Operating through a keyhole …

Dr Mark Hampton, Dr Christo Kloppers and scrib sister Sandra Andrews with the "stack" laparoscopy hardwear.

Medical treatment at Victoria Hospital just got better when a laparoscopic “stack” television screen and hardware was delivered last week.

This large district hospital can now offer more patients minimally invasive, or keyhole, surgery for colonic cancer, appendicitis, hernias and other bowel-related diseases as well as urological procedures and ear nose and throat procedures on children.

According to Dr Mark Hampton, head of general surgery at Victoria Hospital Wynberg, doing more procedures laparoscopically could significantly reduce side effects associated with traditional open surgeries.

He said the state-of-the-art laparoscopy machine, or “stack”, is on trial for one week and costs between R800 000 and R1 million and they had had to motivate hard to get it.

The hospital’s CEO, Dr Melvin Moodley, said budgets were limited and hospitals had to make careful choices about what equipment would be likely to add the most value to service delivery.

“With technology moving faster, keyhole surgery means less post-operative pain with patients recovering quicker and most of them going home sooner after surgery. The patient heals faster and has a much smaller scar,” said Dr Moodley.

He said when done well, by well-trained and experienced surgeons, such as Dr Hampton, the results of keyhole inguinal hernia repair could be equivalent to open procedures, but without some of the side effects of open surgery.

On Monday we were invited to watch a procedure using the stack. Dressed in surgery garb, Dr Hampton said the patient had an inguinal hernia, caused when tissue, such as part of the intestine, protrudes through an area of weakness in the abdominal wall musculature. The resulting bulge can sometimes be painful, especially when the person coughs, bends over or lifts a heavy object.

Assisting Dr Hampton was Dr Christo Kloppers who works at Groote Schuur Hospital and specialises in liver disease but has an interest in hernias.

It was 11.45am and he made the first incision, a tiny one in the belly button. He then inserted a laparoscope the size of my little finger. It’s essentially, a thin telescope with a light on the end.

Dr Hampton made two more tiny incisions below the belly button and inserted thinner pipes. The incisions are small, hence the technique often being called keyhole surgery as opposed to conventional surgery which is called open surgery.

For over half an hour they probed and cut, everything magnified on the stack monitor, resembling a colourful area of yellow muscle and red tissue with spider web fragments.

The procedure was lengthy. A medical student explained that Dr Hampton needed to dissect through membranes to get to the hernia which is then reduced back into the abdominal cavity. Imagine trying to cut the fatty membrane off a piece of meat using chopsticks by torchlight, and you get the picture.

Occasionally Dr Kloppers removed the scope to wash the camera in hot water before re-inserting it.

Almost one hour later, a surgical nurse deftly unpacked what looked like a wire mesh the size of my palm. This was inserted through one of the tubes and within seconds was in place, ,protecting the weak point in the abdominal wall to prevent the hernia coming back.

Assisting the surgeons, scrub sister Sandra Andrews said with laparoscopic surgery they are looking at the hernia differently, operating by using a 2D video image of the site rather than straight down.