Keyhole (laparoscopic) cancer surgery: what patients should know

Minimal access surgery uses a high-definition camera and slim instruments passed through small incisions, usually 5 to 12 mm, instead of one long cut. In the abdomen it is called laparoscopy; in the chest it is called VATS (video-assisted thoracoscopic surgery).

Is it as effective against cancer?

For the operations where it has been properly studied, including colorectal, gastric, oesophageal, gynaecological and early lung cancer, large trials show that keyhole surgery removes the same amount of tumour and lymph nodes and gives the same long-term cancer outcomes as open surgery, provided it is done by a trained surgeon who follows the same oncological principles.

What are the advantages?

• Less pain and less need for strong painkillers
• Shorter hospital stay and faster return to eating, walking and work
• Fewer wound infections and hernias
• Better breathing after chest surgery because the ribs are not spread apart
• Clearer magnified view for the surgeon, which helps with precise dissection

When is open surgery still better?

Very large tumours, tumours stuck to major blood vessels, extensive previous surgery with adhesions, or patients who cannot tolerate the gas pressure used in laparoscopy may be safer with open surgery. Sometimes an operation that begins laparoscopically is converted to open for safety. This is a sound decision, not a failure.

How should I prepare?

Stop smoking, control diabetes and blood pressure, walk daily, and follow the dietitian's advice to improve nutrition before surgery. Fit patients recover faster whichever technique is used.

If you have been advised cancer surgery, ask whether a minimal access approach is suitable for your case.