Endoscopic Surgery

Surgical procedures that use a viewing instrument inserted through a natural body opening or through skin incisions

Endoscopic surgery is a technique that enables various procedures to be performed without making large incisions in the skin. An endoscope is a tube-like viewing instrument with a light source. Some endoscopes have a built-in miniature camera.

Endoscopes are inserted either through a natural body opening, such as the anus, or through a small incision, depending on the site to be accessed. Endoscopic surgery performed through skin incisions is often referred to as minimally invasive surgery (see Having minimally invasive surgery). Endoscopes may be flexible or rigid (see Flexible endoscopy, and Rigid endoscopy) and are used to provide a view of the inside of body cavities, either directly through the endoscope or on a screen.

Endoscopes may be used to carry out treatment, to examine a particular area, or to take tissue samples. Tiny instruments, such as forceps and scissors, are passed through small incisions in the skin or through side channels in the endoscope to reach the operating site. These instruments are operated by the surgeon, who is guided by the view through the endoscope or on the screen.

Since endoscopic surgery may not involve any incisions or only require small ones, the length of stay in hospital and recovery time are shorter than for open surgery. Bleeding from any small incisions that have been made is minimal. Therefore, the wounds heal more quickly and are less likely to become infected than the large incisions that are needed in open surgery.

When is it used?

Endoscopic surgery may be used to operate inside any part of the body that is large enough for the instruments to be inserted into and moved around. Suitable sites include the chest, abdominal cavity, pelvic cavity, digestive tract, large joints, such as the knee and hip, and the nasal sinuses. Endoscopes have different names according to the part of the body in which they are used. For example, laparoscopes are used in the abdominal cavity, bronchoscopes are used to look in the lungs, and colonoscopes are used inside the colon.

If you have symptoms that suggest a disorder of the reproductive system, digestive tract, lungs, sinuses, or bladder, an endoscope may be inserted through the vagina, anus, mouth, nose, or urethra in order to investigate the affected area. Endoscopy through natural openings may be repeated safely many times and can be used to monitor a condition such as a peptic ulcer.

When the area under investigation cannot be accessed through a natural body opening, small incisions need to be made for the endoscope and other instruments. For example, if you have a disorder of the gallbladder, appendix, or some parts of the female reproductive system, such as the fallopian tubes, a laparoscope may be inserted through an incision in the abdomen to carry out investigations or treatment (see Laparoscopy). Laparascopes are also used in female sterilization. If you have a disorder of the joints, such as arthritis, or a damaged cartilage or ligament, an arthroscope inserted through a small incision may be used to view and possibly to operate on the affected joint (see Arthroscopy).

What happens during the operation?

Endoscopic surgery through natural openings in the body, such as the throat or anus, may not need an anaesthetic or may take place under sedation or local anaesthesia. This means that you remain conscious, but the area being operated on is numb (see Having a local anaesthetic, and Having a regional anaesthetic). After the endoscope has been inserted into the body opening, surgical instruments may be introduced through specific channels in the endoscope.

The majority of endoscopic surgical procedures through incisions are performed under general anaesthesia (see Having a general anaesthetic). An incision about 13 mm ( 1 / 2 in) long is made for the endoscope, and then further tiny incisions are made so that instruments, such as lasers (see Laser treatment) and scissors, can be inserted if needed. In a laparoscopic operation on the abdomen, a tube is inserted through an incision, and gas is pumped through it to inflate the abdominal cavity, giving the surgeon a better view and more operating space.

The surgeon looks at the procedure through an eyepiece on the endoscope and also observes a magnified image of the operating site transmitted to a video monitor. The surgeon’s colleagues can also watch the procedure on the screen.

When the operation is complete, the endoscope and all the instruments are removed. The incisions are then closed, often with a single stitch.

What are the risks?

The risk of damage to a body organ or blood vessel is slightly greater with endoscopic surgery than it is with open surgery because the surgeon has to work in a more restricted area. As with all types of surgery, there is a risk of an adverse reaction to the anaesthetic. During the operation, the surgeon may need to access a larger area and perform open surgery. For this reason, you will be asked for your consent to open surgery before an endoscopic operation.

Procedure: Having Minimally Invasive Surgery

From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.

The subjects, conditions and treatments covered in this encyclopaedia are for information only and may not be covered by your insurance product should you make a claim.

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