Keyhole surgery in newborns
Laparoscopic surgery is a minimally invasive procedure that involves small keyhole incisions made on the stomach resulting in shorter recovery time, reduced chance of early and late potential complications and improved cosmetic results in comparison to the traditional open surgery approach.
Here is an excerpt from a video interview of Dr M. Srinivasa Rao, Chief Paediatric Surgeon at Omni RK Hospitals, Visakhapatnam on Keyhole surgeries in newborns and common queries related to open surgery and keyhole surgery.
Q. What is keyhole surgery? Explain the difference between a keyhole surgery in paediatrics and newborns.
A. Keyhole surgery is one in which the surgery is performed without cutting open the abdomen or chest. It is performed using long instruments which are inserted into the abdomen.
This surgery differs between paediatrics and newborns in a way that newborns are very small and are less than or equal to 28 days and weigh less than 5 kgs while paediatric surgeries are performed on children above the age of 1 year and weigh more than 5 kgs.
Q. As a paediatric surgeon, what are the advantages of performing surgeries on newborns?
A. Many newborns are born with medical conditions, small and big, like Hyaline membrane disease (HMD) and Macrophage activation syndrome (MAS). Some newborns also come to the hospital with deformities and small intestine obstruction, large intestine obstruction etc.
In such cases, the newborns need to be operated on, as soon as possible, otherwise, there is a high chance of mortality in these babies. So a lot of precautions are taken from our end to diagnose and treat the baby as soon as possible to help him/her survive.
This makes most newborn surgeries emergency centric.
Q. What surgeries are generally performed in newborns?
A. Generally, most commonly performed surgeries on newborns are,
1. Laparoscopic surgeries for hernia
2. Abdominal surgeries
3. Small bowel obstructions
Although not all babies are suitable for laparoscopic surgery, most babies can be stabilised.
Q. What are the recent advancements in surgeries performed on newborns?
A. There is quite some development in the surgeries performed on newborns in the last five years. Most significant developments are in the areas of,
1. Antibiotics
2. Anaesthetic agents
3. NICU care
Due to these advancements in science and health care unit facilities, the mortality rate of babies has come down to single-digit numbers.
Q. What are the different medical and surgical precautions do doctors take while treating newborns?
A. When babies are born prematurely and weigh just about 500-700 gms, then special care is given to them and they are only taken care of by neonatologists. The nursing unit takes care of these babies for 2 months until their weight is regularised to 1.8kgs.
Once the baby reaches 1.8kgs, they are safe to be taken home.
Q. What are the special units in which newborns are operated?
A. Nowadays, there are special units to operate on newborns. These units consist of advanced equipment and technology which makes the surgical procedures easier. It also consists of advanced specialists and dedicated teams to take care of newborns.
Many such units have opened up in India in the recent past, in government as well as private hospitals.
Due to these advancements in science and health care unit facilities, the mortality rate of babies has come down to single-digit numbers.
Q. What special care do parents have to take care of before surgery?
A. There are no specific care or precautions that parents have to take before the surgery. They just have to be able to notice the problem area in the baby as soon as possible and consult a doctor at the earliest.
Q. Are there any side-effects of endoscopic surgery?
A. Side-effects of endoscopic surgery are equal to that of open surgery. The complications that occur and in open surgery are also seen in endoscopic surgery.
For example, when an intestine is joined, bleeding occurs if it an open surgery or endoscopic surgery.
Hence, there are no special side effects that are seen in endoscopic surgery that are different from open surgery. Minimally invasive surgeries require more expertise and precision from the doctor’s end.
Q. Is a keyhole surgery required for all babies?
A. If the baby is stable and is not suffering from any medical conditions like bleeding, then a keyhole surgery cannot be performed.
Although, if a baby is suffering from infections or any other deformities, then a keyhole surgery will be required.
Q. What are the different conditions that can be treated using keyhole surgery?
A. Different conditions that can be treated using keyhole surgery are:
1. Laparoscopic surgeries for hernia
2. Abdominal surgeries and
3. Small bowel obstructions
4. Cyst surgeries (chest and abdomen)
Although not all babies are suitable for laparoscopic surgery, most babies can be stabilised.
Q. What are the advantages of keyhole surgery?
A. The advantages of keyhole surgery are:
1. The operation is done under good lighting and magnification. Hence, the chances for errors are greatly reduced during surgical procedures.
2. Laparoscopy helps in reaching inaccessible parts of the body with ease due to use of long instruments.
3. The dissection and suturing part of the surgery is also easier in keyhole surgery.
4. Operation on newborns for the second time can be done easily due to the minimally invasive procedure.
Hence, in keyhole surgery, there is less scarring and the healing is quicker when compared to open surgery.
Q. What happens in a minimally invasive surgery?
A. Keyhole surgery is one in which the surgery is performed without cutting open the abdomen or chest. It is performed using long instruments which are inserted into the abdomen.
Different conditions that can be treated using keyhole surgery are:
1. Laparoscopic surgeries for hernia
2. Abdominal surgeries
3. Small bowel obstructions
4. Cyst surgeries (chest and abdomen)
Q. Are there any alternatives to keyhole surgery?
A. Depending on the condition of the baby, an open surgery/conventional surgery can be performed on the baby.
In some cases, the baby doesn’t even require surgery. Minimal medical treatment is enough in some babies.
Q. What special care do parents have to take care of before and after keyhole surgery?
A. There are no specific care or precautions that parents have to take before the surgery. They just have to be able to notice the problem area in the baby as soon as possible and consult a doctor at the earliest.
After the surgery, a follow-up will be required to check on the baby’s healing process.
Q. When can the baby return home?
A. A baby who has undergone a keyhole surgery can be taken home once his/her health stabilises.
Q. How long does the surgery take to heal?
A. As laparoscopic surgery is a minimally invasive procedure that involves small keyhole incisions made on a certain body part resulting in shorter recovery time.