Keyhole Surgery

General Principles

The term keyhole surgery has been coined to describe any surgical technique that uses small incisions and thus limits the postoperative pain and makes any recovery from surgery more rapid.

This has led to patients being able to go home from hospital more rapidly, and in many cases return to work and a good quality of life as soon as possible.

Historically, neurosurgeons have been performing operations in this way for decades as operating on the brain has meant the early development of ‘keyhole’ techniques to prevent damage to the brain during delicate surgery. An example of this is the development of pituitary surgery where the first operation performed via the nose rather than opening the skull was well over 100 years ago.

In the 21st century many operations that would have required a large opening in the skull, or a large opening on the back to access the spine can be performed via a very small incision.

Technological advances have helped greatly with the adoption of modern anaesthetic techniques and a more rapid recover from an anaesthetise, using telescopes (endoscopes) to perform surgery in the brain and spine

The use of computerised navigation in the brain and spine, and the use of tubular retractors in the spine.

The Image below illustrates the endoscopic approach via the nose to the pituitary gland.