Surgery without scars: Doctor explains when is it possible, advantages

Will abdominal surgery leave a lasting scar? How long will recovery really take? And when can life return to normal? These are the questions that most often weigh on people preparing for surgery. The most reassuring answer to all of them lies in minimally invasive, or keyhole, surgery.

Unlike conventional procedures that require large incisions, minimally invasive surgeries are performed through tiny openings using advanced cameras and precision instruments. This approach significantly reduces pain and helps patients recover faster. The biggest leap forward in this field has been the advent of robotic surgery systems. Guided by high-definition 3D visuals, surgeons can operate with accuracy, even in extremely delicate and hard-to-reach areas of the body. Today, the two most widely used advanced surgical techniques are laparoscopic surgery and robotic surgery.

1. Surgeries for cancer treatment
Laparoscopic stomach cancer surgery - This procedure is performed to treat cancer of the stomach. Small incisions are made in the abdomen, through which either a part of the stomach or the entire stomach is removed. This surgery is also known as laparoscopic gastrectomy.
Low anterior resection: A surgical procedure used to treat cancers of the rectum or sigmoid colon.
Abdominoperineal resection -This surgery is carried out to remove cancerous growths located very close to the anus and the surrounding muscles.

Right and left hemicolectomy - This procedure involves the removal of a portion of the large intestine. Right hemicolectomy refers to the removal of the right side of the colon, while Left hemicolectomy involves the removal of the left side of the colon.
Robotic esophagectomy -This procedure is performed to remove cancer of the oesophagus. Robotic surgery enables surgeons to remove cancerous cells with precision, while preserving surrounding healthy tissues and nerves.

2. Advanced hernia surgeries
Compared to conventional procedures, these advanced techniques are designed to reduce the risk of hernia recurrence:
TEP and ETEP - In these methods, a mesh is placed between the abdominal muscles. This strengthens the muscle layer.
IPOM (Intraperitoneal Onlay Mesh) - This technique involves placing the mesh inside the abdomen to repair the hernia.
Robotic hernia repair - Robotic assistance enhances precision, especially in complex hernia cases.

3. Bariatric surgery (Treatment for obesity)
Bariatric surgery is recommended for individuals with severe obesity that cannot be managed through diet and exercise alone.
Sleeve gastrectomy: This procedure reduces the size of the stomach, enabling patients to feel full with smaller amounts of food.
Gastric bypass - In addition to reducing stomach size, this surgery alters the structure of the small intestine to speed up digestion. It also helps improve diabetes control.

4. Pancreatic and liver surgeries
Whipple procedure (laparoscopic or robotic) -This major surgery, performed to treat cancer of the pancreas, can be carried out using keyhole techniques.  These minimally invasive approaches help patients recover faster.
Laparoscopic liver resection -  an advanced surgical method used to remove tumours affecting the liver. The procedure is performed through keyhole surgery, avoiding large incisions.

5. Hiatal hernia and acid reflux treatment
For conditions such as gastroesophageal reflux disease (GERD) and hiatal hernia, laparoscopic fundoplication is an effective surgical option. In this procedure, the upper part of the stomach is wrapped around the oesophagus to prevent acid from flowing back into the oesophagus.

6. Total proctocolectomy with IPAA 
This surgery involves the complete removal of the large intestine and the rectum. To preserve normal bowel function after surgery, a pouch is created using the end of the small intestine (ileum) and is then connected to the anus.

Although both laparoscopic surgery and robotic surgery are forms of `keyhole' surgery, there are significant technical differences between the two.

Surgical technique
Laparoscopic surgery: In laparoscopic procedures, the surgeon directly controls the instruments by hand. Small incisions are made in the abdomen, through which a camera and surgical instruments are inserted to perform the operation.
Robotic surgery: The surgeon does not directly touch the patient. Instead, the surgeon sits at a console and controls robotic arms. The robot precisely replicates the surgeon’s hand and finger movements with exceptional accuracy.

Visual clarity
Laparoscopic surgery: The surgeon views the operative field on a screen that provides a two-dimensional (2D) image, like a television screen. Depth perception can therefore be somewhat limited.
Robotic surgery: Robotic systems provide high-definition three-dimensional (3D) visuals. The organs can be magnified up to ten times, allowing surgeons to clearly identify even the finest blood vessels and nerves with precision.

Precision and flexibility
Laparoscopic surgery: The instruments used in laparoscopic procedures have limited flexibility.
Robotic surgery: Robotic arms can rotate and bend far more freely, offering a full 360-degree range of movement that surpasses the human wrist. This enhanced flexibility allows surgeons to perform highly precise procedures in complex areas of the digestive system, including regions near the rectum.

Post-surgical recovery
Both approaches offer clear advantages over traditional open surgery. However, robotic surgery causes minimal trauma to surrounding tissues, resulting in less pain and reduced blood loss compared to laparoscopic procedures. As a result, patients undergoing robotic surgery often return to normal life more quickly. The choice of surgical method is ultimately made by the surgeon, based on the patient’s overall health and the severity of the disease condition.
(The author is the Head of the Department of Surgical Gastroenterology at Apollo Adlux Hospital, Angamaly)