Some of the most asked questions about Keyhole Surgery in Children.
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 Gleneagles 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.
Keyhole Surgery: A Less Traumatic Surgical Method & Experience for Children
- 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。
- 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。
|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）|
SOURCE: Article originally appeared in 28 Days publication: