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'Keyhole surgery was my solution' – Yahoo! India News
Minimally invasive or keyhole surgery is being increasingly used for the treatment of various conditions ranging from heart disease to cancer and brain trauma. The idea of the long rehabilitation period required after a knee surgery led Dr Priyadarshi Jitender Kumar to choose an arthroscopy instead, after he suffered a meniscus tear in his right knee.
A meniscus tear is a sports injury which leads to uneven distribution of your body weight, affecting the bones in the legs and causing early arthritis of the knee joint. The surgical option for this condition involves trimming of the torn portion of meniscus. However, Dr Priyadarshi did not want to undergo open knee surgery. ''Since I am a doctor, I know that an open knee surgery is no less invasive than a knee replacement and restricts movement for a long time. So I decided to go in for knee arthroscopy, which is a minimally invasive surgery,'' he says.
A minimally invasive procedure is a procedure that is less invasive than open surgery used for the same purpose. It is also referred to as keyhole surgery, since the operation involves making small incisions to introduce the laparoscopic instruments, rather than a large incision, as in conventional surgery. A Knee arthroscopy is a simple operation which requires two small incisions of size 3-4 mm as compared to open knee surgery in which a cut of 7-8 inches is made.
A flexible tube with a small camera is put through one incision and doctors get a magnified inner view of the knee on the TV screen. Surgical instruments are inserted through another incision to do the repair work. ''The benefits of arthroscopy are that there is a smaller scar, no muscle loss, and not much physiotherapy is required to get the patient back on his feet,'' says Dr R K Sharma, senior consultant, orthopaedics, Indraprastha Apollo Hospital. Dr Priyadarshi was able to walk after six hours of arthroscopy and returned to work on the fourth day after the procedure.
''I decided to take a break of four days but that was just a precaution. I was not restricted to bed and carried on my routine activities with ease,'' he recalls. A minimally invasive procedure such as this one creates less operative trauma for the patient than an equivalent invasive procedure.
It causes less pain and scarring, and a patient is ensured both a speedy recovery and a fewer post-surgical complications such as adhe-sions. However, minimally invasive surgery is not necessarily a minor surgery that requires only regional anesthesia: In fact, most procedures still require general anesthesia.
Endoscopy, percutaneous surgery, laparoscopic surgery, coronary catheterization, angioplasty, stereotactic surgery and many other treatments that leave a huge scar on the skin are now being replaced with procedures that are minimally invasive. Some of the most common minimally invasive surgeries in our country are gall bladder stone removal, hernia, appendicitis, weight loss surgery, gastric reflux surgery, colon surgery, hysterectomy and fibroids Dr Deep Goel, head of minimally invasive and bariatric surgery, Artemis Health Institute, says the minimal invasive surgery has made gall bladder operations much simpler.
Instead of 4-6 inch incision made earlier, the new technique requires just three holes to be made in the abdomen. ''A telescope goes inside one of them and we get a magnified view on a television screen. Instruments are inserted through other two holes and we get the stones out. The gall bladder is also deflated and extracted from one of the holes. Conventional surgery puts patients at risk of wound infection and hernia besides delaying the recovery,'' Dr Goel adds.
Pushpendra Vats went in for a keyhole procedure recently and says it has been a real boon. Vats avoided a surgery for the removal of his gall bladder stone for four years out of fear. ''I was scared as I had a surgery for appendicitis around 20 years ago that led to a severe infection which forced me to quit school for one year,'' he explains. However, Vats knew some intervention was called for, since the stones in his gallbladder were getting bigger and caused him excruciating pain.
Fortunately, he heard about the minimallyinvasive surgery being done at Artemis Health Institute. ''I was shown videos about the surgery which helped me decide to go in for it,'' he says. This turned out to be a good decision. ''The next morning I went straight from the hospital to the office. I never thought a surgery could be this easy,'' says the 35-year-old.
A minimally invasive procedure involves the use of laparoscopic devices and special medical equipment such as fibre optic cables, surgical instruments and miniature video cameras. Instruments are manipulated by a remote control while viewing the surgical field indirectly through an endoscope or similar device.
This is done via tubes inserted into the skin or through a body cavity or anatomical opening. The images of the interior of the body are transmitted to an external video monitor, enabling the surgeon to make a diagnosis and actually perform a surgery on the basis of this. Such procedures have some of the same risks and complications as open surgeries.
These include anaesthesia or medication reactions, infections, internal organ injury, and vein or lung blood clotting, breathing problems and may rarely even cause death. There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold and dry gases during the procedure. Doctors suggest the use of heated and humidified CO2 to reduce this risk for simple procedures. Despite these issues, the future of minimally invasive procedures looms bright.
Minimally Invasive Coronary Artery Bypass Grafting (MICS CABG) was recently done on 53 year old Mrs. Singhal, who was diagnosed with multiple artery blockages after she complained of radiating pain in her left arm. The surgery was performed by a team of experts headed by Dr.Naresh Trehan, Senior Cardiovascular and Cardiothoracic Surgeon and Dr. Yatin Mehta, Sr. Consultant Anaesthesia Apollo.
''This new procedure uses two simultaneous grafts, a unique technique used for the first time in India which will revolutionalize treatment for those with cardio vascular disease. The technique allows a surgeon to suture coronary artery bypass grafts safely and effectively without leaving a big scar and simultaneously offers the benefits of beating heart surgery,'' says Dr Naresh Trehan.
Advantages include a shorter length of hospital stay, fewer blood transfusions, improved cosmetic outcomes and a lower cost. Minimally invasive surgery is also being used extensively in cancer treatment: A study published in The New England Journal of Medicine found that laparoscopic surgery for colon cancer was as effective and safe as traditional techniques.
Doctors are also experimenting with robotic surgery, an extension of minimally invasive techniques. The difference is that the surgeon uses robotic arms instead of endoscopes and other tools. Brain tumors have also been successfully treated with the help of minimal invasive technology.
A minimally invasive surgery causes less pain and scarring and fewer post-surgical complications than an equivalent invasive procedure