For many years now, surgery has always been scary for both adults and children—be it a major or minor one. Up until the early 1900s, open surgery was the only surgical method available for patients. However, a discovery by a couple of brilliant doctors on keyhole surgery (laparoscopy), changes everything!
Thanks to these doctors and many others contributing to this advancement in the medical industry, we can now go through surgeries with minimal scarring inside and out.
Join Motherhood.com.my as we chat with Dr Nadarajan Sudhakaran, Paediatric Surgeon and Urologist at Pantai Hospital Kuala Lumpur, on keyhole surgery in kids!
Q1: What are some of the incidences whereby keyhole surgery is a better option for children?
Dr Nada: Any instance where there is a choice of making smaller incisions with minimal trauma is preferable. Hence, we need to consider the possibility of keyhole surgery for every child.
There are some common procedures that have proven evidence of decreasing the pain and shortening the recovery period for children.
These include the common inguinal hernia repair (hernia at the groin), surgery for appendicitis, and surgery for an undescended testis (testis that cannot be felt externally).
There are many other more complex surgeries that are performed in the tummy or in the chest for babies and children which are, again, significantly less traumatic—both physically and psychologically.
Q2: Is there a minimum age for the procedure among babies?
Dr Nada: There is no minimum age or weight that is required to perform keyhole surgeries on babies.
Some conditions may require surgery soon after the child is born, such as oesophageal atresia*, atresia of the duodenum**, or any other part of the intestine, for that matter. In all these cases the child will not be able to feed as there is this discontinuity. Hence, the bowel needs to be re-joined to establish continuity.
Oesophageal atresia surgery is approached by keyhole surgery through the chest, whereas the other atresias are approached through the tummy.
Babies recover so well after this type of surgery and end up feeding and being discharged sooner than the open method.
*Oesophageal atresia: Discontinuity of the oesophagus – food-pipe between the back of the throat to the stomach in the tummy
**Atresia of the duodenum: The part of the intestine just after the stomach
Q3: Is keyhole surgery gaining popularity among Malaysian parents? Can you provide any statistics?
Dr Nada: More parents are requesting keyhole surgery as there is more awareness now on this more advanced method of surgery for kids.
These parents make the choice to avoid traditional surgery which is more painful and mutilating. They opt for the more comfortable keyhole surgery for their child.
The numbers, however, are difficult to quantify. But I have seen a doubling of the total number of my cases over the last 3 years, despite the COVID-19 pandemic.
One-half of my work is for children who need non-urgent surgery but have travelled from other centres or states to have the keyhole option.
There are also a reasonable number of patients who moved from other centres for their child to have urgent or semi-urgent surgeries with me when they were not offered keyhole surgery at their original centre. Surgeries for appendicitis and groin hernias are such examples.
Q4: Can you please briefly explain the keyhole surgery process?
Dr Nada: Keyhole surgery can be conducted in any space. For a child surgeon, those spaces are in the chest or the abdominal cavities. Traditional surgery requires a surgeon to use their hands or larger instruments on the tissue concerned to perform the surgery.
As such, the cut needs to be large enough to allow their hands to enter the abdomen or chest; or for the larger instruments to deliver the organ outside.
Keyhole surgery allows the procedure to be done “on-site” where the work needs to be done, by introducing a tiny camera into the chest or abdomen to view what’s happening on a TV monitor outside, and two tiny instruments to help perform the surgery.
These cameras and instruments used for children are 3mm wide and that’s the size of the cuts seen on their tummy or chest.
Q5: How many hours does the procedure take? What is the healing process like?
Dr Nada: The procedure by keyhole surgery is not much longer than the open surgery in expert hands. The most common procedures that I perform are such as inguinal hernia repair or appendicectomies, which are quicker by the keyhole method.
Some more complex surgeries such as oesophageal atresia repair or repair of the choledochal cyst (cysts of the bile duct from the liver) may take 10% longer time by the keyhole method.
Children go home a few days earlier with the keyhole method vs the open, in both the aforementioned procedures.
Q6: Are there any visible scars from the procedure?
Dr Nada: With any cuts, there will be scarring. The size of the cut or how the child heals determines how visible the scar is after any surgery. With keyhole surgery, the cuts are minuscule as compared to open surgery. Hence, the visible scars are more prominent with the open surgery.
What’s equally important is the scarring on the inside of the chest or abdomen, which may lead to other problems with the internal organs in the future.
The muscle that’s cut with open surgery to enter the chest or tummy will not function as well as normal, especially so with cuts on the chest which can lead to chest deformity, or even spinal deformity later on in life.
Q7: In your opinion, why should more parents opt for keyhole surgery instead of open surgery?
Dr Nada: All parents want what’s best for their children. They would also like to avoid pain, discomfort, scarring, or long-term deformities for their child who needs surgery.
Advanced keyhole surgery offers to be what’s currently the best type of surgery for children and avoiding all the negative association of pain and discomfort that goes with the traditional open surgery.
Q8: In your opinion, why are some parents hesitant to opt for this method?
Dr Nada: As the price between open and keyhole surgery is not too different, I guess the main issue here is on the awareness that this type of surgery even exists.
Some parents are not aware that there are specialised children surgeons, let alone children surgeons who offer keyhole surgery as a first choice.
Q9: Are there any limitations to keyhole surgery?
Dr Nada: Keyhole surgery for children is done for most procedures in the chest or tummy, in developed countries’ most top centres. There are no age or size limits.
However, there are exceptions to its use. For example, if the child had an open surgery previously to the area of concern. It may have created a lot of scarring, in which case there may then be difficulties in proceeding with keyhole surgery.
We also often avoid performing keyhole surgeries for complex tumour surgery. This is still best done by the open method.
Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner.
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