Keyhole Surgery

What is It?

“Keyhole Surgery” is a general term when steps are taken by the surgeon to minimise the disruption and thus damage to surrounding tissues in performing an operation, the medical term is minimally invasive, or minimal access surgery

The advantages are the recovery from surgery is more rapid, there is less damage to suurounding tissues and thus a lower complication rate, and the incision is smaller. This allows patients to be mobilised more rapidly after surgery, and thus be discharged from hospital sooner.

An example of this in another speciality would be a laparoscopic (telescopic) removal of a gallbladder due to gallstones

How can these techniques be applied to neurosurgery?

Because of the nature of neurosurgical operations neurosurgeons have practiced minimally invasive surgery for many years. Use of the operating microscope and intraoperative XRays were early examples of the application of these techniques. Recently there have been some technological advances that have allowed even less invasive operations to take place, some examples of this include:

• Microdiscectomy of the lumbar spine
• Microforamenotomy of the lumbar and cervical spine
• Endonasal Transsphenoidal surgery for pituitary tumours
• Image guided surgery

More recently still these techniques have been refined further allowing:

• Minimally invasive microdiscectomy
• Minimally invasive microforamenotomy of the cervical and lumbar spine
• Endoscopic pituitary and skull-base surgery (using a telescope)
• Minimally invasive spinal fusion including pedicle screw fixation
• Mini-craniotomy for intracranial tumours using image guided surgery techniques
• ‘Eyebrow’ craniotomy for tumours using endoscopic assistance