Minimally invasive surgery Shoulder Surgery

Definition: Minimally invasive or "keyhole" surgery

utilises small incisions (size of a buttonhole) through which cameras and a variety of instruments are passed inside the body cavity to carry out the surgery.

The minimally invasive surgical approach offers several advantages over traditional open surgery.

The most important advantage is the greater accuracy with keyhole surgery. Mr Lam uses the most advanced instrumentations with the latest technology including high definition 3 chip camera system and cutting edge NASA space image enhancement system. This allows an excellent outstanding view of the pathology with enhanced clarity and is extremely useful in small spaces which are difficult to see in open surgery.

Other additional benefits include:

• There is less pain with minimally invasive surgery since it does not require splitting muscle layers in the way that the traditional approach did. As a result the pain caused by splitting the muscle layers is spared.
• The approach is less invasive and does not require splitting muscle layers in the same way that the traditional approach did. As a result the pain caused by splitting the muscle layers is decreased.
• There is far better cosmetic result with these mini stab incisions than open surgical scars.
• As a result of significantly less post-operative pain, patients can be discharged from the hospital much quicker than open surgery, allowing nearly all shoulder operations to be carried out as a day case.
• A smaller incision also means that there is less chance of wound complications such as infection.
• A more rapid recovery means that patients can return to work and full sports activities much quicker.
• There is significantly less stiffness post-operatively due to less scaring Keyhole surgery allows complete visualization of small confined spaces which are normally not accessible through open surgery.
• There is negligible blood loss

What does keyhole surgery involve?

The surgery is carried out under general anaesthesia. Multiple mini incisions approximately the size of a button hole are made around the shoulder to permit the passage of surgical instruments into the joint.

Depending on the presenting pathology, the surgery may involve releasing contracted scarred tissue as in frozen shoulder, or repairing torn soft tissues such as tendons and ligaments. A variety of suture anchors can be used for the repair. These anchors are essentially micro screws (2.9mm to 5 mm) with an eyelet at the end through which sutures pass through. The suture material is made of an ultra-high molecular weight polyethylene and is biomechanically stronger than stainless steel wires.

Depending on the underlying pathology and the quality of the bone, these mini screw may be made of titanium or a dissolvable plastic material.

What can be treated with Keyhole surgery?

The conditions which can be treated with keyhole surgery are rapidly expanding. It is certainly well established in treating conditions such as frozen shoulder, labral tears, SLAP tears, rotator cuff tears, biceps tendonitis, calcifying tendinitis, subacromial impingement, shoulder instability, shoulder separation as well as some cases of arthritis and fractures around the shoulder.