MOTOROLA first released the cellular phone in 1983. That phone called the DataTAC weighed in at almost two pounds, had less than a one hour battery life, took 10 hours to charge and cost a whopping US$4,000. Since then, technology has allowed these cellular phones to evolve into smaller, smarter, cheaper devices. Similarly, surgery has evolved leaps and bounds from its origins. Initially we thought that in order to see better and to do more complex surgeries, we had to make a bigger cut. However, just as with the cellphone, we have found that bigger is not always better, and minimally invasive surgery (MIS) is a testament to that.
MIS involves any surgical technique that uses smaller cuts (or sometimes none at all) to get the job done. The advantages are clear and well documented. You'll likely have less pain after surgery, and therefore will need far less pain medication when compared to open/traditional surgery. The infection, internal scarring and bleeding rates are also generally lower. Cosmetic outcomes are superior, with most incisions being around the size of a fingernail when healed. Most patients can be sent home the same day of surgery or spend just a single night. You'll be back on your feet and feeling like yourself much sooner, with some people returning to work just one week after major surgery.
Economics of MIS
The operating theatre fees are higher for these procedures, owing to the special equipment needed. This is offset somewhat by the reduced hospital stay, and less medications used. Also, because you are able to return to work quicker, there is less income loss, especially for those whose income is dependent on them physically being at work. That being said, these MIS procedures are covered by our insurance companies, thus making them just as affordable as open surgery.
In the field of gynaecology, MIS includes laparoscopy (keyhole surgery), hysteroscopy and vaginal procedures.
Here a thin lighted camera is inserted into the belly, usually through the navel, to provide high-definition video of the internal organs. Then depending on what is being done, one to three smaller incisions are made to allow insertion of specialised surgical instruments to perform the procedure itself. We can use laparoscopy to diagnose the cause of pelvic pain and infertility, as well as to treat a variety of conditions. Ovarian cysts, fibroids and endometriosis can all be treated using laparoscopy.
This uses an even smaller camera to look inside the womb and perform surgeries in that area. Finding the cause of abnormal/ heavy periods is a common reason to have this done. The advantage of hysteroscopy over other diagnostic procedures is that we can treat the problem at the same time. Certain fibroids, polyps, scar tissue impairing fertility can all be removed at the time of hysteroscopy.
The vaginal hysterectomy (removing the womb) is probably the OG of minimally invasive surgery. Its use goes back over a century before the first laparoscopy was done. Here, the entire womb (with or without the ovaries) are removed through the vagina with no cuts. It is actually amazing that this age-old technique is somewhat equal or superior to its laparoscopic counterpart. Same advantages of reduced pain, bleeding, infection and hospital stay, plus the added benefit of having no cuts on the belly whatsoever. I remember patients asking me if I was sure I took out their womb, one of whom even demanded an ultrasound to be certain.
Is MIS right
YES! With all the advances in surgery, and the known benefits of MIS, the question shouldn't be if it's right for me. The answer will most times be yes. Now don't get me wrong, there is a role for open surgery as not every fibroid or cyst can be handled minimally invasive. In fact in our setting, our women tend to have many large “breadfruit-sized” fibroids, and these are often best managed with open surgery. Some suspected cancer surgeries are also better managed with an open approach. However, most if not a great percentage of gynaecological surgeries can be handled with a MIS approach.
My advice would be to think minimally invasive first. Ask if your surgery can be offered using a MIS technique, and if you are not convinced, get a second opinion. It's 2022, don't settle for a DataTAC when the latest smartphones are available.
Dr Ryan Halsall is a consultant obstetrician gynaecologist who operates at ILAP Medical, 22 Windsor Avenue, Suite 2, Kingston 5. He can be contacted at email@example.com or 876-946-0353. Follow him on Instagram: @drhalsall
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