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Surgery Lite: Understanding Endoscopic Surgery
When is minimally invasive surgery better than traditional surgery? What are the risks?
Reviewed by
Matthew Hoffman, MD
When is minimally invasive surgery better than traditional surgery? What are the risks?
It's not often that a surgical technique becomes a national craze. But endoscopic or minimally invasive surgery has, albeit a minor one. It's in the newspaper. It's on the lips of your uncle, who can't resist showing off his tiny scars at every family function. Even on your commute to work, billboards trumpet the minimally invasive surgery centers at competing local hospitals.
"For patients, 'minimally invasive' are the hot buzzwords," says Michael Argenziano, MD, director of minimally invasive cardiac surgery and arrhythmia surgery at New York Presbyterian Hospital. "And surgeons are responding to their patients' demand. I don't think that there's a single surgical field that hasn't tried some sort of minimally invasive approach."
While the term is pretty vague, "minimally invasive" - or endoscopic or "keyhole" surgery - generally means operations that are less traumatic than traditional surgery. By using special instruments, the approach can allow for smaller incisions, quicker recovery, and fewer side effects. Since it was first used in the late 1980s, minimally invasive surgery has changed the standards for how many operations are done.
It makes intuitive sense to patients. Why get cut open if you can avoid it?
But minimally invasive surgery isn't right for everyone. Despite what you hear, "minimally invasive" doesn't always mean "better."
"People have this idea that minimally invasive surgery is not painful or that it's not really surgery," says Marshall Z. Schwartz, MD, professor of surgery in pediatrics at St. Christopher's Hospital for Children in Philadelphia. "Neither is true. It's not Star Trek technology, where we wave a wand over someone and they're healed."
Getting the Facts on Minimally Invasive Surgery
When it comes to deciding whether to get minimally invasive surgery, the key is to make an informed decision.
What is minimally invasive surgery?
If you think about it, traditional surgery can seem crude. For instance, in order to correct a problem deep in the heart, traditionally surgeons have to crack open the chest. They have to cut through bones and muscle before they can operate. The long and painful recovery largely stemmed from the side effects and not the surgeon's work on the heart itself.
Minimally invasive surgery tries to avoid these problems.
"Minimally invasive surgery focuses more on the quality of life for the patient," says Mehmet Oz, MD, director of the Cardiovascular Institute at the Columbia University Medical Center in New York. "It's a trade-off. You accept some negatives, like maybe a longer operating time, in order to improve the patient's experience."
The specifics of these operations vary widely. In general, minimally invasive surgery uses an endoscope. This is a long, flexible tube with a camera and light attached. It is inserted into the body through a small incision. The image is sent to a screen that the surgeon watches during the operation. The surgeon also makes other small incisions to insert whatever tools are necessary to do the procedure.
The number and size of the incisions depend on the operation. Mark A. Malangoni, MD, professor of surgery at Case Western Reserve University School of Medicine in Cleveland, says that for simple procedures - like diagnostic tests, in which the endoscope is used only to look around - a small incision, 1/3 of an inch, is all he needs. If larger instruments are needed - or large organs are being removed - he needs bigger incisions, perhaps up to 3/4 of an inch.
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