The term keyhole surgery is commonly used, but it may not be terribly descriptive for some patients. What is keyhole surgery? Keyhole surgery is another way of saying laparoscopic surgery. Instead of a large incision in the skin, the incisions used in keyhole surgery are quite small—on the order of half an inch wide. In most cases the keyhole is only the wide enough for a single finger to be passed inside the body.
The keyhole surgery procedure begins by sterilization of the skin, just as it would in a normal surgery. Instead of a large incision that may be several inches long, keyhole surgery requires several small incisions in strategic locations, each incision being quite small. These small incisions are used as portals into the body. The object used to maintain the portal is called a trocar, which is a tunnel of sorts that is anchored to the skin. A trocar permits surgical instruments to be inserted across the small, keyhole incision.
For abdominal surgery the keyhole surgery incision is used to fill the abdominal space with gas, usually nitrogen or carbon dioxide. The gas lifts the fascia, muscle, and skin so that the surgeon can reach all areas.
Another critical component of the keyhole surgery procedure is the video camera. One of the keyhole incisions (and trocar) is dedicated to a video camera attached to a thin tube. The tube can be moved so that the surgeon can see all aspects of the surgical field.
The goal of most surgical procedures is to make the smallest incision possible. A considerable amount of practical surgical research has been devoted to pioneering and adapting keyhole surgery procedures. Surgeries that once required a large incision and some that traditionally needed a large incision are now routinely performed as keyhole surgery. It is now unusual for any general abdominal surgery to not be performed as a keyhole surgery. Obvious exceptions are the transplant of large organs (even kidneys can be transplanted with a modified keyhole surgery) or emergency surgery.
It should be mentioned that even types of surgery that are traditionally keyhole surgeries may need to be moved to an open procedure (large incision) under some circumstances. If the procedure is to correct an urgent or immediate condition (like acute appendicitis) surgeons may be more comfortable with an open approach. This is done in the interest of patient safety—open surgery is faster, in general. Also, if the surgery is needed to address a trauma, like suspected trauma to the intestines after a stab wound or automobile accident, surgeons will opt for open rather than keyhole surgery to “run the bowel” looking for cuts in the intestine.
Since the incisions are so small, keyhole surgery recovery is much more tolerable and faster than traditional open surgery. Patients are able to return to work and life activities much sooner with keyhole surgery recovery.
Surgeons have long practiced in laboratories outside of the surgical theater in order to perfect their abilities with surgical instruments and equipment. Keyhole surgery has taken this training to a new level. Training surgeons often practice on surgical obstacle courses. They use surgical instruments under a covering and see the area by using a camera rather than looking at the objects directly. In fact, video games are being adapted to train surgeons in how to perform keyhole surgery. Instead of a normal controller, the peripherals are surgical instruments. This is also good preparation for robotic keyhole surgery.