Can Keyhole Surgery Replace Open Surgery? | Truth About Minimally Invasive & Robotic Surgery | KMCT

[00:00:00]Let's all be honest for a second. How many of you get a bit anxious when you hear the word surgery? Uh the thought of anesthesia, cuts, pain, and spending a lot of days in the hospital can itself be scary. And it's a completely normal fear. But the medical science has advanced incredibly fast. We have been hearing a lot about keyhole surgery.

[00:00:23]It's called minimally invasive surgery for a reason. Because it keeps things to an absolute minimum. Uh you will have lesser pain, lesser scars, and spending lesser days in the hospital so that you can go home faster.

[00:00:38]Well, what is this keyhole surgery all about? And who all can avail it? And is Oh, is it always the only option? Or is it also an option?

[00:00:48]Well, welcome back to Calida Talks by KMCT, the official podcast series of KMCT Group of Institutions. And I am your host for today, Anamika K Rajesh, a final year MBBS student of 2022 batch.

[00:01:04]>> [music] >> In today's episode, we'll dive deep into this topic of minimally invasive surgery or keyhole surgery. And to guide with us today, we have a very special guest who's also an expert in keyhole surgery.

[00:01:21]Let's welcome Dr. Hitesh Gopalakrishnan, Professor and HOD, Department of Orthopedics, KMCT Group of Institutions.

[00:01:29]Welcome, sir.

[00:01:30]>> Hi.

[00:01:31]>> So, sir, shall we begin with a few questions which actually arise in the common people's mind? Uh so, let's begin. What exactly is a minimally invasive surgery or a keyhole surgery?

[00:01:42]>> Minimally invasive surgery or keyhole surgery is a modern surgical technique where the surgeon operates through very small incisions, like 0.5 to 1 cm in size, instead of a big incision, the traditional large incision, right? A tiny camera called a laparoscope or arthroscope and specialized instruments are inserted through these small openings allowing the surgeon to perform the operation while actually viewing the inside of the body on a high definition monitor.

[00:02:08]>> So, sir, why is it called a keyhole surgery?

[00:02:11]>> This name comes from the fact that the surgeon uses very tiny incisions which resemble the size of a keyhole.

[00:02:17]Although the openings are very small, the surgeon can perform complex operations through these small incisions, right? We use specialized instruments to reach a particular organ and everything is seen on the monitor.

[00:02:29]Okay, we have a monitor that relays everything simultaneously and we can actually do really complex procedures using these.

[00:02:37]Even though the incisions are this small, we have special instruments to reach a particular corner of the For example, I do a lot of knee knee arthroscopic surgeries, right? So, my traditional surgery or my classic surgery is an ACL reconstruction.

[00:02:50]What I do is the knee is a very small I mean, compared to the abdomen, which is usually called a laparoscope.

[00:02:59]Knee is a very small area.

[00:03:01]Abdomen is huge, right? Lot of space there. But knee is very small, so you can use a specialized instrument called an arthroscope and you can see it in a big monitor in a magnified view.

[00:03:14]Okay, so that is the beauty of keyhole surgery and you can do a hell lot of procedures using these.

[00:03:20]Uh for example, my standard procedure is an ACL reconstruction. You can do meniscal repairs. You can do PCL reconstructions. You can do cartilage surgery and so many of these.

[00:03:29]>> Okay, so what are the advantages of this keyhole surgery compared to these open surgeries?

[00:03:35]>> Now, compared to a traditional open surgery, keyhole surgeries have less pain, less morbidity, right? So, that is a medical term that we use as morbidity.

[00:03:43]So, less pain, uh I mean, they recover faster, less blood loss and shorter hospital stays. For the For example, they don't need to stay in the hospital for very long periods. So, that is a biggest advantage in keyhole surgery, that you can send them home like next day. For example, I do as I said before is an standard ACL reconstruction, I can send them home the next day. So, the For example, you have a big incision, you need to do wound dressings and all that, right? So, here in open and in arthroscopic surgery, you the blood Since the blood loss is very less, you don't need to do dressings that often. The bleeding is less and the impact and the recovery is much faster.

[00:04:25]>> Are keyhole surgeries generally safer when compared to these traditional surgeries?

[00:04:30]>> Now, compared to traditional surgeries, keyhole surgeries come with the same kind of risks like a traditional surgery. But, the advantage of a keyhole surgery is the precision, right? You can see everything in magnification.

[00:04:43]Okay? Even a small lesion can be seen in a magnified view and you can For example, if it's an excision of a particular part or removal of a particular part, you can see it in a magnified way.

[00:04:55]So, accuracy is much superior compared to a traditional surgery where you are looking through a normal eyes.

