Minimising pain and maximising gain

Minimising pain and maximising gain
Minimally invasive surgical techniques have become increasingly sophisticated to offer more benefits to patients. Priya Kulasagaran looks at common types of minimally invasive procedures carried out today

Surgery can seem like a scary procedure to undergo. This is in part due to the popular image of what open surgery looks like; a patient lying unconscious while his body is hacked at by surgeons wielding any number of sharp instruments. Never mind that this has not been the case for most surgeries being performed in this day and age.

For a long time, traditional open surgery was the only choice patients had. Aside from the thought of literally having your body sliced open, one also had to contend with the aftercare involved. The larger the surgical wound, the higher your chances are of pain and infection, hence leading to longer stays at the hospital before you are given a clean bill of health.

With advancements in modern medicine in the past few decades, minimally invasive surgery (MIS) has increasingly become an alternative way of going under the knife. With MIS, doctors use specialised tools which enable them to access the body’s internal organs through smaller incisions, and less trauma to the body, in comparison to open surgery. Patients who undergo MIS also generally experience less pain and complications, and a faster recovery period.

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A common example of MIS is laparoscopy, also sometimes known as ‘keyhole surgery’. Here, the surgery is carried out through several small incisions, and involves the use of small tubes and tiny cameras to help the surgeon ‘see’ and manoeuvre surgical instruments in the body.

Although MIS techniques have been readily available in Malaysia for the past 30 years or so, a substantial number of people are still unaware of the possibilities offered by this type of surgery. In a bid to educate the general public about MIS, Gleneagles Kuala Lumpur held a ‘showcase’ of MIS called ‘Less Pain, More Gains – Minimally Invasive Surgery’ at Kidzania recently.

Aside from an exhibition of the evolution of MIS techniques, the hospital also held a special sneak peek for the media as to how some of these surgeries are performed by two of their specialists; Consultant Colorectal and Laparoscopic surgeon Dr Paul Selvindoss and Consultant Orthopaedic surgeon Dr Charanjeet Singh.

With the first laparoscopic cholecystectomy (removal of the gallbladder) performed in 1985, Dr Paul explained that for many abdominal procedures, such as removing kidney stones, MIS is now seen as the default technique rather than an experimental procedure. “About 40 years ago, people used to say that the bigger the scar, the better the surgery; that’s hardly the case anymore,” he said. “It does require specialised training because of the hand-eye coordination involved; your viewing the body through a scope (inserted into the body) instead of seeing it ‘first-hand’ and you need to know how to use the tools.”

As Dr Paul shows a video of laparoscopic surgery, it’s easy to see why, as handling laparoscopic tools seem similar to handling chopsticks. “Compared to my time as a student, younger surgeons these days are trained in these techniques during their residencies itself,” adds Dr Paul, who runs training workshops himself. “While MIS is preferable to open surgery, because of the benefits to patients in terms of pain and recovery time, there are instances where it might not be a suitable option. The most important thing surgeons need to know is that switching to an open surgery, sometimes even during the procedure, is not a sign of ‘failure’. At the end of the day, as doctors, everything we do must be for the benefit of the patient.”

Meanwhile, Dr Charanjeet focused his presentation on arthroscopic surgery, which involves the examination and treatment of joints through an arthroscope (a thin metal tube that has a light and camera attached to it) that is inserted into the joint through a small incision. “The word arthroscopy comes from two Greek words; ‘arthro’ meaning joint, and ‘skopein’ meaning to look,” explained Dr Charanjeet. “Technically, it can be done for virtually all types of joints, but I am not a proponent of this because the method does have its limitations. But we tend to use it for the knee, shoulder, wrist, ankle, hip and elbow.” Taking knee replacement surgery as an example, he added that arthroscopy can help treat meniscus tears as well as damage to the cartilage and ligaments without the need for large incisions or the risk of cutting through muscle.

Dr Charanjeet also demonstrated how minimally invasive techniques can be used to treat fractures, particularly Minimally Invasive Plate Osteosynthesis (MIPO) which enables doctors to slide a plate into the body through a relatively small incision. “With conventional surgery, you have make an incision that is the length of the plate used — so that would obviously mean a larger wound, and longer healing time,” he said.

Of course, these sophisticated techniques do come with a price, namely a larger hospital bill. For those who can afford to consider the option however, MIS may be the way to go if you want to get back on your feet as soon as possible. “There’s no denying the cost involved for some MIS techniques,” admits Dr Charanjeet. “But it has made a lot of difference in the lives of many people; there is not having to sit around waiting to fully recover for one. There have been cases of patients undergoing knee surgery and walking the next day. Ultimately, it’s about giving patients options so that they can choose what suits them the best.”

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