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Surgery Lite: Understanding Endoscopic Surgery

When is minimally invasive surgery better than traditional surgery? What are the risks?

What operations are possible?

The first endoscopic cholecystectomy - removal of the gallbladder -- was in 1987. That year kicked off the minimally invasive era.

Gallbladder removals, along with appendectomies, are some of the most common minimally invasive procedures in the country, says Malangoni. Keyhole approaches are used in a number of other fields - cardiology, urology, neurology, gastroenterology, gynecology, and many others. Companies have designed a number of endoscopes for specific operations. For instance, the laparoscope is used for surgery in the abdomen. Heart surgeons use a thoracoscope to examine the interior of the chest.

Many experts are now trying minimally invasive surgery for cancer. A 2004 study published in The New England Journal of Medicine found that laparoscopic surgery for colon cancer was as effective and safe as traditional techniques.

What are the advantages of endoscopic surgery?

"There are a lot of reasons people want minimally invasive surgery," says Argenziano. "Some don't want a scar. Others are focused on returning to normal life as quickly as possible. Others are trying to avoid the trauma of traditional surgery, especially if they have had it before and can't bear going through recovery again."

Minimally invasive techniques reduce the risk of infection and allow faster recovery. According to the American Academy of Family Physicians, you may need only one night in a hospital -- or none at all -- after laparoscopic gallbladder removal. After traditional surgery, you would be hospitalized for about five days.

Experts agree that for many common operations, minimally invasive techniques are as good or better than traditional procedures. Some, like laparoscopic gallbladder removal, have become the new standard.

Drawbacks and Safety Issues With Endoscopic Surgery

There are a few key drawbacks to endoscopic, or minimally invasive surgery:

  • Endoscopic operations may last longer.
  • They may be more difficult for the surgeon.
  • As a result, surgeons should be well-trained and experienced to perform these surgeries well.

"I've always said that minimally invasive surgery takes the pain of surgery away from the patient and gives it to the surgeon," says Argenziano. "That's still true, to some extent."

But there can be advantages to minimally invasive operations even for the surgical team. In many cases, the surgeon can see much more clearly with laparoscopic surgery, says William J. Hoskins, MD, Director of the Anderson Cancer Institute at the Memorial Health University Medical Center in Savannah, Ga.

And with a surgeon who is experienced with minimally invasive surgery, the operation may go quickly.

"Ninety percent of the cardiac operations that I do with minimally invasive techniques don't take any longer than traditional surgery," says Argenziano. "A few are actually faster."

What is the safety record of endoscopic surgery?

It's impossible to generalize about the safety of minimally invasive surgery. It depends on the specific operation.

Common laparoscopic procedures, like the removal of a gallbladder or appendix, are known to be as safe as open surgery. But that isn't the case for some newer, experimental techniques. For some forms of heart surgery or cancer treatment, for instance, we just don't know how well they work.

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