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. In endoscopic
surgery, a probe with a tiny camera transmits images inside the body
to a video monitor.
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 been introduced more
recently. 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 web site 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 Dr.
Monteiro about anything you don't understand.
About 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
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 Dr.
Cosmetic procedures that may be assisted by endoscopy are:
(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.
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 may also 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.
- 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
may also assist in the positioning of cheek and chin implants.
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 procedures that may be assisted by endoscopy are:
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.
consideration and risks
endoscopic procedures do not require a hospital stay and are performed
in Dr. Monteiro's office or at an out-patient surgery center.
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.
And, keep in mind that if a complication occurs at any time during the operation Dr.
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.
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.