Laparoscopic surgery: improving patient outcomes

This article has two parts. If you are a patient or family member, start with For patients. If you are a referring GP or colleague, skip to For referring doctors.

For patients

Most of the operations I do — gallbladder, hernia, appendix, bowel and pelvic-floor procedures — I now perform through a few small incisions rather than one long cut. We call this laparoscopic ("keyhole") surgery, and when we use a robotic system it is called robotic-assisted surgery. From your side, both feel the same: smaller wounds, less pain, and a quicker return to normal life.

What it means for you

Smaller cuts. Usually 5–12 mm each, instead of a 15–20 cm open incision. Scars fade to thin lines.
Less pain. Most patients need only mild pain relief after the first day or two.
Shorter hospital stay. Many go home the same day or the next morning; bowel operations that used to need a week often now take two to four nights.
Faster recovery. Back to driving in about a week for most procedures, back to desk work in one to two weeks, back to the gym in four to six.
Fewer wound problems. Small incisions mean less risk of wound infection and hernias at the scar — particularly important if you are overweight or diabetic.

Is it right for you?

Keyhole surgery is not automatic — it depends on your condition, previous operations, and general health. In consultation I will tell you honestly whether the laparoscopic, robotic, or open approach gives you the best result. Sometimes we start laparoscopically and convert to open if it is safer; that is a good decision, not a failure.

For referring doctors

My practice is built around minimally invasive general and colorectal surgery. The bulk of my elective and emergency workload is now laparoscopic or robotic-assisted, across benign and malignant disease.

Procedures routinely performed minimally invasively

Colorectal: right and left hemicolectomy, sigmoidectomy, anterior resection, total and subtotal colectomy, proctocolectomy — for diverticular disease, IBD complications, polyps and colorectal cancer.
Pelvic floor: robotic rectopexy and sacrocolpopexy (the latter in conjunction with Dr Colin Martheze, urologist).
Hernia: inguinal (TEP/TAPP), incisional and ventral repairs — with robotic repair a strong option in obese and re-do cases.
Upper GI & general: cholecystectomy, appendicectomy, anti-reflux and hiatus hernia repair, diagnostic laparoscopy.

Clinical rationale

The published evidence — reflected in the Mediclinic feature referenced below — is consistent across disciplines: minimally invasive access reduces post-operative pain, ileus, wound morbidity and length of stay, without compromising oncological or functional outcomes when performed by trained teams. Robotic assistance adds articulated instruments, tremor filtration and 3D vision, which is most useful deep in the pelvis (low rectal cancer, prolapse) and in the obese abdominal wall.

Patient selection

I consider almost every elective patient a laparoscopic or robotic candidate first. Absolute contraindications are few; relative factors — dense adhesions, unstable physiology, advanced local invasion — are discussed case by case. Elderly and obese patients often benefit more, not less, from a minimally invasive approach because the wound and pulmonary burden of open surgery is what usually derails their recovery.

Referrals

I consult at Johannesburg Surgical Hospital (Room 21) and operate at JSH, Netcare Olivedale, Life Bedford Gardens and Cure Day Hospitals. Urgent cases are accommodated the same or next day — please phone the rooms directly. Full contact details are on the contact page.

Source and further reading: This article draws on the Mediclinic Foundation feature "Laparoscopic surgery: improving patient outcomes", in which I discussed the shift toward minimally invasive general and colorectal surgery in South Africa.