8 Facts About Paediatric Keyhole Surgery in Malaysia Parents MUST Know
In keyhole surgery for children, a few tiny incisions, the size of little dots, are made on the abdomen or chest to conduct the surgeries inside. This process, when done in the abdomen, is called Laparoscopic surgery or Thoracoscopic surgery in the chest.
Children’s keyhole surgery has been around since the 1990s in Malaysia but many parents are still unaware of its benefits and advantage over traditional open surgery.
One of the key benefits is that the small incisions create minimal pain and trauma and by that it would be less traumatising for your child in the long run.
Dr. Nadarajan Sudhakaran, a Paediatric Surgeon at Pantai Hospital Kuala Lumpur and Gleneagles Hospital Kuala Lumpur, will be sharing his in-depth insights on the development of children keyhole surgery and his personal experiences as a leading expert in performing keyhole surgery for children in Malaysia.
What is keyhole surgery? How is this different from any other surgical methods?
Keyhole surgery (minimally invasive surgery, MIS) or otherwise known as laparoscopic (surgery in the tummy) or thoracoscopic (surgery in the chest) is surgery conducted in the abdomen or chest using 2 very small instruments about 3mm in diameter. In the abdomen, usually a small opening is made in the belly button to insert the telescope and to distend the tummy with gas so that there is more room for the surgery to be done.
Two other miniscule incisions are made to insert instruments into the tummy to conduct the procedure. The video image captured by the tiny telescope is projected onto a screen viewed by the surgeon and his assistants. Most procedures for children and new born babies can be done by the keyhole method, even complex reconstruction of conditions they are born with. Once surgery is complete, by removing the instruments, the tissues snap shut and tissue glue is applied to the little wounds on the skin.
The muscles are not cut in these procedures hence they are not distorted and does not cause much pain unlike traditional open surgeries. Traditional open surgery would require a cut big enough through all layers including muscles, to take the organ in question out or to allow the surgeon’s hands to enter the child’s abdomen or chest. The big cuts are significantly more painful and it takes a longer time to heal.
Are there any statistics to indicate the growth rate of children keyhole surgery in Malaysia?
There is a steady progression of the use of keyhole surgery in children in Malaysia. It’s mostly to do with the surgeon’s skills and the availability of equipment in their centre.
I have been involved with training a few centres around Malaysia, mostly in the northern states of peninsular Malaysia. Currently there are centres there who routinely choose to perform keyhole surgery over standard open procedure, knowing and having experienced its benefit. Parents who are aware of this type of surgery would naturally request for it.
How long does the operation usually take?
Performing keyhole surgery generally takes an additional 10 to 20% of time to perform, compared to an open surgery. Simple operations such as hernia repair could be done much faster by the keyhole method in expert hands.
What is the healing process like?
Since the cuts are miniscule, the pain and trauma post operatively is minimal. After a day care post minor keyhole procedure, children are seen to be running about and seemingly pain free. While for major procedures, patients are often discharged after 2 days, which is still much shorter compared to a 7-day stay with the same procedure done by an open surgery.
What are the benefits and advantages of performing a keyhole surgery?
The main benefit is that your child does not have to endure the severe pain of large cuts on his or her body. The length of stay in hospital is significantly shorter as their bodily function gets back to normal in a faster rate. Hence, parents do not have to stay in the hospital with their child for too long compared to that of a open surgery. This means that the child could go back to school faster. The child could spend more time with the family at home with a shorter hospitalisation. The scars from keyhole surgery are usually hardly visible compared to unsightly large scars from open surgery.
In addition, the “scarring” on the inside of the tummy from open surgery has a higher chance of complications or bowel obstruction in the long run.
What are the processes involved before and during the surgery?
Usually before any surgery, parents and their child are expected to be in clinic and the planned surgery is discussed in detail including any possible complications. The child need to fast for 6 hours without milk and solid food but can still take water up till 2 hours prior to the surgery. This will ensure that there is no chance of vomiting with the induction of anaesthesia. Usually one parent is allowed to go into the operation theatre with their child until he or she is asleep. Parents can then have a rest and some refreshments whilst the surgery is done but remain contactable throughout the procedure. Once the surgery ends and the child is waking up, the parents will be called back to collect the child.
Are there any risks or complications that parents should know about this surgery?
The risks involved in keyhole surgery are more or less the same as that of an open surgery. The common ones are bleeding and infection though quantitatively the risk is minimal with keyhole surgeries.
What should be done after the surgery? Is there any specific post-surgery care?
With keyhole surgery, the incisions on the skin are so small that it can be glued together. This glue makes a waterproof layer hence the wounds can’t get wet and the child can be bathed. The child will be mobile as he or she will experience minimal pain. The child would therefore spring fully back to the liveliness just like how he or she was before the surgery.
For more information including what conditions are commonly treated with keyhole surgery check out Dr Nada’s website and all the helpful articles and videos in the resources section.
