If
Your Doctor Has Recommended Endoscopy
Endoscopy is a surgical technique
that involves the use of an endoscope, a special viewing
instrument that allows a surgeon to see images of the body's
internal structures through very small incisions.
Endoscopic surgery has been used for
decades in a number of different procedures, including
gallbladder removal, tubal ligation and knee surgery. However,
in the world of plastic surgery, endoscopic instruments have
recently been introduced. Plastic surgeons believe the
technique holds great promise, but further study is needed to
establish its effectiveness, especially over the long-term. As
important research continues, endoscopy is being used on a
limited basis for both cosmetic and reconstructive procedures.
This brochure will give you a basic
understanding of endoscopy in plastic surgery how it's
performed, what risks are involved, and the type of surgical
training to look for in a surgeon. Please ask your doctor if
there is anything you don't understand about the specific
procedure you're planning to have.
The Endoscope
An endoscope consists of two basic
parts: A tubular probe fitted with a tiny camera and bright
light, which is inserted through a small incision; and a
viewing screen, which magnifies the transmitted images of the
body's internal structures. During surgery, the surgeon
watches the screen while moving the tube of the endoscope
through the surgical area.
It's important to understand that the
endoscope functions as a viewing device only. To perform the
surgery, a separate surgical instrument such as a scalpel,
scissors or forceps must be inserted through a different
point of entry and manipulated within the tissue.
Advantages of Endoscopy
All surgery carries risks and every
incision leaves a scar. However, with endoscopic surgery, your
scars are likely to be hidden, much smaller, and some of the
after effects of surgery may be minimized.
In a typical endoscopic procedure,
only a few small incisions, each less than one inch long, are
needed to insert the endoscope probe and other instruments.
For some procedures, such as breast augmentation, only two
incisions may be necessary. For others, such as a forehead
lift, three or more short incisions may be needed. The tiny
"eye" of the endoscope's camera allows a surgeon to
view the surgical site almost clearly as if the skin were
opened from a long incision.
Because the incisions are shorter
with endoscopy, the risk of sensory loss from nerve damage is
decreased. Also, bleeding, bruising and swelling may be
significantly reduced. With the endoscopic approach, you may
recover more quickly and return to work earlier than if you
had undergone open surgery.
Endoscopic surgery may also allow you
to avoid an overnight hospital stay. Many endoscopic
procedures can be performed on an outpatient basis under local
anesthesia with sedation. Be sure to discuss this possibility
with your doctor.
In endoscopic surgery, a probe with a
tiny camera transmits images inside the body to a video
monitor.
Uses in Plastic Surgery
As research continues, it's expected
that many new uses for endoscopy will be developed. In the
meantime, some plastic surgeons are using the technique on
carefully selected patients. Some procedures that may be
assisted by endoscopy are:
Cosmetic Surgery
Abdominoplasty (tummy tuck)
Endoscopy is sometimes used as an adjunct for selected
patients who have lost abdominal muscle tone. Guided by the
endoscope, the muscles that run vertically down the length of
the abdomen may be tightened through several short incisions.
Endoscopy is generally not used in patients who have a
significant amount of loose abdominal skin.
Breast augmentation
Inserted through a small incision in the underarm or the
navel, an endoscope can assist the surgeon in positioning
breast implants within the chest wall. Endoscopy also may
assist in the correction of capsular contracture (scar tissue
that sometimes forms around an implant, causing it to feel
firm) and in the evaluation of existing implants.
Facelift Although the
traditional facelift operation is still the best choice for
most patients especially those with a significant amount
of excess skin certain selected individuals may benefit
from an endoscopically assisted procedure. When an endoscope
is used, the customary incision along, or in, the hairline is
usually eliminated. Instead, small incisions may be
strategically placed in areas where the most correction is
needed. If the muscles and skin of the mid-face need to be
smoothed and tightened, incisions may be hidden in the lower
eyelid and in the upper gumline. To tighten the loose muscles
of the neck, incisions may be concealed beneath the chin and
behind the ears. The endoscope also may assist in the
positioning of cheek and chin implants.
