Jonathan Koea’s health article in the Mahurangi Matters

Twenty years ago, the average hospital stay for a patient undergoing groin hernia repair was one and a half days, five days for gallbladder removal, one night for repair of an umbilical hernia and four days for repair of an incisional hernia. Up to six weeks off work was required to recuperate after each operation. Today, all of these procedures can be carried out in a single day and the patient can return to work in seven to ten days. This is obviously good for patients and families. It has come about through a number of often random medical advances.

Traditionally surgical operations have been carried out through incisions in the skin that are deepened through the underlying tissues until the area requiring treatment is exposed and the operation can proceed. At the end of the procedure the tissues are replaced and the skin incision is closed. Recovery relied on successful completion of the procedure, gradual return of function of the disturbed tissues and healing of the skin without complication such as infection or scarring. Open surgery can now be performed in many day-stay patients because of the development of enhanced recovery programs. These emphasize good preoperative education, short acting anaesthesia with minimal hangover, early mobilization and excellent social support at home.

Laparoscopic surgery uses small skin incisions (5mm long) to permit the passage of long instruments into body spaces along with a high resolution camera. The area of the body requiring treatment can be accessed without disturbing the overlying tissues and structures and seen with a magnified view on a screen. Laparoscopic surgery benefits the patient by resulting in less time in recovery and an easier recovery with reduced need for pain relief, less change in food intake, less risk of skin infection and scarring. Most importantly, return to normal leisure activities and work is faster. For surgeons, its notable that laparoscopic operations often provide a better view of the area to be treated than open operations and the surgical dissection can be gentler and more precise. This technological advantage has been furthered with the development of surgical robots which have increased the optical quality and allowed highly dextrous instruments to be used in a magnified operative field allowing precise and minimally traumatic procedures to be undertaken – even complex operations involving the liver, pancreas and stomach.

What’s clear now for patients is that both they and their surgeons have a choice of surgical procedure to treat their condition – either open, laparoscopic or robotic operations can be offered depending on the patient and the diagnosis. Early thoughts that one form of surgery would fully replace the other have not eventuated and each approach has benefits in given situations. However the development of laparoscopic and robot surgery has encouraged surgeons to re-examine open procedures and look to optimize patient experience and minimize patient disability. Patients should not hesitate to ask their surgeons about day-stay treatment options and ask whether laparoscopic or robotic operations are appropriate for them since “less” surgery may mean “more” benefit.

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