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On the frontier of Endoscopic Surgeries

 

Advancements in imaging techniques play key role in the evolution of surgery (P1)

 As highlighted in our articles, Endoscopies in Sri Lanka and Common Endoscopic Procedures; many surgical procedures in the fields of General Surgery, Gynecology, ENT, and Orthopedics are done endoscopically. On the frontiers of medicine, endoscopy is also used in cardiothoracic and neurosurgery. Endoscopic surgeries in these fields require additional instruments, but however allow surgeons to provide patients with minimally invasive solutions at the forefront of medicine.

 
 
Illustration comparing a minimally invasive and invasive chest surgery

Open and minimally invasive surgery for heart valve surgery (P2)

Minimally invasive cardiothoracic surgery

The thorax is the region between the neck and abdomen, commonly referred to as, ‘the chest’. It contains the lungs and heart which are enclosed within a cavity bound by the ribs, breastbone, and spine. One of the traditional surgeries to gain access into this region is a thoracotomy. This involves the separation of ribs and the division of major chest muscles. The disadvantages of this and other open surgery procedures include; risk of rib damage, and lengthy periods of pain and recovery.(1)

With minimally invasive surgery however, the incisions are only about ½ inches and do not require separation of the muscles or ribs. As a result it is associated with low blood loss, a fast recovery and less pain in comparison to open surgery.

There are 2 main types of cardiothoracic surgery.

Video assisted thoracoscopy (VATS)

VATS is used by surgeons to take biopsies, tissue samples, to diagnose diseases in the lungs, pleura and diaphragm. More recently, with the current developments in technology, it is also used to perform surgical procedures including lung resections in patients with lung cancers.(2)

Minimally invasive cardiac surgery

An even more recent progression in minimally invasive surgeries is coronary bypass surgery. It is however, only done in cases where less than two arteries are blocked. Further, as this method is relatively new, and technically challenging, it’s converted to a traditional open surgery 10% of the time.(3)  

 

 
Illustration of a minimally invasive brain surgery

Minimally invasive neurosurgery (P3)

Endoscopic Neurosurgery

Neurosurgery includes the treatment of diseases in the brain and spinal cord. Here, doctors are able to visualize vulnerable structures through small incisions with the use of miniature cameras. The cameras which can also magnify images provide the surgeon with a much clearer view of the operating field. Thus, removing the need for large skull incisions and dissections of the brain tissue.

This is advantageous as even the smallest mistake could result in significant disabilities, particularly in surgeries involving the brain and spinal cord. It is also associated with a faster surgery, reduced postoperative complications, scarring and recovery time.

These endoscopes can either be passed through small incisions through the skull (intracranial surgery) or via the nasal canal (endoscopic nasal surgery), depending on which part of the brain has to be visualised. Endoscopic procedures on the brain further include the obtaining of biopsies, and the resectioning of cysts and tumours.

In spinal diseases, endoscopes are placed via small openings in the spine. As of now, prolapsed intervertebral disc, slip disk, and compression fractures, common in those with osteoporosis, are widely treated endoscopically.(4

   
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