See what Dr Nada’s past patients have to say >>>
”钥匙孔“手术：还孩子快乐童年！
Keyhole Surgery: A Less Traumatic Surgical Method & Experience for Children
钥匙孔胸腹腔镜手术自90年代就已运用于马来西亚儿科外科手术中，但大多数父母对于“儿童手术”的印象仍然停留在传统的开腹手术。进行传统开腹手术的父母与孩子，大都需要面对这3件令人头疼的情况：
- 较长的术后恢复期 – 开腹手术需要更长的恢复期，并且需要病患（孩童）在手术后留院观察或等待伤口恢复到一定程度后才能出院。
- 承受手术伤口的严重疼痛，并可能留下无法彻底消失的手术疤痕、肌肉组织损伤，对孩童的自信心、自尊心造成伤害，甚至让孩童对医院、医生与治疗留下恐惧与疼痛的印象。开腹手术术后如果恢复不好，还可能导致肌肉变形等后遗症。
- 术后恢复期的不适与焦虑导致孩童与父母巨大压力 – 术后恢复期将成为孩童与父母极为压力的时期。孩童没有办法处理因身体不适、疼痛、留院（陌生环境、被约束、不同的日常活动等情况）而引起压力与不安的情绪，常常导致孩童在术后恢复期间发脾气、哭泣、失眠，让照顾孩童的父母、长辈心疼又倍感压力。
相较于开腹手术，Gleneagles Hospital Kuala Lumpur 儿科外科医生纳德医生（Dr. Nadarajan Sudhakaran）认为父母在面对孩子需要动手术治疗的情况时，其实还可以试着去了解并寻求另一种风险较低，且几乎没有任何后遗症的手术方式——钥匙孔胸腹腔镜手术。
儿童钥匙孔胸腹腔镜手术属于微创手术（Minimal Invasive Surgery, MIS）。手术时，医生将分别在胸部或腹部部位开3个如钥匙孔般小的手术切口，通过内视镜传回来的影像以及导入孩童体内的腹腔镜手术器械进行手术。这种手术风险低，手术创面小，加上不涉及肌肉组织的切割，孩童疼痛感也会大大的降低，手术疤痕隐蔽不明显，通常可以当天出院，极大的缩短了术后恢复期。孩子与父母也可以迅速回到熟悉的日常生活，不会对孩子的身心灵造成太大的负担与影响。
手术风险低 术后恢复快
钥匙孔胸腹腔镜手术的风险与普通开腹手术种类相似—— 需留意术中出血风险以及术后感染的情况。从统计上来说，钥匙孔胸腹腔镜手术的手术风险的案例比开腹手术少。
钥匙孔胸腹腔镜手术由于并不需要通过切割皮肤皮层与肌肉组织才能接触到病患处，所以病患的复原时间比开腹手术迅速。举例来说，进行小型钥匙孔手术的孩童术后经过1天的观察，大多已经能到处跑跳，没有表现出疼痛的样子；而大多数进行大型胸腹腔镜手术的孩童2天后已能出院。
至今为止，钥匙孔胸腹腔镜手术并无明显的后遗症。相反的，由于创口小、没有伤害到皮层与肌肉组织，仅需使用外科粘合剂/手术胶处理手术切口。防水的材质让父母不必担心弄湿手术创口，也不影响日常清洁与洗澡。孩童还可以自由活动，不会因扯到创口而感到疼痛。
传统开腹手术与钥匙孔分别
| 开腹手术 | “钥匙孔”胸腹腔镜手术 | |
| 手术切口 | 需切开皮层与肌肉组织才能接触患处，切口较大 | 仅需切开3个钥匙孔般大小的切口 |
| 手术时间 | 根据手术类型与复杂性而有所差别 | 需要医生更高的手动稳定性与操作技术，所以比开腹手术多耗时10-20%。 |
| 术后复原时的疼痛程度 | 创口较大，术后根据复原时间需忍受一段时间的疼痛 | 创口小、复原快，需忍受疼痛的时间很短 |
| 术后恢复状况 | 留院复原时间长期间需保护伤口、避免感染、避免伤口撕裂，行动受限 | 小型手术 – 1天即可自由活动大型手术 – 2天基本可出院创口小，仅需使用防水的外科组织粘合剂处理切口。病患基本上可自由行动、不影响洗澡等日常卫生与清洁 （适合好动的儿童） |
| 手术疤痕恢复情况 | 术后留疤明显，涉及的肌肤范围以手术切口为准 | 术后伤口仅3个小孔，皮肤愈合后疤痕隐蔽 |
| 手术风险 | 出血术后感染 | 出血术后感染 |
| 可能的手术后遗症 | 肌肉变形手术疤痕可能影响孩子心理健康 | 没有明显后遗症 |
SOURCE: Article originally appeared in 28 Days publication:
https://28days.my/articles/1148
