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Surgery Lite: Understanding Endoscopic Surgery

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

What is minimally invasive surgery? continued...

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.

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.

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