Forehead Lift Of all the
cosmetic procedures that use endoscopy, forehead lift is the
one which plastic surgeons more commonly perform. Instead of
the usual ear-to-ear incision, three or more
"puncture-type" incisions are made just at the
hairline. The endoscope helps guide the surgeon, who removes
the muscles that produce frown lines, and repositions the
eyebrows at a higher level.
Reconstructive Surgery
Flap surgery Endoscopy can
assist in repairing body parts that are damaged from injury or
illness. Often, healthy tissue is "borrowed" from
one part of the body to help repair another. Using an
endoscope, the tissue or flaps can be removed from the donor
site with only two or three small incisions.
Placement of Tissue Expanders
Used frequently in reconstructive surgery, tissue
expanders are silicone "balloons" that are
temporarily implanted to help stretch areas of healthy skin.
The newly expanded skin is then used to cover body areas where
skin has been lost due to injury (such as a burn) or disease.
Using an endoscope, a surgeon can help ensure that a tissue
expander is precisely positioned beneath the surface to bring
the greatest benefit to the patient.
Sinus Surgery An endoscope
can assist a surgeon in pinpointing and correcting
sinus-drainage problems. It can also help locate nasal polyps
(growths) or other problems within the sinus cavity, and
assist in full rhino-septal surgery.
Carpal Tunnel Release
After the endoscope is inserted through a small incision in
the wrist area, the surgeon locates the median nerve, which
runs down the center of the wrist. A separate incision may be
made in the palm to insert scissors or scalpel to cut the
ligament putting pressure on the nerve.
Finding a Well-Trained Surgeon
Because endoscopy is a relatively new
technique in plastic surgery, it's extremely important that
you select a board-certified plastic surgeon who has adequate
training and experience.
Many endoscopic procedures do not
require a hospital stay and are performed in a surgeon's
office or an out-patient surgery center. If you're planning to
have out-patient surgery, be sure that the surgeon you've
selected has privileges to perform your particular endoscopic
procedure at an accredited hospital. This assures you that
your surgeon has been evaluated by the hospital's
quality-assurance review committee and is generally considered
to have the needed training.
Be sure to find out if the surgeon's
hospital privileges cover both the endoscopic and the open
version of the procedure you plan to have, since your doctor
may have to switch to a traditional open procedure if a
complication occurs during surgery.
Keep in mind that many plastic
surgeons in practice today received endoscopy training as part
of their plastic surgery or general surgery residency
training. And all board-certified plastic surgeons are
continually being trained in new procedures.
Special Consideration and Risks
It's important to keep in mind that
the endoscopic approach has only recently been applied to
plastic surgery procedures. There are some known risks, which
vary in severity depending on the procedure being performed.
These include infection, fluid accumulation beneath the skin
(which must be drained), blood vessel damage, nerve damage or
loss of feeling, internal perforation injury, and skin injury.
Keep in mind that if a complication
occurs at any time during the operation, your surgeon may have
to switch to an open procedure, which will result in a more
extensive scar and a longer recovery period. However, to date,
such complications are rare estimated to occur in less
that 5 percent of all endoscopy procedures.
Deciding if Endoscopic Surgery Is
Right for You
Although much is still unknown about
endoscopic plastic surgery, you may want to focus on what is
known as you make your decision. Considering the following:
For decades, endoscopy has been used
successfully in orthopedic, urologic and gynecologic
procedures. Improved technology now permits endoscopy to be
used by plastic surgeons.
If performed by an experienced,
well-trained plastic surgeon, endoscopic procedures may
provide the same results as open-method procedures but with
less scarring.
In some cases, endoscopic surgery may
require less recovery time than is usually required for open
procedures.
Patients who tend to be the best
candidates for cosmetic endoscopic procedures are those who
don't have large amounts of loose hanging skin. Patients with
loose facial or abdominal skin may benefit from a combination
of classic and endoscopic techniques in face or forehead lift,
or abdominoplasty.
