Minimally Invasive Surgery

"It [keyhole surgery] reduces the impact on patients' lives."
"It was a light switch [first exposure to keyhold incisions and laproscopic tools]. I went to my chief of surgery and said, 'We need to do this."
"Dr. Poulin always used to say that laparoscopic surgery is surgery of the eyes: it's what you see. If you can't see it, you can't do it, no matter how good you are, no matter how well trained you are."
Dr. Joseph Mamazza, The Ottawa Hospital

Surgery during a minimally invasive surgical procedure in the new, high tech operating room at the Ottawa Hospital. Wayne Cuddington / .

Surgery has steadily moved into the future with the help of imaging technology in the operating theatre. Where new optical instruments have brought successful new operating procedures to the fore. Attaching a micro-camera on the end of a surgical scope represented an especial gift that biomedical engineers blueprinted and produced; a boon to both surgeons and their patients. Doctors are being trained in ever greater numbers across Canada in the new technique.

Where, for example, in surgery around the stomach area, the abdomen is inflated with carbon dioxide, a fibre-optic light and camera are inserted allowing surgeons to operate through keyhole incisions as opposed to large, invasive slashes through the epidermis, musculature, sinew and bone to approach the surgical site. Operating through the keyholes now, surgeons view what is happening in real time on a screen.

With the advent of minimally invasive surgical techniques, miniaturized tools are used, guided by computer-assisted tracking and real-time X-rays to allow surgeons to navigate their way through the body interior. Throughout the process there is little blood, as surgeons face a large television monitor to check their instruments' progress within the human body. A technician in an adjoining room full of computers orchestrates the onscreen show for the surgeons.

An X-ray during surgery. Wayne Cuddington

Laparoscopies have been performed for more than 40 years, in tying off Fallopian tubes in a tubal ligation procedure for the purpose of permanent birth control. The techniques used are similar; the carbon dioxide inflation, the fibre-optic light, a keyhole incision and miniature tools. Over the years the procedure graduated to far more complex surgeries like preventing ruptures of aortic aneurysms, splenectomies  and bariatric bypass surgery.

Patients undergoing these surgeries remain in hospital for a day or two rather than for a more usual open-surgery, post-operative week. Gall bladders can be removed quickly in a cholecystectomy with the use of keyhole incisions and laparoscopic tools. Instead of a 10- to 16- centimetre incision in the abdomen, doctors use four tiny keyholes to remove a patient's gall bladder. From gynaecology to opthalmology and paediatric surgery, minimally invasive surgery has revolutionized operations.

The result is less pain involved with the MIS procedure, shorter hospital stays and improved patient outcomes. No need to cut through muscle, resulting in faster recovery times, and less scar tissue. At The Ottawa Hospital the first high-tech operating room, with three more to follow, custom built for minimally invasive surgery, opened last year. The renovation which cost $9-million included a movable, laser-guided GE Discovery IGS 730, the only one yet in Canada.

Hovercraft-like tool improves surgery 1:56 

This is a high-tech device that produces high-resolution X-ray images in real time which can be married to CT scans to produce three-dimensional pictures of organs and blood vessels. With MIS there is no need for patients to undergo general anesthesia which is a requirement for open surgery.