Less pain - now is the age of minimal invasive surgery

Less pain - now is the age of minimal invasive surgery

Tantri Yuliandini, The Jakarta Post, Jakarta

Long convalescences in hospitals and ugly postsurgery scars
are a thing of the past, thanks to today's advances in medical
science and the developments of minimal invasive surgery.

Minimal invasive surgery is basically a type of surgery that
uses minimal skin incisions to reduce access trauma. Because the
incisions made are small -- 2 millimeters (mm) to 12 mm in size
-- and the wound minimal, the technique avoids leaving
unattractive postsurgery scars, and at the same time, cuts down
on hospital recovery time.

Although relatively new in Indonesia, minimal invasive surgery
has been around since the beginning of the 19th century but was
not popular until the advent of high-resolution cameras in recent
years.

Many types of surgery can be carried out with minimal invasive
surgery, including laparoscopy or surgery through the abdomen,
such as hernia repair, splenectomy, and gastrointestinal
operations.

The laparoscopy procedure places ports -- varying in size from
5 mm to 12 mm -- throughout the abdomen. The abdomen is then
distended with carbon dioxide gas to provide enough room for the
surgical instruments to maneuver, and a small telescopic camera
introduced into the abdominal area for visual examination.
Surgery is then carried out externally, with the surgeon
monitoring the picture relayed by the camera.

According to Barlian Sutedja, president of the Pluit Hospital
in North Jakarta, the world's first laparoscopy was done in 1987
on a gall bladder.

However, the technique was only introduced to Indonesia in
1991, and only about 89 surgeons are currently able to perform
laparoscopic surgery, he said.

W.K. Cheah from the National University Hospital in Singapore
stated that after a laparoscopic hernia repair, a patient could
recover after only six days, compared with 10 days for
conventional surgery. The patient could also return to work after
14 days, compared with 21 days normally, and participate in sport
after only 24 days, compared with the usual 36 days.

However, laparoscopy does not bring with it a decrease in the
operative risk nor does it represent a surgical action requiring
less skill, Cheah said. On the contrary, the surgeon needs to be
more skillful in maneuvering the surgical instruments in a
limited space, as well as recognizing the anatomy.

"It is different from recognizing the anatomy from the
outside: From the inside many surgeons often have difficulty (in
this)," Cheah said.

The cost of a laparoscopic operation is higher by about 15
percent to 40 percent compared with a conventional operation,
Barlian said. However, the difference between the overall cost of
hospitalization is not all that great.

"Here at Pluit hospital, the overall hospitalization cost for
laparoscopic surgery is about Rp 7 million (about US$693), while
for conventional surgery it is about Rp 6.5 million," Barlian
said, explaining that the higher surgery cost for laparoscopy
were offset by a shorter hospitalization time.

Nonetheless, even with the advances in technology, it seems
that nothing can beat the sensitivity of the hands, and not all
abdominal surgery can be done using total laparoscopy.

"Tactile feedback is lost because our hands do not directly
touch the organs," Michael K.W. Li of the Pamela Youde Nethersole
Eastern Hospital in Hong Kong, said.

"More complex and advanced operations have not gained
popularity due to lack of confidence by surgeons in controlling
the operation via the total laparoscopic approach".

For this reason, experts have devised hand-assisted
laparoscopic surgery. Using this technique, surgeons can perform
more complex operations with an increased margin of safety and
without the loss of advantages of the total laparoscopic
approach, Li said.

"One very important advantage relates to the immediate control
of bleeding with the internal hand, and this greatly reduces the
stress factor for the surgeon during liver and pancreas
operations, for example" he said.

In the fifth meeting of minimal invasive surgery on March 2 at
Pluit Hospital, Cheah performed a demo-operation using the total
laparoscopic technique, while Li did a demo using the hand-
assisted laparoscopic surgery.

"This will have been the first time ever that hand-assisted
laparoscopic surgery was carried out in Indonesia," Barlian said,
adding that it would be an opportunity to watch and learn for the
surgeons attending the meeting.

With the 63 year-old man on whom he operated, Li made an
incision on the man's abdomen the size of his size 7 gloves, he
also made smaller incisions for the telescopic camera and
surgical instruments to enter.

"We use the nondominant hand, because we still need our
dominant hand to control the surgical tools," he said.

With his left hand placed internally, Li could determine with
confidence the position of the organs and could quickly zero-in
on the problem areas. Making incisions on the internal organs and
sewing up colons are also made easier with the steadying hand
inside the body.

"About 20 percent to 30 percent of laparoscopic surgery could
be done with the hand-assisted method," Li said.

And the best part is that the wound leaves a minimal scar and
the patient can go home soon.