Minimally-invasive Surgery
Minimal invasive surgery is a general term to describe a group of surgical procedures that uses a set of modern surgical technique to perform surgery using much smaller wound incisions. As a result, there will be less post- operative wound pain, shorter hospital stay and faster recovery to work. In traditional open surgery, surgeons are required to create large cuts in order to to gain access to the operative site. Whereas in minimal invasive surgery, only small cuts, specialized instruments and cameras are needed to perform the same procedure.
There are many different types of minimal invasive surgical operations across many specialties in medicine. In Surgical Care, we offer a comprehensive range of procedures from laparoscopic cholecystectomy, minimal invasive hernia repair to laparoscopic surgery of the esophagus, stomach and large intestine to treat conditions such as gastric cancer, colonic cancer and acid reflux etc.
There are relatively few disadvantages of minimal invasive surgery as long as the surgeon has had proper training and experience in performing these procedures. Occasionally, the operation may not be able to be completed by minimal invasive surgery due to bleeding, unusual anatomy or other complications arising from the procedure. In these circumstances, the surgery will need to be converted to the “traditional” open surgery.
The overall safety and efficacy of minimal invasive surgery appears to be at least as good as, if not better compared to traditional open surgery. The blood loss and operative time in many minimal invasive procedures has also proven to be superior to traditional open surgery. In the end, the training and experience of the surgeon, availability of special equipment will govern the success and outcome of the procedure.
Gastric cancer
Cancer is the most common killer in Hong Kong. Amongst these cancers, gastric (stomach) cancer is the 6th most lethal. In the early stages, gastric cancer is generally asymptomatic. As the disease progresses, patients may experience abdominal pain, bloating, and indigestion. Gastric cancer is typically diagnosed with endoscopy and CT scan and by the time it is detected, the cancer may have spread to the surrounding lymph nodes and other organs. For patients who are suitable for surgery, laparoscopic gastrectomy to remove part of or the entire stomach along with surrounding lymph nodes can be considered.
Esophageal cancer
Esophageal cancer is one of the most complicated and difficult cancers to treat in general surgery. Common contributing risks factors include smoking, drinking, obesity, drinking very hot drinks, previous radiotherapy and Barrett’s esophagus. Patients most commonly experience difficulty in swallowing, weight loss, chest pain and even hoarseness of voice. However, early stages of the disease carries no symptoms. Endoscopy and CT scan is performed in order to determine if surgical treatment is possible. Patients eligible for surgery may undergo minimally invasive video-assisted thoracoscopic esophagectomy if curative treatment contemplated.
Acid reflux
Patients with acid reflux may experience a wide range of symptoms. Typical symptoms include acid reflux to the throat, and heartburn. There are other atypical symptoms such as burping, bloating, chest pain, coughing, sore throat etc. The first-line treatment for acid reflux is proton- pump inhibitors (PPI) to suppress stomach acid secretion for symptomatic relief. However, not all patients respond satisfactorily to PPIs. In addition, there are also studies that have demonstrated long-term PPI use may result in osteoporosis and increase in the risk of stomach cancer. Patients may consider laparoscopic fundoplication if they do not want to receive long-term medications.
Gastrointestinal Stromal Tumour (GIST)
Gastrointestinal stromal tumours (GIST) can appear anywhere along the gastrointestinal tract, but more than half of them arise from the stomach. GISTs are mostly asymptomatic but if they grow larger, they may cause symptoms such as abdominal pain, vomiting, dark- colored stool due to bleeding or a lump you can feel at your abdomen. The majority of them are detected by endoscopy or CT scan and endoscopic ultrasound (EUS) can be used to confirm the diagnosis, exclude any invasion to surrounding organs and obtain a needle biopsy. In the majority of the cases, GISTs can be locally resected by laparoscopic surgery. However, laparoscopic partial or total gastrectomy maybe required in larger tumors when there is more extensive involvement of the stomach.
Colorectal cancer
Colorectal cancer is the second most lethal cancer in Hong Kong and common risk factors include smoking, alcohol, obesity, diet rich in red and processed meat and a strong family history. Typical symptoms include blood in the stool, change of bowel habit, abdominal pain and anaemia. However, it is not uncommon for patients to be asymptomatic, only discovering the cancer during routine endoscopic examination. Since surgical intervention is imperative to cure colorectal cancer, CT scan, PET- CT scan or MRI maybe performed to confirm the staging of the disease and deduce whether surgery is feasible.Patients may consider laparoscopic colectomy, which has shorter recovery and smaller wounds compared to traditional open surgery.
Inguinal hernia
Patients with an inguinal hernia will usually notice a lump at the groin which becomes more obvious if you stand up, cough or strain. It can occur at any age and happens when internal organs such as intestines protrude through a weak point at the groin, which will not close down by itself. If the protruded intestines fails to return back into the abdomen, we may result in peritonitis and subsequent emergency surgery. Patients who are contemplating for surgery may consider total extraperitoneal repair (TEP) due to smaller wounds with less pain and faster recovery.
Incisional Hernia
Incisional hernia commonly occurs in patients who have previously received open abdominal surgery with impaired wound healing due to various reasons. As a result, abdominal organs may protrude through a weak spot in the abdominal wall resulting in a hernia. Patients most commonly notice a bulge at the previous surgical site accompanied with various degrees of pain and discomfort. If left untreated, the hernia may enlarge, and the protruded intestines may not be able to return to its original position, leading to peritonitis and emergency surgery. As the defect at the abdominal wall will not close down spontaneously, surgical repair is mandatory in order to treat the hernia. Most patients are suitable for laparoscopic surgery, which is potentially superior to traditional open surgery due to smaller wounds, reduced pain, and faster recovery with similar success rate.
Symptomatic Gallstones
Gallstones disease is very common in Hong Kong. It is estimated that around 5-10% of the population suffer from gallstone disease and the majority of them are female. In general, patients with gallstones who are asymptomatic do not require any treatment. However, those who suffer from abdominal pain caused by gallstones, cholecystitis, cholangitis or pancreatitis will need to consider cholecystectomy. Nowadays, laparoscopic cholecystectomy is the surgery of choice to remove the gallbladder together with the gallstones. Patients can expect to have 3-4 small surgical wounds at the abdomen and to stay at the hospital from around 1-2 days after the surgery.