Minimally Invasive Surgery - Yale Medicine

If your doctor has recommended surgery, it’s natural to feel anxious about it. But minimally invasive (also known as laparoscopic or keyhole) procedures are making many surgeries dramatically safer and more tolerable. Instead of a large incision at the treatment site, the surgeon makes one or more very small incisions, and inserts slender instruments and a tiny camera to help visualize progress on a monitor. In some cases, the patient goes home with only bandages to cover the wounds.

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“Almost every surgeon at Yale Medicine performs some type of minimally invasive surgery,” says Nita Ahuja, MD, chair of Yale Medicine Surgery and chief of surgery for Yale New Haven Hospital. “Of course, there may always be situations where the most effective way to perform a surgery will be through a larger incision. But minimally invasive approaches are an important tool in our toolbox now. They can be far easier on the patient, causing less tissue damage, fewer complications, and minimal pain and scarring. Patients recover quickly and leave the hospital sooner.”  

Typically, the surgeon will make one or more small incisions, which are called “ports.” The exact size of the ports will vary according to the procedure. Unlike an open surgery, the surgeon typically will not need to make extensive cuts through skin, muscle, tissue, and nerves.

The surgeon then works through the ports, inserting short, narrow tubes called trochars. The next step is to insert surgical instruments, along with tiny video camera equipment, through the ports. The surgeon manipulates the instruments to perform the surgery, while watching video pictures sent back from the camera on a monitor.

Depending on your procedure, there may be other differences in how a minimally invasive surgery is performed. For example, if you are having abdominal surgery, the surgeon will send carbon dioxide gas into your abdomen through a trochar to expand the area and provide room to operate.

Because minimally invasive surgery does not provide direct access to the surgical site in the same way as traditional open surgery, the procedure may be more complex for the surgeon. In some cases, it may take longer to perform.  

Surgeons are using minimally invasive approaches to diagnose and/or treat many cancers. Such approaches can also treat abdominal issues such as appendicitis or gallbladder problems, hip and knee replacements, hiatal hernia repair, some heart surgeries, lung surgeries, and weight loss surgeries, among other types of procedures. A variety of terms are used to describe the various minimally invasive approaches:

Arthroscopic surgery: An orthopedic surgeon inserts a thin, flexible fiber optic video camera called an arthroscope through an incision the size of a buttonhole, near a joint (such as the knee), to examine, diagnose, and sometimes repair joint damage.

Bronchoscopy: A flexible tube with a light and a camera, called a bronchoscope, is inserted through the nose or mouth to look inside lung airways. Bronchoscopy helps to evaluate and diagnose lung problems, assess blockages, obtain samples of tissue or fluid, and help remove a foreign body.

Endoscopy: A small, flexible tube with a light and a camera lens at the end (endoscope) is used to examine the inside of the digestive tract. Tissue samples from inside the digestive tract may also be taken for examination and testing.

Hysteroscopy: A small, narrow telescope (a hysteroscope) is inserted through the vagina to allow visualization of the inside of the uterine cavity without the need for any incisions. This is often done to evaluate uterine bleeding. Specialized hysteroscopes are also used for treatment in some cases, such as the removal of fibroids, polyps, or scar tissue.

Laparoscopy: This was one of the first types of minimally invasive surgery. It involves making tiny incisions and inserting a tube with a light and a camera (the laparoscope) on its end. The camera sends live pictures to a video monitor, which allows the surgeon to visualize the anatomy as he or she performs complex surgeries with minimal trauma to the patient. Laparoscopy can also be used for diagnostic purposes, to examine organs, check for abnormalities, or take tissue samples.

Natural orifice transluminal endoscopic surgery (NOTES): This is a surgery that allows access to the abdominal cavity through natural orifices, such as the oral, rectal, or vaginal openings, with little to no scarring.

Parathyroidectomy: This technique removes abnormal parathyroid glands through an incision at the front of the neck, under local anesthesia, often on an outpatient basis.

Robotic: The surgeon sits at a console, tracking his or her progress using a 3D image on a monitor, while operating controls to maneuver robotic arms that will perform the surgery. While robotic surgery is new, it has proven useful for treating areas of the body that are difficult to navigate, such as the head and neck or genital areas. Use of the robotic arms allows surgeons to work with more precision and dexterity.

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Sigmoidoscopy: A small, flexible tube with a light and a camera lens at the end (endoscope) is used to examine the rectum and sigmoid colon.

Video-assisted thoracoscopic surgery (VATS): A tiny camera (thoracoscope) and surgical instruments are inserted through small incisions in the chest to diagnose and treat problems affecting the lung, esophagus, and other areas in the chest.