Endoscopic Surgery

Endoscopic surgery is a minimally invasive (small-cut or no-cut) surgical method in which a doctor uses an endoscope — a thin, flexible or rigid tube fitted with a tiny camera and light — to see inside the body and carry out treatment through very small openings.

Instead of making a large incision, the surgeon guides the endoscope through a natural body opening such as the mouth or anus, or through one or more small cuts in the skin. A live video image from the camera is shown on a screen, allowing the surgeon to cut, remove, repair, or seal tissue without fully opening the body. This means less damage to the surrounding area and, for most patients, a faster recovery than traditional open surgery.

Endoscopic surgery is used across many parts of the body. The specific type — for example, laparoscopy (endoscopic surgery inside the abdomen), arthroscopy (inside a joint), or hysteroscopy (inside the uterus) — depends on the organ or area being treated. Your doctor will recommend it when the targeted area can be safely reached through a small opening and the expected benefit outweighs the risks.

• Polyps (small growths) or tumours in the colon, stomach, or oesophagus (food pipe)
• Gallstones (hard deposits in the gallbladder) causing pain or blockage
• Appendicitis (inflammation of the appendix) requiring removal
• Hernia (tissue pushing through a weak spot in the abdominal wall) repair
• Endometriosis (uterine lining tissue growing outside the uterus) and uterine fibroids (non-cancerous growths in the uterus)
• Joint problems such as torn cartilage (cushioning tissue in joints) or ligaments (bands connecting bones) in the knee, shoulder, or hip
• Urinary tract conditions including kidney stones and bladder tumours
• Chronic sinusitis (long-term inflammation of the sinuses) that does not respond to medication
• Blocked or damaged bile ducts (tubes that carry digestive fluid from the liver)

Endoscopic surgery is not always the right choice. Your surgeon will discuss other options if any of the following apply.

• Extensive previous abdominal surgery causing heavy internal scarring (adhesions) that blocks safe access
• Very large tumours or areas of disease that cannot be fully treated through a small opening
• Severe bleeding disorders that cannot be controlled before surgery
• Certain heart or lung conditions that make it unsafe to use the gas inflation needed in laparoscopic (abdominal) procedures
• Morbid obesity (very high body weight) in some specific procedures where visibility cannot be guaranteed

Endoscopic surgery is generally considered safer than open surgery for many conditions, but like all surgical procedures it carries some risks.

• Pain or discomfort at the incision site or inside the body after the procedure
• Infection at the skin cuts or, less commonly, inside the body cavity
• Bleeding during or after the procedure, which occasionally requires additional treatment
• Accidental injury to nearby organs, blood vessels, or nerves during instrument movement
• Conversion to open surgery — if the surgeon cannot complete the procedure safely through the endoscope, a larger incision may be needed
• Blood clots (deep vein thrombosis — clots forming in leg veins) related to being still during and after surgery
• Reactions to anaesthesia (the medication used to prevent pain and keep you unconscious), including breathing difficulties
• Gas pain or bloating, particularly after laparoscopic (abdominal) procedures where the abdomen is inflated with carbon dioxide gas
• Scarring or narrowing (stricture) of the treated area over time
• Incomplete removal of tissue, which may require a repeat procedure

Good preparation helps the surgery go smoothly and reduces your risk of complications. Your surgical team will give you personalised instructions, but the following points cover what is typically expected.

Before the procedure, you will usually be asked to fast — stop eating and drinking — for a period determined by your anaesthesia team, often starting from midnight before the surgery day. Smoking and alcohol should be avoided for at least several days beforehand, as both can affect healing and anaesthesia safety. Your doctor will review all medicines you take, including supplements and herbal remedies. Blood thinners, anti-inflammatory drugs, and certain diabetes medications are commonly paused in the days before surgery, but your doctor will give specific guidance for your situation.

Standard pre-operative (before surgery) tests are usually arranged to check that you are fit for the procedure. These commonly include:

• Blood tests to check for anaemia (low red blood cell count), clotting ability, kidney function, and infection markers
• An EKG (electrocardiogram — a recording of the heart's electrical activity) to assess heart rhythm
• A chest X-ray to check lung and heart health
• Imaging such as an ultrasound (USG), CT scan, or MRI to map the area to be operated on
• Blood pressure and other vital sign measurements

On the day of surgery, the steps typically follow this order:

• 1. Arrival and check-in: You arrive at the hospital, change into a surgical gown, and your team confirms your identity, allergies, and consent.
• 2. IV line placement: A nurse inserts an intravenous (IV) line — a thin tube into a vein, usually in the arm — so fluids and medications can be given during surgery.
• 3. Anaesthesia: The anaesthesiologist (specialist in sleep and pain control) administers anaesthesia. Most endoscopic surgeries use general anaesthesia (you are fully unconscious), though some use regional or sedation-based approaches depending on the body area.
• 4. Positioning and skin preparation: You are positioned on the operating table, and the skin over the entry area is cleaned and sterilised.
• 5. Entry creation: One or more small incisions are made, or the endoscope is guided through a natural opening, depending on the type of procedure.
• 6. Endoscope insertion: The endoscope and any additional instruments are carefully advanced to the target area under continuous camera guidance.
• 7. Surgical treatment: The surgeon performs the intended action — removing tissue, repairing a structure, stopping bleeding, or another specific task.
• 8. Closure and dressing: The instruments are withdrawn, any gas used to inflate the space is released, incisions are closed with stitches or surgical tape, and a sterile dressing is applied.
• 9. Transfer to recovery: You are moved to a recovery room where nurses monitor your vital signs as the anaesthesia wears off.

Recovery after endoscopic surgery is generally faster than after open surgery, but the exact timeline depends on which part of the body was treated, how long the procedure lasted, and your overall health. Your surgical team will guide you through each stage, and the points below reflect what is typically involved.

• Monitoring: Immediately after surgery you are observed in a recovery room until the anaesthesia has worn off and your vital signs are stable. Depending on the procedure, some patients go home the same day; others stay in hospital for one or more nights.
• Pain management: Some pain, soreness, or bloating around the incision sites or inside the body is normal in the first few days. Your team will provide appropriate pain relief.
• Diet: For abdominal or digestive tract procedures, your team will advise starting with clear fluids and advancing to solid food gradually as your digestive system recovers.
• Wound care: Keep the small incision sites clean and dry as instructed. Watch for signs of infection — increasing redness, warmth, swelling, or discharge — and report these to your doctor promptly.
• Physical activity: Light walking is usually encouraged within a day or two to reduce the risk of blood clots. Strenuous exercise, heavy lifting, and activities that strain the operated area are typically restricted for several weeks; your surgeon will set specific limits.
• Driving and work: Most patients are advised not to drive while taking strong pain medication or until cleared by their surgeon. Return to desk work may be possible within days for some; physical jobs may require a longer break.
• Follow-up appointments: A check-up is usually scheduled within one to two weeks. If biopsy specimens (small tissue samples taken during the procedure) were collected, results are reviewed at this or a subsequent visit.
• Medications: Your team may prescribe antibiotics to prevent infection, blood thinners to reduce clot risk, or other specific medications related to your diagnosis.
• When to seek urgent help: Go to the nearest emergency department or contact your surgical team immediately if you experience heavy bleeding, a high fever, severe abdominal pain, difficulty breathing, or a wound that opens up.