Laparascopic Surgery

Small Incision Surgery
(Keyhole Surgery)

Laparoscopic surgery (or laparoscopy) is a modern surgical technique where operations in the abdomen are performed through small incisions (usually 0.5 to 1.5 cm versus 10- 20 cm in conventional surgery).

A small thin telescope with a light is inserted through the incision. A camera attached to the scope is connected to a display (like a television screen) and the surgeon performs the operation looking at the screen. On a high definition screen, the view is as good as open surgery (and sometimes better because of magnification in the laparoscope).

If needed, other specially designed instruments can be inserted through separate incisions. Using these instruments, the surgeon is able to dissect and remove diseased organs, suture and join bowel, remove tissue for biopsy, drain fluid collections and abscesses and repair hernias. It can also be used as a highly accurate tool for diagnosis. The technique is also known as minimally invasive surgery or keyhole surgery.

Types Of Laparoscopic Surgery

Who Needs Laparoscopic Surgery?

You may need laparoscopic surgery if your doctor or surgeon needs to:

  • Check and remove tumors in the belly or pelvis
  • Do a biopsy (and hence, the need for tissue samples)
  • Determine if there is cancerous spread to the belly
  • Repair a hernia
  • Remove diseased organs such as gallbladder, appendix etc.
  • Find the cause of unexplained abdominal pain

Why Is Laparoscopic Surgery Better?

Laparoscopic surgery is a much better option if you’re going to go for surgery as it is carried out through small incisionsinstead of the larger incisions of conventional surgery.

You’d experience less pain because the incisions are smaller. With a smaller incision, there is less scarring.  Smaller incisions are less at risk for wound infection. Best of all, you don’t need to stay very long in the hospital thus saving you money!

As a surgeon, I’ll use a small telescope with a camera to examine your organ while carrying out the operation with specially designed instruments. Laparoscopic surgery is commonly used for surgery in the abdominal region where there is a ready made natural cavity.

Advantages of Laparoscopic Surgery

Dr Khoo performing laparoscopic surgery at Gleaneagles Penang.

Studies have shown laparoscopic surgery is at least as effective and as safe as conventional open surgery in “getting the job done”.

In cancer surgery, laparoscopic surgery achieves a clearance at least equal to (and in my experience, sometimes better than because of the clearer views) open surgery.

In some types of surgery (gallbladder surgery & appendicitis), the laparoscopic approach is the first choice or “gold standard” and in other types (bowel cancer, hernia surgery), it is fast becoming the gold standard.

In my years of surgical work, 98% of my appendicectomies & 91% of my gall bladder operations are done via laparoscopy.

What Happens During Laparoscopic Surgery

3 small incisions for laparoscopic cholecystectomy or gallbladder removal surgery. Note the tube to introduce carbon dioxide gas.

We start with a small 5mm incision, usually at the umbilicus (belly button). A specially designed small hollow needle is inserted and carbon dioxide gas is passed in to inflate the belly. This is to lift the abdominal wall away from the organs creating a working space for me to have a clear view of the internal organs.

Once this is done, a small thin telescope called a laparoscope is inserted. The laparoscope has a bright light and has a camera attached. I will be able to view all the internal organs clearly on a high definition TV screen.

Other small incisions are made so that I can insert specially designed instruments to carry out the procedure (remove diseased organs and/or tumours, drain abscesses or repair hernias).

The entire operation is carried out with me looking at the screen to see what is going on. At the end of the operation, the gas is let out of the abdomen and the incisions closed with absorbable stitches.

You’ll be under general anaesthesia during surgery so you’ll sleep throughout surgery and feel nothing. (Here are 3 types of anaesthesia you should know about.) When you wake up after surgery, you might feel sleepy for a few hours. Depending on the type of surgery you may need to stay 1-2 nights in hospital (longer for major cases).

Resuming Normal Activity

Although small incisions are used, they do still need to heal. You should avoid heavy lifting or strenuous activity for about 2 weeks after surgery. For hernia cases, I recommend that you avoid strenuous activity for 4 weeks just to make sure the mesh is securely stuck to the muscle of the abdominal wall.

How Safe Is Laparoscopic Surgery?

When properly done, laparoscopic surgery is as safe as open surgery. However, note that not all cases are suitable for this type of surgery.

While laparoscopic surgery is my passion, I will only recommend this surgery when you’ve been assessed and considered suitable.
You will be provided alternative approaches if necessary.

This is my promise to you – to find you the best and most effective methods to deal with your health problem. Sometimes, surgery isn’t even necessary. But we can only determine this once I have you properly assessed.

If you suspect something is amiss,
contact me so we can have you assessed first.