Surgery via keyhole
Dr. RAMESH BABU SRINIVASAN
IN the Mahabharatha, Arjuna was asked to perform the impossible task to win princess Draupadi's hand. He had to shoot down a revolving fish with his arrow without looking at the fish directly. He could take aim only by its reflection in the water below.
Laparoscopy is one such technique, mastered many centuries later, which follows a similar process. Here the surgeon who operates does not look directly at the parts but at their image on television.
Laparoscopic surgery is also known as "keyhole surgery", as no cut is made. Instead the surgery is performed via tiny holes. The laparoscope is a telescope-like instrument used to visualise organs inside the body. This is passed inside the tummy via the navel. The tummy is distended with a gas to make more room.
Two or three small pencil-like instruments are passed on the sides along with it to perform the procedure. Initially started in adults to remove gallstones, the technique is now successfully being used in children also. It is usually done under general anaesthesia.
The advantages are many. As there is no cut, there is no scar. There is almost no pain as there no cuts are made.
The healing is also faster. Complications of wound healing are lesser. Patients recover more quickly and can be discharged faster and this helps to reduce the cost. There isn't much restriction in games or sports after surgery
Laparoscopic surgery has been performed safely in children. There are no disadvantages. However one has to be prepared for open surgery in case there is instrument failure or technical difficulty. The common operations performed this way include operations for appendicitis; gall stones; spleen surgery; kidney surgery; varicocele; undescended testis; empyema (pus in chest); and ovarian problems.
Laparoscopy can be used as a diagnostic modality in situations where the cause of abdominal pain is not known. It is useful to take biopsies from inside in conditions like tuberculosis of abdomen. In addition there are multiple problems of bowel and other organs that can be tackled via laparoscopic surgery. It is particularly useful in older children and adolescent girls in whom it is desirable to avoid a long scar.
The author is a paediatric surgeon and urologist based in Chennai.
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