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
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
- 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,
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.