Keyhole surgery is a technique that allows the surgeon to perform a procedure inside the body through a small incision in the skin. Some people refer to keyhole surgery as laparoscopic surgery, as it involves the use of an imaging instrument called a laparoscope.
Many types of surgery do not require a large incision. Keyhole surgery can diagnose and treat various conditions, including those of the abdomen and pelvis.
The laparoscope, which includes a light and camera, transmits images from inside the body to a monitor in the surgical room. Surgeons can also pass other surgical equipment through the small incisions to perform procedures.
This article looks at what keyhole surgery is, how surgeons perform it, how to prepare, and what to expect. It also discusses the recovery time, risks, and complications, as well as the advantages of keyhole surgery over traditional open surgery.
Surgeons perform keyhole surgery — also known as minimally invasive surgery or laparoscopic surgery — through small incisions, using a device called a laparoscope to transmit images of the inside of the body to a monitor in the operating room.
The laparoscope is long and thin, with a light and camera on the end. It is possible to insert it through a small incision in the body.
If the surgeon determines the need for other surgical interventions, more surgical equipment can pass through the keyhole incisions to allow the surgical team to perform various procedures.
After the surgery is complete, the person will receive stitches to close the incisions, which the surgical team will then cover with a sterile dressing.
For outpatient keyhole surgery, most people can go home the same day, but some individuals may have to stay in the hospital overnight.
Keyhole surgery works on nearly every part of the body. Depending on which region the surgical team is examining, the procedure may have a specific name:
- Arthroscopy: This is the term for keyhole surgery that takes place on or near a joint.
- Laparoscopy: Keyhole surgery that uses small incisions and a laparoscope to provide images from any part of the body is called a laparoscopy.
- Parathyroidectomy: This procedure is the removal of the parathyroid glands using keyhole incisions.
- Video-assisted thoracoscopic surgery (VATS): For VATS, the surgical team inserts a small camera called a thoracoscope and small instruments through keyhole incisions in the chest to perform surgery on the lungs, esophagus, and chest.
The common factor is that the size of the incisions in keyhole surgery will be much smaller than those that surgeons use in traditional surgical procedures.
As keyhole surgery incisions heal more quickly than larger incisions and lead to fewer complications, recovery times tend to be shorter than for other types of surgery. Due to this, surgeons may recommend this type of surgery when it is an option.
The smaller incision also produces a less noticeable scar. For people with concerns about scarring, keyhole surgery may, therefore, be a good option for procedures that take place on parts of the body that may be more visible to others.
Surgeons can perform keyhole surgery on nearly any part of the body or organ system, including the:
- abdomen and pelvis
- lungs
- head and neck
- skull base and spine
- veins
- joints
The surgeon will create one or more small incisions, which they call ports. These are just large enough to allow the surgical instruments to pass through.
Using the ports, the surgeon passes cameras and instruments into the body to assess the affected site. They then use a video monitor to see what is taking place inside the body.
The exact nature of how the surgical team will operate depends on the site of the surgery and the nature of the condition they are trying to repair.
If the problem is in the abdominal area, the surgeon may pump carbon dioxide into the abdomen to increase the space and allow better access and visibility. After the surgery, the surgical team will let the gas out. In some cases, gas may remain behind and cause temporary shoulder pain.
The surgical team will then close the ports using stitches and sterile dressings. The person can often go home the same day, although this is not always possible.
The surgical team should provide presurgery instructions to anyone about to undergo keyhole surgery. These will typically include instructions on:
- stopping food and fluids for a recommended period before the surgery
- stopping smoking for a minimum length of time before the surgery
- following any preoperative bathing or shaving instructions
- leaving valuables and jewelry at home
- avoiding putting on makeup or perfume
- refraining from putting in contacts
- prearranging a ride home for after the surgery
Prior to the surgery, a person should also be sure to discuss any concerns with the surgical team and get answers to all of their questions.
Some people who undergo keyhole surgery on the abdomen may have some pain in the shoulder or back due to gas that the team uses to expand the abdomen during the procedure. This pain should resolve within a few days.
Soreness at the incision sites is normal, and a person may experience fatigue for a few days. If the surgery involved putting a tube down the throat, the person may have a sore throat afterward. Throat lozenges or a warm saltwater gargle may help.
The type of surgery and the condition requiring treatment will determine when a person can resume their usual activities. Their healthcare team will discuss this with them after the procedure.
If a person experiences unusual pain after the surgery or any soreness or fatigue does not clear up within a few days, they should contact their surgeon.
Complications from keyhole surgery are uncommon, but there are risks to any surgery.
Minor complications may include:
- infection
- bleeding or bruising at the incision site
- nausea or vomiting
Serious complications may include:
- organ damage, which could result in loss of organ function
- damage to an artery
- complications from the use of gas during the procedure
- an allergic reaction to anesthesia
- pulmonary embolism, which is a blood clot that can travel to the lungs and block blood flow
Smaller incisions cause less pain and bleeding, and they heal faster, leading to shortened recovery times following keyhole surgery.
In addition, the resulting scarring is smaller and less pronounced than it is after open surgery.
Open surgery can also cause adhesions, or bands of scar tissue, which can lead to problems with internal organs. The risk of this occurring due to keyhole surgery is much lower.
Surgeons can use keyhole surgery to diagnose and treat conditions all over the body. They use laparoscopic equipment, which they insert through small incisions to view the inside of the body and perform procedures.
Laparoscopes are long, thin wands with a camera and light on the end. They send images from inside the body to a monitor in the surgical room for the surgeon to view. Using these images, the surgeon can diagnose problems or insert other surgical equipment through the keyhole incisions to perform procedures.
The recovery time after keyhole surgery is shorter than that of traditional surgery. People can often go home the same day.
As with any surgery, keyhole surgery carries the risk of complications. However, it has a shorter recovery time than open surgery due to the small size of the incisions.