Keyhole Surgery and Laparoscopy: Understanding the Terminology
Yes, keyhole surgery and laparoscopy are the same surgical approach. Keyhole surgery is simply the popular or colloquial term for laparoscopic surgery, which is a minimally invasive surgical technique that uses small incisions and specialized instruments including an endoscope (camera) to perform procedures 1.
Definition and Characteristics
- Laparoscopic surgery (keyhole surgery) involves making small incisions through which a camera and surgical instruments are inserted to perform procedures, rather than creating a large surgical opening as in traditional open surgery 2, 1
- This minimally invasive approach has gained broad acceptance across multiple surgical specialties and has become the standard of care for many procedures 1
- The term "keyhole" refers to the small incisions (typically 0.5-1.5 cm) that provide access to the surgical site, resembling a keyhole in appearance 1
Advantages of Laparoscopic/Keyhole Surgery
- Shorter hospital stays compared to open surgical approaches 2
- Faster return to normal activities and work 2
- Fewer moderate-to-severe postoperative complications (14% vs 21% in open surgery) 2
- Less blood loss during procedures 2
- Better quality of life outcomes, particularly in the early postoperative period 2
- Improved cosmetic results due to smaller incisions 1
Common Applications
- Widely used in gynecological procedures including hysterectomy and myomectomy 2
- Frequently employed for general surgical procedures such as cholecystectomy (77.1%), appendectomy (79.2%), and bariatric surgery (94.0%) 3
- Used in colorectal surgery, with increasing adoption for colectomy (52.4%) and rectal resection (18.3%) 3
- Applied in hernia repairs, including parastomal hernia repair using modified keyhole techniques 4, 5
- Utilized in emergency abdominal surgery, though with higher conversion rates to open procedures 6
Limitations and Considerations
- Longer operative time compared to open surgery (204 vs 130 minutes in some studies) 2
- Requires specialized training and equipment 7
- May be converted to open surgery in complex cases or when complications arise 6
- Absolute contraindications include hemodynamic instability, severe coagulopathy, and inability to tolerate pneumoperitoneum 7
- Conversion rates vary by procedure type, with higher rates in emergency settings (63%) and complex operations like rectal resection (16.4%) 6, 3
Variants and Technological Advancements
- Robotic-assisted laparoscopy is becoming increasingly popular, offering enhanced dexterity and visualization 2, 8
- Single-site laparoscopy uses a single incision rather than multiple ports, though with some limitations in visualization 2
- Specialized techniques have been developed for specific procedures, such as modified keyhole approaches for parastomal hernia repair 4, 5
Laparoscopy/keyhole surgery has revolutionized surgical practice by reducing patient morbidity while maintaining or improving surgical outcomes. The choice between laparoscopic and open approaches should be based on patient factors, surgeon experience, and the specific procedure being performed 7.