Endoscopic surgery is a minimally invasive surgical procedure done inside a body cavity with the assistance of an endoscopic video camera and several thin instruments also known as endoscopic instruments.(1) In this article, we will look at how endoscopy has become the preferred choice for surgeons of many disciplines including; Gynaecology, ENT and Orthopaedics. Thanks to the benefits of endoscopic procedures, surgeons from multiple disciplines are taking advantage of them to provide better medical treatment options for their patients.
Laparoscopic cholecystectomy (Gallbladder removal) (P2)
Endoscopy in General Surgery
General surgery focuses on the treatment of organs in the abdomen, associated with the digestive system, such as the stomach, gallbladder, liver, small and large intestines, appendix and rectum. As most of these surgeries are conducted in the abdominal and pelvic region, these endoscopic surgeries are commonly known as Laparoscopic surgeries. Laparoscopic surgery has widely replaced open surgery in this field. With cholecystectomy (gallbladder removal) being the most common laparoscopic surgery performed.(1) Other common procedures performed laparoscopically include removal of the appendix, sections of the colon and the kidneys. Once again, incisions are much smaller than conventional surgery and therefore it is associated with reduced postsurgical infections, shorter hospital stays, and reduced pain.
Gynaecological laparoscopic surgery.(P3)
Endoscopy in Gynaecology
Gynaecological surgery primarily deals with the treatment of diseases affecting the reproductive system. Like in general surgery most of these surgeries are conducted in the abdominal and pelvic region these surgeries and are therefore also commonly known as Laparoscopic procedures. They allow for the majority of gynaecological surgeries to be done minimal invasiveness. This includes procedures such as, early stage cancers, and removal of non-cancerous growths, fibroids and adhesions caused by endometriosis. Today, most gynaecological surgeries can be done laparoscopically.(1)
Arthroscopic procedure of knee joint. The irrigation Instrument clears the area the surgeon is looking at through his viewing scope. If there is any damage, a trimming instrument is used to repair the tendons or cartilage(P4)
Minimally invasive orthopaedic surgery
Orthopaedics is an area of surgery which deals with diseases related to the musculoskeletal system (bones, tendons, ligaments and joints). Degenerative diseases common among the elderly, including; traumatic fractures, bone infections and tumours, often require surgical intervention. More of these surgeries can now be performed endoscopically with the most common endoscopic orthopaedic surgery performed being arthroscopy for diagnosis and therapeutic intervention.This commonly used for diseases of the shoulder, knee joint and wrist joint (carpal tunnel syndrome).
Another area of orthopaedic surgery in which minimally invasive techniques are often used is with spinal surgery. For patients with severe lower back pain and nerve compression, endoscopic removal of a prolapsed intervertebral disc (endoscopic discectomy) or debris (endoscopic foraminotomy) can be done to relieve tension on the nerves. (2,3)
Similar to other endoscopic surgeries, recovery time and hospital stay is shorter than open surgery. This is advantageous as physiotherapy which is a mainstay in the management of orthopaedic patients can be started almost immediately.
Endoscopic Snare (P5)
Endoscopic ENT surgery
ENT or “Ear, Nose and Throat” surgery has widely incorporated minimally invasive techniques in their diagnostic, and surgical management of diseases.
As the nose and throat serve as a natural pathway for the insertion of endoscopes and instruments to explore. It is possible to treat diseases of the sinuses, remove nasal polyps and growths, and diseases which affect the base of the skull.(4)
This avoids intrusive and extensive facial incisions as well as damage to bones and tissues. In particular, the scopes provide a clear magnified view of structures and organs that otherwise would be hard to visualise.
Endoscopic procedures are also used in more advanced surgeries, in the fields of cardiothoracic and neurosurgery. However, its use in these fields is not so prevalent in Sri Lanka. For more on endoscopy in Sri Lanka click here.