Minimal pain, quick recovery
Laparoscopic surgery minimizes surgical cuts

By Emily Hui

Laparoscopic surgery is named after a fibre optic instrument, the laparoscope. It is a sophisticated lens inserted through the abdominal wall to look at the organs inside. It makes a small hole of about one to 1.5 centimetres for the insertion of surgical tools.

The image of the internal organs is transmitted to a monitor, and the surgeon can perform an operation while watching it.

“It’s just like playing video games,” said Dr. Edward Lai of Department of Surgery at Queen Mary Hospital.

Nowadays in Hong Kong, laparoscopic surgery has become a common practice for the removal of gall bladder. It can also be applied in cutting the appendix and large intestine, as well as stomach ulcer therapy. It was first used in sterilization in the early ’80s.

The first attempt at gall bladder removal was done in 1987 by French doctors. They used animals like pigs to test its feasibility. It turned out to be a breakthrough, and doctors worldwide followed suit.

In Hong Kong, the first successful laparoscopic surgery to remove a gall bladder was conducted in 1990 by doctors at The Prince of Wales Hospital. United Christian Hospital and Queen Mary Hospital adopted this new technology afterwards.

Dr. Samuel Kwok, chief of service and consultant surgeon of United Christian Hospital, did the first laparoscopic surgery involving the cutting of large intestine four years ago. So far, he has done 200 cases.

According to Dr. Lai, to perform this operation, the surgeon first cuts four tiny holes and then pumps in carbon dioxide to widen the gap between the abdominal wall and the internal organs. The next step is to insert the laparoscope and chopstick-like instruments. When everything is ready, the surgeon makes the incision while watching the monitor.

As the surgical cuts are small in size, postoperative pain is hence minimized.

“The hole is so small that a few stitches will be enough and the thread need not to be unsewn,” said Dr. Grace Tang of the Department of Obstetrics and Gynaecology at the University of Hong Kong.

Patients who have undergone traditional surgery normally have to stay in hospital for at least four to five days. Those who have laparoscopic surgery can be discharged the next day. Women receiving sterilization can be back at work after three weeks of rest.

Small wounds also mean lower chances of infection from other diseases.

Dr. Lai said that patients are usually very satisfied with the surgery due to the minimal pain, unnoticeable scar and quick recovery.

Despite these strengths of the technology, problems and difficulties do exist.

“Laparoscopic surgery differs a lot from the conventional one,” said Dr. Kwok. “The eye-hand coordination of watching a monitor is very different from seeing directly. Training and practice are crucial.”

Moreover, since the incision is small, special instruments put into the body may injure the internal organs. Yet, Dr. Tang said other forms of surgery may have similar risk. It depends on the skill and experience of the surgeon.

The difficulties as a result lengthen the time in surgery, especially at the learning stage. Dr. Kwok said, “Taking the removal of large intestine as an example, normal surgery only needs two hours, but laparoscopic surgery takes four hours.

“Nevertheless, as experience accumulates, the surgery time can be as short as two and a half hours,” Dr. Kwok added.

March 1996