A physician, who has witnessed the development of minimally-invasive surgery from the beginning, is a Professor Georg Kähler. He is the Director of the center for interdisciplinary endoscopy, University hospital Mannheim, Germany. With him FOCUS Online spoke about the possibilities and limits of the “key-hole”surgery.
30 years ago it was a surgical Revolution: surgery, got along without large incisions with the scalpel, and the surgical instruments and a miniature camera through small holes at the surgical site were shoehorned that was only seen on a Monitor. The classic surgeons were then in arms against this “unnecessary” method, in which the sensitivity of the surgeons remained hands on the track. Today, minimally invasive surgery, surgical craft, some interference Standard and to conquer new fields of application. The surgeon Georg Kähler, 61, directs the center for interdisciplinary endoscopy, University hospital Mannheim, Germany, and has experienced the development from the beginning.
FOCUS Online: Endoscopic surgery, laparoscopy, a “keyhole SURGERY”, minimally-invasive interventions – there are so many names for the surgery without a large incision from the outside. These are just different terms for the same thing?
Prof. Georg Kähler: no, because there are differences, but in the use of language is often confused. Minimally invasive an Umbrella term that encompasses all interventions with minor injuries from the outside. The cut is the arthroscopy of the knee, as well as a bowel-OP without the belly. “Key hole surgery” is a pithy, colloquial term that means laparoscopy, minimal invasive surgery with rigid instruments in the abdominal cavity. Endoscopic operations are the correct way, especially the openings at the endoscopy (endoscopy) of a body with a flexible Instrument through the natural body.
Gallbladder, appendicitis, hernia – most of the OPs are minimally invasive
FOCUS Online: Where is the “key hole surgery” are already Standard today and what is in the future still possible?
Kähler: gall bladder and appendectomies are now only minimally-invasive. The removal of the gallbladder, with over 90 per cent is the Prime example. A hernia can be surgery without a large incision through the abdominal wall. Colon surgery can be performed today to 50 percent endoscopically. It is, however, always to the conditions in the patient. Already operated on you will live without it because of the potential of existing scarring. In the case of stomach, liver and lung cancer, individual hospitals also have achieved good results. In the oncological surgery is surgery in the future as less open.
FOCUS Online: And where are the limits of the method of operation?
Kähler: If a lot of tissue or a large Tumor must be removed, and will not by the instruments, it is between three millimeters and one centimeter in diameter. What also works well is if multiple organs are to be affected and/or many vessels closed. A good example of the limits of the pancreas. It is unfavorable for the rigid guide tubes of the instruments and there is a delicate vascular system. As the traditional surgery with the scalpel more sense.
Patients recover much faster
FOCUS Online: Where do you see the major advantages of minimally invasive surgery?
Kähler: For the patient, the benefits clearly in the immediate period after surgery: less pain, earlier mobility, shorter hospital stay, lower risk of wound infection or incisional hernias. We can operate today is also a lot of more elderly patients who no longer had we operated earlier the classic way. In the long term, there are no differences with respect to the operation result, apart from the lack of a large scar.
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FOCUS Online: Did the method also has advantages for the surgeon? Or you can learn just more difficult?
Kähler: I would not say that the Operate from the outside more difficult to learn. Today, there are very good training Devices, plastic models of the animal body to Video OPs. You can see there’s a lot more than in the case of films of classical operations. And because in the OP all look the Same on the Monitor, we can control the young assistant doctors, correct and better form.
Robots and 3-D representation of are perfect, the endoscopic Operation more
FOCUS Online: Is the development of the minimally invasive technique already maxed out?
Kähler: Certainly not. We benefit from the General technical development. The optics of the cameras is much better today than even a few years ago, so that we can operate more precisely. There are 3D systems, in the area of operation in three dimensions is presented. Is this for a tumor removal is extremely important. The two-dimensionality of the Monitor was always a certain disadvantage of the operations from the outside. In the future surgical robots will be more important – the instruments can perform movements of a human Hand are impossible. Or, the robot automatically finds the best insertion angle for the instruments. This, then, is for the surgeon, such as a Parking assistant at the car.