Minimally invasive surgery or "keyhole" surgery uses a laparoscope or lighted tube with a tiny magnifying camera on its tip. The camera is inserted into the patient's body through a tiny incision to view a desired area. Other laparoscopic tools, including devices such as scissors, dissectors or tweezer-like graspers, are inserted into incisions ranging in size from two millimetres to ten millimetres to perform the actual procedure. In conventional open surgery, the surgeon makes a large incision, places his hands inside the body cavity and focuses his eyes directly on what he is doing. In keyhole surgery, the procedure is performed with the laparoscopic tools while the surgeon watches a two-dimensional monitor set up in the room.
Residents at University of Kentucky's Center for Minimally Invasive Surgery spend hours practising with the laparoscopic instruments, grasping small metal pegs or stapling virtual tissue on a sponge-like foam as they view their progress on a monitor. The exercises are being videotaped for critique and reference, and the students are equally able to review digital video of actual surgeries from nearby computer CD-ROMs for observation. Dr. Adrian Park, director of the center, describes it as one of only a handful institutions which trains residents and practising surgeons by using its own simulators and models designed and built on site. The continual challenge is to develop a programme, providing formal training guidelines in the complex techniques involved in minimally invasive surgery.
Although simple laparoscopic procedures have been done for years, only in the last decade has minimally invasive surgery been thrust into the medical spotlight. Minimally invasive surgery is more expensive than a traditional intervention, depending on the procedure and the institution. Those costs however are offset by a shorter hospital stay and a quicker recovery time for the patient. Future advances in technology, both in the tools which are used to perform the surgeries, as well as the simulators that are designed to teach the necessary skills, will allow surgeons to perform even the most difficult procedures laparoscopically.
Dr. Park illustrated these optimistic forecasts, by giving a series of realistic examples. "Aneurysm surgery used to be a massive operation, with a patient in the hospital a week to ten days and then another two to three months of recovery", he explained. "Now, people are going home the next day and they are hardly missing a week of work. It's phenomenal. It's the same thing with kidney transplants. It used to be that to donate a kidney to a relative, you were faced with this huge scar, a lengthy hospital stay and about two months of recovery. We now can do it laparoscopically and patients go home the next day and are back at work in only a week or two."
Dr. Paige Cornette, a 28-year old first-year surgical resident at the University of Kentucky's Chandler Medical Center is using similar high-tech skills to become a more highly trained and sought-after surgeon, and able to perform operations in which only small incisions are made in the patient. "The challenges of teaching these procedures are unique", stated Dr. Park. One of the old dictums in surgery is see one, do one, teach one. That does not fly at all in minimally invasive surgery since there is an entirely different set of skills involved as well as a different way of viewing the anatomy."
"The students spend time here in an inanimate setting where they are not practising on patients but on several innovative models we have designed right here", stated James Hoskins, the center's information technology manager. "So trainees learn the elemental skills necessary to perform a procedure before ever getting near a live patient." It took Dr. Cornette a while before the laparoscopic tools became comfortable in her hands. She knows it will take her many more hours of work and study before she will get the chance to demonstrate her skills on a patient. "What we are seeing is the future unfolding in front of us", Dr. Park commented. "The revolution toward less and less invasive therapy is becoming unstoppable. As the technology gradually improves, we will be able to do more and more both in the way of teaching and performing the procedures."