[00:05:02]Right? Here, you use the endoscope or arthroscope or laparoscope, whichever you're using it, and you see everything on a larger screen in a magnified way.

[00:05:10]So, your precision is much better.

[00:05:14]So, that is a beauty of a keyhole surgery. Now, it comes with As I said before, it come it comes with the same risk as an open surgery. You need to do all the pre-anesthetic checkup, all the consultations, everything, because anesthesia is the same, right?

[00:05:29]So, it comes with all the risks, but the morbidity is much lesser. So, that is a beauty.

[00:05:35]>> Okay.

[00:05:36]Can every surgery be done through keyhole procedure?

[00:05:39]>> Not every surgery is possible using a keyhole procedure, right? For example, it depends on the pathology.

[00:05:46]Some pathologies can be addressed using an endoscope, arthroscope, or laparoscope, whichever is the specialty.

[00:05:53]But, you can't address every problem using the endoscope, right? So, some surgeries traditionally dictate an open surgery, okay? And you have no option but to do do it open.

[00:06:08]Uh So, the whereas what has happened is more and more surgeries are being done using an endoscope or an arthroscope.

[00:06:19]But, sometimes it requires a conversion.

[00:06:21]Say, you go in and do a particular procedure, the classic example is in a shoulder or even sometimes in lab surgeries, you go in with the mindset of doing an arthroscopic or endoscopic procedure, and sometimes you're unable to do it completely or execute it well, and you end up converting into an open procedure. So, that is kind of accepted sometimes. So, we have a backup plan, right? So, every procedure you should have a backup plan.

[00:06:50]So, it is not always that you go in and you have to complete arthroscopy or endoscopically. You may have to do an open procedure. So, you need to be skilled in doing an open procedure as well. So, that is what happens normally is you're skilled in endoscopic, but you're not skilled in in an open surgery. So, you need to have equal skills, I mean, equal dexterity when compared to arthroscopy or endoscopy versus an open surgery.

[00:07:16]>> Okay. So, which are the common specialties that mostly use keyhole surgeries?

[00:07:21]>> See, what happens is every specialty wants to improvise, right? So, most specialties are trying to find out some ways to do keyhole surgery. For example, in arthroscopy, we do mostly on the knee, then we do on the shoulder, we do ankles, we do elbows, wrist, and even the first metatarsal metatarsophalangeal joint, the MTP joint of the big toe.

[00:07:41]Even small joints are being explored. Okay, even the ankle, there's something called as subtalar joint. So, there's hardly any space.

[00:07:48]So, there are surgeons are trying to innovate and find out ways to explore these small joints as well. The same thing has happened across specialties.

[00:07:56]For example, in the in the ENT department, they do something called as a functional endoscopic sinus surgery or the FESS. They see the sinuses through the nose. And they have specialized surgeries for the ears, gynecology, they do lap-assisted procedures.

[00:08:13]General surgery, of course, is that's the most famous among all the keyhole surgeries. They do all kind of procedures using endoscope. And also, they have this They always tell the patient about the conversion risk, right? You end up doing an open surgery.

[00:08:27]And especially what I've seen personally is the huge advantage that has come up in spine surgery.

[00:08:34]So, you The traditional spine surgery has a very long incision.

[00:08:38]But, what has changed with endoscopic surgery is you can do a discectomy using very minute incisions.

[00:08:44]The problem with spine surgery is has been a big incision, big approach, and a lot of muscle dissection. So, that itself creates a lot of morbidity. So, that is completely eliminated by this advantage. And even neurosurgery, they do a lot of brain tumor resections all using an endo endoscope. Okay, so every specialty is trying to improvise and catch up with this It's not a trend.

[00:09:12]I would I wouldn't say it's a trend.

[00:09:13]It's already established everywhere, right? It's already come up and it's been here for I mean, so so many decades, I would say.

[00:09:20]So, actually, we are at at the current level, we are focusing on the next level of minimal invasive surgery and robotics.

[00:09:29]>> Okay, will I recover faster if I do a keyhole surgery?

[00:09:32]>> See, that is the most common question that people ask, okay? So, compared to a traditional open surgery is my recovery fast? So that's the question that everyone ask me in the OPD.

[00:09:43]So uh compared to uh traditional open surgery, as I said before, the incisions are smaller, the morbidities less.

[00:09:52]So definitely your recovery is going to be faster, right? So whenever the incision size itself becomes small, the recovery is going to be faster.

[00:10:01]So I would say there are two kinds of morbidity. One is the approach-related morbidity. And the other one is the pathology-specific morbidity. For example, that doesn't change. The pathology-specific morbidity does not change. Only the approach-related morbidity changes.

[00:10:18]So that is that part has been altered by the uh keyhole surgery.

[00:10:23]So that is the advantage of doing a keyhole.

