Q & A with Dr. Nadarajan, Paediatric Surgery, Gleneagles Kuala Lumpur (GKL)
We may have come across the term keyhole surgery is completely aware of this type of procedure and why it’s done. BabyTalk caught up With Dr Nadarajah, a Pediatric Surgeon from Gleneagles Kuala Lumpur to learn more about keyhole surgeries for children and here’s what we’ve managed to uncover.
What is Keyhole surgery? How is this different from any other surgical methods?
Keyhole surgery (minimally invasive surgery, MIS) or otherwise known as laparoscopic (it it is performed in the abdomen) or thoracoscopic (surgery performed in the chest) is surgery conducted in aforementioned areas using 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 deliver the organ in question out or for the surgeons’ hands to enter the child’s abdomen or chest. The big cuts are significantly more painful and require a longer time to heal.
Are there any statistics to indicate the growth rate of child 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 that routinely choose to perform keyhole surgery over a 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 longer to perform, compared to an open surgery. Simple operations such as hernia repair, is much faster being performed 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 minor day care keyhole procedure, children are running about and seemingly pain free and with a major procedure they are often discharged after two days compare to about seven days with the same procedure done by 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 duration of stay in hospital as well as the time it takes for their function to get back to normal is much faster and significantly shorter. So parents do not have to stay in the hospital with their child for too long compared to open surgery. This means a faster time back to school for your child and less time away from home and other children and more family time at home, together. The scars from keyhole surgery are usually hardly visible compared to unsightly large scars from open surgery. In addition, he “scarring” inside the tummy from open surgery has a higher chance of causing complications of 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 seen at the clinic and the planned surgery is discussed in detail including any possible complications. The child needs to fast for 6 hours with milk and solid food but can have water till 2 hours prior to surgery and then they will have to fully fast. This will ensure that there is no chance of vomiting with the induction of anaesthesia. Usually one parent is allowed to go into the operating 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. Once surgery is done and your child is waking up, you will be called back to collect your child.
Are there any risks or complications that parents should know about this surgery?
The risks involved in keyhole surgery is much the same with 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 opening on the skin is so small that it can be glued together. This glue makes a waterproof layer hence the wounds can get wet and the child can be washed. The child will be mobile as he or she will experience minimal pain. The child would therefore be much the same as before the surgery with the keyhole procedure.
For more information including what conditions are commony treated with keyhole surgery see this article by Dr Nada: What Is ‘Minimally Invasive Paediatric Surgery’ (MIS)?