Technical advances now make it possible to do surgery with smaller incisions and less tissue disruption than occurs with traditional surgery. To do this surgery, surgeons insert tiny lights, video cameras, and surgical instruments through keyhole-sized incisions. The surgeons can then do procedures using the images transmitted to video monitors as guides for manipulating the surgical instruments. In robotic surgery, the cameras provide surgeons with a three-dimensional view and surgeons control surgical instruments from a computer.

Keyhole surgery has various names depending on where it is done: laparoscopy in the abdomen, arthroscopy in joints, and thoracoscopy in the chest.

Because it causes less tissue damage than traditional surgery, keyhole surgery has several advantages, including the following:

• A briefer hospital stay (in most cases)

• Often, less pain after the operation

• Lower risk of infection at the operative site

• Earlier return to work

• A tendency toward smaller scars

However, the difficulties of keyhole surgery are often underestimated by people undergoing the surgery and sometimes by surgeons. Because surgeons are using a video monitor, they are seeing only a two-dimensional view of the site on which they are operating. Also, the surgical instruments used have long handles and are controlled from outside of the person’s body, so the surgeon may find that using them feels less natural than using traditional surgical instruments. For these reasons, keyhole surgery has potential disadvantages:

• Keyhole surgery often takes longer than traditional surgery.

• More importantly, especially when a procedure is new, errors are more likely to occur than with traditional approaches because of the complexity of keyhole surgery.

People also should know that although keyhole surgery may cause less pain than traditional surgery, pain still occurs, often more than anticipated.

Because keyhole surgery is technically difficult, people should do the following:

• Choose a highly experienced surgeon.

• Establish that surgery is necessary.

• Ask the surgeon how pain will be treated.