[00:10:26]>> Does keyhole surgery really leave no scar?

[00:10:29]>> No, that is a misconception that is being uh I mean, people think that it's a scarless surgery, okay? So that is not possible. You need to have There's going to be some scar, okay?

[00:10:39]Only thing the size of the incisions have gone down drastically. I would say that is something that has happened in the last 10 years. The The introduction of something called as a nanoscope, okay? It's a tiny arthroscope, the size of just few millimeters.

[00:10:55]So you can have a nanoscope into the joint, and that for that, the size is much smaller, okay? So some people call it as needle arthroscopy.

[00:11:06]That is kind of an extrapolation, but still there's going to be a very small incision, but it's uh slightly bigger than a needle.

[00:11:14]>> So is robotic surgery the same as that of keyhole surgery?

[00:11:18]>> No, actually robotic surgery is not the same. It is a completely different system. For example, you need to have a robo that is going to assist you, right?

[00:11:28]So some people confuse a robo and keyhole surgery. I mean that's a very common like it's a kind of misconception.

[00:11:37]I'm sure you've seen some of these reels. So, that's the reason why people think that robo and key hole are the same.

[00:11:44]So, you've seen those reels where the surgeon is sitting inside a console and he's operating and the robo is operating on the abdomen. Okay, so that is a classic example where a combination of a [snorts] robo and a key hole is done.

[00:11:58]So, a variation of that is called as a remote surgery. Okay, the surgeon sits in one place in a different location altogether.

[00:12:05]And an entire robotic setup is created in a different location.

[00:12:10]And he operates in the console from that particular location.

[00:12:14]And the surgery is being done in a different location. But, you need to have a entire team who's going to coordinate that, right?

[00:12:20]That is the extreme version I would say. In a milder way, there is robotic surgery that's happening using key holes.

[00:12:28]So, that is happening in the hospital setup.

[00:12:32]Okay, so surgeon again remains in the console.

[00:12:35]But, the patient is near to you. It is not a remote surgery.

[00:12:39]But, in in true sense in orthopedic surgery, when you talk about robotic surgery, it is classically for a knee replacement. Okay, so robotic knee replacements have changed the perspective of a modern knee [snorts] replacement.

[00:12:54]So, if you see most of the hospitals, they they advertise themselves as robotic surgery hospitals. Okay.

[00:13:00]>> [snorts] >> So, I'm sure KMC is also coming in that way.

[00:13:03]So, the advantage is you get high accuracy with the robo, the precision.

[00:13:10]So, you get suppose the robo has a manual a cutting device where the precision level is close to 1 mm. Okay, so that is the advantage of robotic surgery.

[00:13:22]So, it's commonly confused or mixed up with key hole, but sometimes it's keyhole and robo are done in unison.

[00:13:31]>> Okay, so what message would you like to give to the public or you want them to remember regarding the keyhole surgery?

[00:13:38]>> I want to tell people that uh the risks involved in a traditional open surgery and a keyhole surgery are the same.

[00:13:50]Especially anesthesia and intraop because everything is going to be the same.

[00:13:55]Of course, there's going to be some a reduction blood loss.

[00:14:00]Lesser blood loss is a part of uh but you can have the same risks with the I mean a keyhole surgery. Okay, so that is going to be there, but the recovery process is going to be fast.

[00:14:14]They're going to recover fast. They're going to leave the hospital very soon.

[00:14:18]Uh I mean, bleeding is going to be less in the post-op period. They're going to have uh uh what do you say? Less frequent dressings of the wound.

[00:14:27]So, that part is almost eliminated. Okay. I would say the classic example is uh uh of course, in my state my case it is a uh ACL reconstruction arthroscopic ACL reconstruction.

[00:14:41]Even though so for example, if if I've done a surgery yesterday, I've done a few surgeries yesterday. I mean, they mobilize today.

[00:14:47]Today, we asking them to walk.

[00:14:50]Today, we are asking them to ambulate.

[00:14:53]Same thing applies to uh lap surgeries. Lap cholecystectomy, a classic example. You do the surgery, next day you're going home.

[00:15:03]Right? So, that is a beauty of uh endoscopic surgeries in general.

[00:15:08]>> Thank you so much, doctor, for joining with us today.

[00:15:11]Uh it's always a pleasure to have you over here and as you as you know, when these complex terms are broken down into simpler terms and explained it to us by a expert themselves and also it's really uh heartwarming to know that medical science is expanding really fast and it's actually benefiting the people.

[00:15:30]Keyhole surgery is a perfect example for that. And thank you to all our viewers for being with us here today and with this we come to an end of the session of Calida Talks by KMCT. This is your host Anamika signing off. Till then, take care and bye-bye.

[00:15:49]>> [music]