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Great Ormond Street Hospital for Children NHS Trust UCL Institute of Child Health
 

Children and families

Keyhole surgery

This leaflet explains about keyhole surgery and what to expect when your child comes to Great Ormond Street Hospital to have an operation.

Contents

What is keyhole surgery?

Keyhole surgery, or laparoscopic surgery as it is also known, is a method of carrying out an operation without having to make a large incision. Many different types of operations can now be carried out using keyhole surgery. This type of surgery reduces the length of time your child needs to stay in hospital and leaves little scarring.

How long does a keyhole operation take?

The operation time may be longer than conventional surgery - the length of time your child spends away from the ward may be between one and a half and four hours.

What are the advantages of keyhole surgery?

Children tend to recover more quickly after keyhole surgery and have fewer side effects. There is little scarring after keyhole surgery which becomes more important as your child grows older and becomes more self-conscious. One side effect of ‘open’ surgery - minimised with keyhole surgery - is ‘adhesions’. This is where internal organs stick together and form bands of scar tissue, which can be painful and cause obstruction. Adhesions have been proven to occur less often in adults after keyhole surgery, and the risk of adhesions in children after keyhole surgery is thought to be less as well.

Are there any risks?

Every anaesthetic carries a risk of complications but this is very small. Your child’s anaesthetist is an experienced doctor who is trained to deal with any complications. After an anaesthetic, children sometimes feel sick and vomit, may have a headache, sore throat or feel dizzy. These effects are short-lived. Any surgery carries a small risk of infection or bleeding.

After the operation, some older children may complain of shoulder pain. Your child may also feel some crackling under the skin because the carbon dioxide sometimes escapes into the tissue just under the skin. These side effects are usually short-lived and do not require any specialised care.

There is always a chance that keyhole surgery will not be possible for your child. Sometimes the surgeon will not be able to carry out an operation using the keyhole method for technical reasons or because of unexpected findings. If this is the case, the surgeon will carry out the operation using a larger incision instead.
One risk specifically associated with keyhole surgery is gas embolism. This risk is very rare - but occurs when an internal organ is punctured accidentally and gas passes into the circulation. However, methods used at Great Ormond Street Hospital minimise this risk so this is very unlikely to occur.

Are there any alternatives to keyhole surgery?

All operations carried out as keyhole surgery can also be carried out using ‘open’ surgery, that is, with a larger incision.

What happens before the operation?

You will receive information about how to prepare your child for the operation in the admission information sent out before you come into hospital. Your child should not have anything to eat or drink beforehand for the amount of time specified in the letter. It is important to follow these instructions - otherwise your child’s operation may need to be delayed or even cancelled.

The day you come into hospital for the operation, your child’s surgeon will explain the operation in detail, discuss any worries you may have and ask you to sign a consent form. An anaesthetist will also see you to explain your child’s anaesthetic in more detail. If your child has any medical problems, like allergies, please tell the doctors.

Your child may need to have some special preparation for the operation. This may include an enema to empty your child’s bowel, so that this does block the surgeon’s view of the other internal organs. This is particularly used for children who have special needs.

What does the operation involve?

Your child will be given a general anaesthetic and will be asleep during the operation. Once your child is asleep, the surgeon inserts a small metal tube called a cannula into your child’s tummy button. A telescope, with a miniature video camera mounted on it, is inserted into this tube to project a very high quality video image onto a television screen. The abdomen is then inflated with carbon dioxide to create space in which the surgeon can operate. The operation is performed by inserting specialised instruments which are passed through small hollow tubes which are inserted through separate very small incisions. There may be two or more small incisions required to perform the operation. Once the operation is over, the surgeon will stitch up the inside of the holes and your child will be taken to the recovery room to wake up from the anaesthetic.

What happens after the operation?

After the operation, your child will return to the ward to recover. He or she will always have some form of pain relief, which can include:

  • epidural which is given through a small space between the bones in the back;
  • nurse- or patient-controlled analgesia (NCA or PCA) which is given through a small plastic needle in the back of the hand. The amount of pain relief given is controlled either by the nurse or the patient.

Your child may also have a naso-gastric tube, which is a tube passed through the nose into the stomach, so that he or she can be given feeds or medicines easily. Your child may also have an intravenous (into a vein) infusion of fluids as he or she may not feel like eating and drinking after the operation.

You may be able to feel a few lumps under the skin by the wound sites, which are stitches inside the body. This is nothing to worry about and the stitches will dissolve on their own in about three months.

When you get home:

  • Your child may need some pain relief when you get home. Please make sure you have some paracetamol ready - bear in mind that children under 12 should not take aspirin. If your child is likely to need stronger pain relief, this will be prescribed by your doctor and should be collected from Pharmacy.
  • Your child should not have a bath or shower for 48 hours after the operation to let the wounds settle down.
  • With some operations there is a small risk of infection, so your child may need to take antibiotics for a while after the operation.
  • The doctor will see you again six weeks after the operation to check that your child is progressing well.
  • Your child can return to school or nursery when he or she is feeling well. This is usually about one week after the operation.
  • The doctor will advise on return to playing games and PE.

You should call the hospital if:

  • Your child is in a lot of pain and pain relief does not seem to help.
  • The wound sites look red, inflamed and feel hotter than the surrounding skin.
  • There is any oozing from the wound sites.

Ref: F040282 © GOSH Trust
This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.

This page was last updated on 6 August, 2008