Minimally invasive surgery

Minimally Invasive Surgery procedures are performed and led by our team of highly skilled and experienced consultants in many areas of specialties, commonly in General Surgery, Orthopaedic and Spine. Today, we are delighted to provide you an insight on how surgeries have evolved in the last 30 years. Be fearless, as you watch, learn and experience how technological advances can help change your life for the better.

The advantages of Minimally Invasive Surgery includes:

less pain
increased
safety
precision in
performance
faster
recovery
less
scarring
less injury
to tissue

What is Minimally invasive surgery

Undergoing surgery or any medical procedure can be a worrying time, but knowing what to expect during and after the process helps you to be well-prepared. What you experience and how each process affects you depend on the methods and technologies used to diagnose or treat a specific illness or injury. Broadly speaking, these different procedures are performed in one or a combination of three ways – invasive, non-invasive or minimally invasive.

Medical procedures that are non-surgical are deemed non-invasive. Diagnostic physical examination and imaging studies, such as Ultrasounds and rehabilitative treatments such as chiropractic manipulation are examples of non-invasive procedures. Quite simply, they are non-invasive because they do not break the skin in a way that surgery does.

In surgical procedures, major open surgeries are highly invasive as they require the surgeons to make long incisions to the body.

However, with remarkable technological developments, a third choice, the less invasive surgical option, has been made available through Minimally Invasive Surgery (MIS). Here, incisions are small and the procedure is performed by a specialist MIS surgeon. As a result, patients can expect to experience less post-operation pain and heal faster.

Evolution of MIS


HIPPOCRATES (460-377 BC)
Made the original reference to a speculum to examine the rectum.

PHILIP BOZZINI (1800) - AUSTRIA
Examined the urethra of a patient using a simple tube and candlelight.
‘Lichtleiter’ - Provided basic design for development of future endoscopes.

*Endoscope – Greek word; illuminated optical, typically slender and tubular instrument used to look deep into the body and used in procedures called endoscopy.

PIERRE SALOMON SEGALAS (1826)
Developed their improved cystoscopes.

*Cystoscope – a medical instrument to carry out cystoscopy; an endoscopy of the urinary bladder via urethra.

JOHN D. FISHER (1824) - BOSTON, AMERICA
Developed an endoscope that not only afforded him a better view of the vaginal speculum, but also placed him at a suffiently discrete distance to satisfy the patient’s modesty.
ANTONIN J. DESORMEAUX (1853) - FRANCE
Introduced a versatile new endoscope using cystoscope.
Diagnosed and treated urology disease in numerous patients using his endoscope.
JULIUS BRUCK (1867)
Dentist from Breslau.
Developed a platinum wire cooled by water to illuminate the inside of the mouth called “stomatoscopy”.

*Stomatoscopy – a procedure to examine the interior of the mouth.
THOMAS EDISON (1879)
Invented the incandescent light bulb.

NEWMAN - GLASGOW
Miniaturised Edison’s invention and incorporated it into the Nitze’s cystoscope (first Laparoscope).
Although this cystoscope was limited to use in women, Newman was able to carry out numerous procedures and recognised many bladder lesions.

*Laparoscope – a medical instrument consisting of a tube that is inserted through an incision in the abdom

MAXIMILLIAN NITZE (1887)
Developed his first improved cystoscope with a miniature incandescent bulb that produced the wider angle of vision desired, corrected image inversion, magnified the image and illuminated.

JOSEF LEITER (1886)
Miniaturised the bulb and incorporated it into the distal end of the cystoscope.
GEORGE KELLING (1866-1945)
German surgeon from Dresden.
First person to create the pneumoperitoneum.
First to introduce cystoscope into a living dog.

*Pneumoperitoneum – a condition in which a person has air in the abdominal cavity.

D.O. OTT (1901)
Russian Gynaecologist reported on “Ventroscope”, illumination of the abdominal cavity during pregnancy using culdoscopy.

*Culdoscopic – an endoscopic procedure performed to examine the rectouterine pouch and pelvic viscera by the introduction of a culdoscope through the posterior vaginal wall.

HANS-CHRISTIAN JACOBEUS (1910) - STOCKHOLM, SWEDEN
Performed the first laparoscopy and thoracoscopy on human based on Kelling’s animal experiments.
Published his first experiences with laparoscopic surgery in the Munchner Medizinische Wochenschrift under the title “The possibility to perform cystoscopy in examinations of serious cavities”.

*Thoracoscopy – an endoscopic procedure to visually examine the pleura, lungs, and mediastinum and to obtain tissue for testing purposes.

RAOL PALMER (1904-1945)
French gynaecologist.
Introduced the most popular method of the closed laparoscopic entry in 1947.
Use of the Veress needle to induce CO2 pneumoperitoneum for laparoscopy.
Published on its safety in the first 250 patients.
RICHARD ZOLLIKOFER (1924) - SWITZERLAND
Recommended to be the preferred insufflations gas.
H. KALK (1929) - GERMAN
Published “Experience with laparoscopy, together with the description of a new “Instrument”.
Presented the role of angled laparoscope in diagnostic laparoscopy.
JC RUDDOCK (1934)
American internist.
Developed a new lens system with an integrated biopsy forceps which he used during “Peritoneoscopy” for taking liver biopsy.

