Minimally Invasive Surgery (MIS) Centre

What is Minimally Invasive Surgery (MIS)?

MIS, also called laparoscopic surgery/ “keyhole” surgery, is a modern surgical technique in which operations are performed through small incisions (usually 0.3–1.5cm) as compared to larger incisions needed in traditional surgical procedures. Traditionally, surgery used to be performed via large incisions to afford easy access and visibility. However, MIS has now developed to such an advanced stage that every known open procedure can be performed via the MIS technique.

MIS has several benefits:

  • Shorter hospital stay
  • Faster recovery
  • Better cosmesis
  • Lesser pain
  • Lesser blood loss
  • Cost effective

We offer the management of minimally invasive surgeries across multi-disciplines which include:

Specialty Types of Surgery
Bariactric (Obesity) Surgery
  • Intragastric Balloon
  • Gastric Banding
  • Sleeve Gastrectomy
  • Gastric Plication
  • Gastric Bypass
ENT & Neurosurgery
  • Endoscopic Pituitary Surgery
General Surgery
  • Benign & Cancer Gastrointestinal (Oesophageal, Stomach, Appendix, Large & Small Intestines)
  • Hernia (Abdominal Wall, Groin & etc)
  • Hepatobiliary Pancreatic Surgery (Gallstones, CBD Stone, Pancreatic Pseudocyst & etc)
  • Spleen
  • Endoscopic Thyroid Surgery
  • Precutaneous Endoscopic Gastrostomy (PEG)
  • Diagnostic Procedures (Biopsies etc.)
Gynaecology
  • Diagnostic Laparoscopy + Dye Insufflation
  • Laparoscopic Ovaraian Drilling
  • Laparoscopic Salpingectomy/ Salpingotomy
  • Laparoscopic Ovaraian Cystectomy, Oophorectomy, Myomectomy
  • Laparoscopic Assisted Vaginal Hysterectomy, Laparoscopic Hysterectomy
Neurosurgery
  • Computer-aided Surgery
  • Craniotomy
  • Ventriculostomy, Biopsies
Orthopaedic
  • Joints, Ligaments Reconstruction & Repair
Paediatric Surgery
  • Intestines
  • Tumours
  • Appendicitis
  • Hernias
Paediatric Urology
  • Testicular Problems
  • Varicocoele
Spinal Surgery
  • Endoscopic Discectomy
  • Nucleoplasty
  • Vertebroplasty
  • Kyphoplasty
Surgical Oncology
  • Distal Pancreatectomy
  • Laparoscopic Colectomy
  • Mesorectal Resection
  • Sentinal Node Mapping For Breast & Colon Cancer
  • Colonic Stenting For Tumors
Thoracic Surgery
  • Video-Assisted Thoracoscopic Surgery (VATS)
Urology
  • Tumours, Varicocele

Access and Monitoring

The cavity (chest, abdomen or joint) is accessed through small ports and the cavity is inflated with carbon dioxide (safe and harmless for this purpose) to provide a large and unobstructed view of the organ being operated on, as the rest of the other organs are pushed away from the operative site.

Trocars (5-10 mm. tube cylinders) are inserted through the thumb-size ports and, through one of these trocars, a flexible fiber-optic scope with a lens (lighted magnifying video-camera) at the tip is inserted. This will send real time and live images (high definition) to a TV monitor for everyone in the operating room to view as the surgeon manipulates the various instruments to perform the surgery. Through the other ports are inserted the long stem needle (suture) holder, scissors, grasping/dissecting instrument, endoknife, suction tip, etc. The images on the monitor are magnified to about 5 times the normal size of the structures for easier surgery.

Recovery

After surgery, patient will be taken to the recovery room to allow the effects of anaesthesia to wear off and subsequently warded for post-operative care. Assessment and treatment of pre-cancers including vulvoscopy, colposcopy and loop excision.

If required, patient may request for pain relief options such as:

  • Oral/ intravenous medication
  • Nurse or patient-controlled analgesia (NCA or PCA). (The amount of pain relief needed can be adjusted by either the nurse or the patient.)

After surgery, patient may not be able to eat or drink for a few hours and will be put on an intravenous drip.

