical techniques that use minimal skin incisions. Video cameras, light sources and surgical instruments are inserted into the body through these small incisions in the skin in order to be able to operate under the view of a video camera.

The great advantage of this method is that these small interventions are gentle on the skin and soft tissues, there are hardly any wound pain after an operation because of the only tiny incisions and patients recover more quickly from the interventions than with open operations. Since only tiny scars are created, the risk of adhesions is also reduced. That is why more and more operations are performed using the keyhole method.

Function, effect & goals

Due to the great advances in minimally invasive surgery, more and more minimally invasive surgery is used. The technical effort and the professional requirements for the surgeons are, however, much higher in these operations compared to conventional ones. Special skills are required for handling the special surgical instruments, including a. good spatial awareness and good coordination skills.

Most interventions are carried out with special optics and delicate instruments that are inserted into the body at various points, e.g. B. through the abdominal wall, chest wall or through joint capsules. During laparoscopic abdominal surgery, such as a laparoscopy, carbon dioxide is pumped into the abdomen to make room for the operation.

The enlargement of the operating field together with the targeted lighting creates optimal conditions for the display and visibility during the operation. In interventions such as arthroscopy on joints, water is used to expand the joint and to protect the surrounding tissue.

Due to technical advances, keyhole operations can already be performed for many diseases and orthopedic problems:

• Gallbladder removal
• Diaphragmatic hernia, reflux
• Gastric band / bypass
• Appendicectomy and other bowel surgery
• Removal of adhesions in the abdomen
• Inguinal hernia surgery
• Umbilical hernia and hernias
• Tissue biopsies
• Removal of superficial tumors
• Thyroid surgery
• Removal of abdominal cysts
• Examination of the fallopian tube patency
• Joint reflections
• Meniscal surgery
• Carpal tunnel operations
• Spinal surgery

In the future, more and more operations will be minimally invasive. Laparoscopic biliary removal has already become a standard procedure. The first minimally invasive interventions lasted up to 9 hours; today, uncomplicated interventions only take a maximum of an hour.

The advantages of MIC are obvious and have been extensively researched scientifically in recent years:

• minimal skin incisions
• less risk of adhesions and scarring
• less pain than with conventional surgery
• faster recovery after surgery
• Shorter hospital stays
• aesthetic advantages through minimal scars

For doctors, however, these interventions are technically no less complicated than conservative operations and involve at least the same amount of effort.

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Risks, side effects & dangers

Minimally invasive surgery is still a relative branch of surgery, which has undergone very strong technical development over the past few decades and has therefore been expanded to include many operations. In addition to many advantages, minimally invasive operations also have disadvantages and are not without risks.

On the one hand, the technology sets limits due to the two-dimensional orientation on the screen. On the other hand, the surgeon cannot use the sense of touch during these interventions.

Before a minimally invasive procedure, patients cannot be sure whether an open operation will be necessary because of complications or other necessities. You will therefore be informed about these risks before the anesthesia, as consent can no longer be obtained during the operation.

In addition, some MIS operations require the patient to be positioned in a special position, which also means additional risks, especially for people with heart disease. With some operations with the keyhole procedure, the risk is even higher than with an open operation. In the case of an inguinal hernia operation via a laparoscopy, the risk is higher than with a conventional operation, which is why surgeons are increasingly returning to open surgery in certain cases.

The MIS is generally gentler on the patient, but the surgeons have more physical complaints. In contrast to conventional operations, doctors have to work with their hands and arms in a very confined space and monitor their movements for hours on a monitor. 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 operate minimally invasively. Many suffer from shoulder / arm pain, carpal tunnel syndrome, back pain, headache and eye problems.

Overall, it can be said that minimally invasive surgery is a blessing in many cases, especially for patients, but careful consideration should be given to when such an intervention makes sense, especially with regard to possible complications. Since the technical possibilities are developing rapidly, further interventions will certainly become technically possible in the future.