*Peritoneoscopy – internal examination of peritoneum with a peritoneoscope passed through an incision in the abdominal wall.
JANOS VERES (1938) - HUNGARIAN
Presented his “New instrument for puncture of the thoracic cavity for pneumothorax”.
This needle is still the commonly used device for the creation of a pneumoperitoneum.

*Pneumothorax – or collapsed lung occurs when air is trapped in the space around lungs.

PROFESSOR KURT SEMM (1960)
The importance of a constant intraabdominal pressure was recognised.
Developed automatic gas insufflators.
From 1964, he played a key role in the development of laparoscopy and developed many new instruments over the next 15-20 years.
Performed first laparoscopic appendicectomy by looking into the abdomen through television monitor but was not recognised for this innovative work.

*Appendicectomy – a surgical procedure to remove the appendix when an infection has made it inflamed and swollen.

HARRITH M. HASSON (1978)
An American gynaecologist introduced an alternative method of port placement.
Proposed a blunt minilaparotomy that permitted direct visualisation of the port entrance in the cavity.
The Hasson trocar system was initially developed for laparoscopy in patients who have had a previous laparotomy.

*Trocar – a surgical instrument with a three-sided cutting point enclosed in a tube, used for withdrawing fluid from a body cavity.

JR DINGFELDER (1978)
Developed the direct laparoscopic trocar insertion technique.
ERICH MUHE (1985) - GERMAN
Performed the first laparoscopic cholecystectomy using a modified rectoscope and employed carbon dioxide insufflations for this procedure.
As surgical instruments, he used a pistol grip applier with hemoclips to ligate, and pistol grip scissors to cut between the clipped cystic duct and artery.
PROFESSOR PHILLIP MOURET (1987) - LYON, FRANCE
Performed the first laparoscopic cholecystectomy using video-guided surgery.

*Cholecystectomy – a surgical procedure to remove the gallbladder due to gallstones causing pain or infection.

1991
First laparoscopic cholecystectomy in Malaysia.
1996
First laparoscopic adrenalectomy in Malaysia.

*Adrenalectomy – a surgical procedure to remove one or both of the adrenal glands.
2000
First and self-innovated method of video assisted endoscopic thyroidectomy in Malaysia.

*Thyroidectomy – a surgical procedure to remove all or part of the thyroid gland.
2000'S
First laparoscopic hepatectomy and laparoscopic choledochol cyst excision.

*Choledochol Cyst – a congenital dilatation of part or whole of the bile duct.
Hepatectomy – a surgical procedure to remove all or part of the liver.

2003
First laparoscopic roux-en-y gastric bypass surgery in Malaysia for the super obese.
2005
First laparoscopic gastric banding in Malaysia for the morbidly obese using the Swedish Adjustable Gastric Band.
First laparoscopic enucleation of pancreatic head insulinoma in Malaysia.
First endoscopic insertion of the BioEnteric Intragrastic Balloon (BIB) in Malaysia for the super obese.
2006
First laparoscopic sleeve gastrectomy in Malaysia for morbid obesity.

*Gastrectomy – a surgical procedure to remove all or part of the stomach.
2009
First single-incision laparoscopic cholecystectomy.

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MIS in General Surgery & Orthopaedic was part of the initial services when the hospital started in 1996.
MIS Evolution in General Surgery
General surgeons performed the first laparoscopic cholecystectomy 20 years ago, followed by laparoscopic appendicectomy and now the whole range including colectomy, nephrectomy and also video assited thoracoscopic surgery (VATS).
MIS Evolution in Orthopaedic
The initial operations were arthroscopic surgery of the knee such as meniscus procedures and reconstruction of the Anterior Cruciate Ligament (ACL). This gradually expanded to arthroscopic procedures of the shoulder followed by procedures to the ankle and to a lesser extent the elbow and wrist. The spine surgeons also perform MIS procedures such as endoscopic discectomy and nucleoplasty.
*Colectomy – a surgical proceudre to remove all or part of the colon.
Discectomy – a surgical proceudre to remove the whole or part of an intervertebral disc.
Nephrectomy – a surgical procedure to remove one or both of the kidneys.
Nucleoplasty – removal of tissues from a herniated disc to relieve pressure on the affected nerve.

explore the types of mis in different treatment


The efficient gall bladder removal approach
The surgical procedure to remove the gall bladder is known as Laparoscopic Cholecystectomy. The main advantage of the laparoscopic cholecystectomy is that incisions can be as tiny as 1 cm which may be adequate to take the gall bladder out.

How MIS WORKS IN SURGERIES


Open vs. VATS Wedge Resection Animation
Open vs. VATS Lobectomy Animation
Open vs. Laparoscopic Colon Surgery

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WhatsApp Operating hours:
Monday to Friday : 9am – 5pm
Saturday : 9am – 1pm
(Excluding Public Holidays)

*Terms and conditions:
1. Appointment booking is subject to availability of specialist.
2. We will respond to your message within 1 working day.
3. WhatsApp messaging service is available in English.
4. This mobile number is for WhatsApp use only.