Although the recovery period may vary, depending on the type of surgery performed, most patients feel well enough to resume their normal activities and return to work a week after the operation. Your doctor will advise when you can take up more vigorous activities and sports.

Follow-ups

Patients will be asked to come back for review upon their discharge from the hospital. Please consult the doctor if any of the following symptoms develop:

  • Intense pain (which medication does not seem to relieve)
  • Wound sites that are red, inflamed and feel warmer than the surrounding skin
  • Oozing from the wound sites

Frequently Asked Questions

MIS, also known as keyhole surgery, is a method of carrying out an operation without having to make a large incision (as is the case with conventional or ‘open’ surgery). Surgical scars are between 3mm and 15 mm in length.

Many types of operations can be performed using MIS. These include surgery for appendicitis, inguinal/ ventral hernia repair, gallbladder disease, hyperhidrosis (sweaty palms), adrenal mass, benign and malignant colorectal diseases, gastroesophageal reflux disease and removal of spleen and kidneys.

Compared to ‘open’ surgery, patients who have undergone laparoscopic surgery tend to recover earlier, experience fewer side effects, feel less post-operative pain and have smaller scars. The duration of hospitalization is also reduced.

A common side effect of ‘open’ surgery is the formation of adhesions, a condition whereby internal organs stick together and form bands of scar tissue. Adhesions can be painful and cause bowel obstruction. The risk of adhesions is reduced in laparoscopic surgery.

All operations, including MIS, carry a small risk of infection and bleeding. Anaesthesia used in surgery also carries a risk of complications and may result in side effects. These include nausea, vomiting, sorethroat, headache, dizziness and shoulder pain. These are usually short-lived and do not require any specialized care. Remote injuries may involve the bowels and vessels which will require ‘open’ surgery.

All operations carried out via MIS can be carried out using the ‘open’ method. However, ‘open’ surgery has its own disadvantages as listed previously.

Most patients would be suitable candidates for MIS. However, some may not be able to proceed with MIS due to reasons such as late pregnancy or unexpected intraoperative findings where ‘open’ surgery is needed. Your doctor will be able to advise you on the surgical options that are more suitable for your condition.

Small incisions are made in the abdomen after which a harmless gas is pumped in to create space for the surgeon to operate. Viewing equipment (comprising of a camera connected to a TV monitor) and surgical instruments are then inserted through the incisions into the newly formed space. With a clear image of the operating field projected onto the monitor, the surgeon then carries out the operation.

Pre and post-operative care required for ‘open’ surgery and MIS are the same.

Prior to hospital admission for surgery, you will receive a letter listing the things you need to do/note to prepare for surgery (e.g. not eating and drinking for a length of time before surgery). It is important to follow all the instructions to ensure that your surgery can proceed as scheduled.

Your surgeon will explain the procedure and also answer any questions that you may have. You will also need to sign a consent form for surgery. The anaesthetist will also discuss the anaesthesia options with you. If you have any medical condition (such as drug allergies), please inform the doctor.

After surgery, you will be taken to the recovery room to allow the effects of anaesthesia to wear off. Thereafter, you will be warded for post-operative care.

If required, you can request for pain relief options such as:

  • Oral/ intravenous medication
  • Nurse or patient-controlled analgesia (NCA or PCA). The amount of pain relief needed can be adjusted by either the nurse or the patient.

After surgery, you may not be able to eat or drink for a few hours and will be put on an intravenous drip.

After discharge, you may need some medication for pain relief. Usually, Paracetamol will suffice but, if required, your doctor can prescribe you stronger pain relief medication. These prescribed medicines can be obtained from the hospital pharmacy. Please inform your doctor of any allergies.

Try to rest as much as possible and refrain from vigorous activities to allow your body to recover.

Most patients feel well enough to resume their normal activities and return to work, a week after the operation. Your doctor will advise when you can take up more vigorous activities and sports.

IMPORTANT: You will need to return for a review by your doctor in about 4 – 6 weeks after the operation. Please see your doctor if you have any of the following symptoms:

  • Intense pain (which medication does not seem to relieve)
  • Wound sites that are red, inflamed and feel warmer than the surrounding skin
  • Oozing from the wound sites

Please consult your doctor if you require more information about the operation.