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Surgical Procedures: Keyhole Surgery

Keyhole Surgery, or Arthroscopy, is an advanced surgical technique with reduced recovery time.

Surgery is often enough the last and only option for the treatment of certain medical problems. In the past this procedure did sometimes involve major surgery, resulting in a disfiguring scar and elongated post-operative rehabilitation time. In the 1960th keyhole surgery techniques were developed. In the early stages of this surgical technique it was only used to find or confirm the medical diagnosis. With further development it allows the surgeon to not only to get a visual impression of the body part, but also deal with medical problems, like clean and wash out and repair damaged structures.

Keyhole surgery is nowadays used in several different surgical fields. Abdominal surgeon use this technique to remove the appendix, gynaecologist use it to remove small tumours from the ovaries, heart surgeons to advance a catheter towards the heart to check and clean the major blood vessels. Out of 20 arthroscopies performed by orthopaedic surgeon, 17 of these a done on a knee joint, and two are done on a shoulder. The other joints that could be examined and treated by keyhole surgery are the elbow, the wrist, the hip and the ankle.

Key hole surgery on a joint is not very demanding technically, but it still has a rather long learning curve due to the circumstances that the surgeon is looking straight ahead on a television screen, meanwhile his/her hands are using arthroscopic instruments pointing in a different direction. The surgeon also has to get use to the fact that the pictures visualized on the screen is magnified 2,5 fold.

Once the medical examine, radiographic or even magnetic resonance images have confirmed that there might be some medical problem, degenerative changes or damage following an accident inside the joints, keyhole surgery would be indicated. The typical arthroscopy on a knee joint takes about 45 minutes. It is usually performed under general anaesthetics, but could be performed under spinal anaesthetics (epidural). A tourniquet (like a blood pressure cuff) is applied around the thigh to stop the blood flow into the leg and allow good visibility inside the joint, if needed. Two small, about half an inch long cuts are made on each side of the knee joint to introduce the camera on one side and the instruments on the other. The camera has the size of a pencil and is equipped with a light source and a magnifying lens. The coloured pictures are directly transferred by a cable to a television screen.

Nowadays there a many different arthroscopic instruments available, like scissors, forceps, shavers, suturing devices and other. The equipment allows not just cleaning the knee out from any debris, but also repair damaged parts of the meniscus, fill up gabs in the cartilage surface and even repair a ruptured anterior cruciate ligament. A part from the cruciate ligament repair, the other procedures would be performed as a day case surgery, allowing the patient to go home the same day, using two crutches fully weight bearing through the operated leg. The stitches, usual one per skin cut, would be removed after 10 days, and the total recovery to normal daily activity like walking, swimming, driving and even minor sports like going on a bicycle or playing golf takes about 10 to 14 days.

Private Hospital

The private hospital used by Dr. Alf Neuhaus is about 10 minutes’ drive away from his out- patient clinic. It is a fully equipped and very clean hospital with all facilities needed, 4 modern operating theatres, intensive care unit and 24h on-call medical staff and physicians. All rooms are equipped with TV (Spanish, English, German), WiFi and a private bathroom / shower.

The friendly and helpful staff speaks English, and Dr. Alf Neuhaus and his physiotherapists will come in every day of your stay to look after you (wound control, change of bandage, pain medication, arranging further tests if needed, joint mobilisation, etc.).

Where does it hurt?