BASICS: ENDOSCOPIC PLASTIC SURGERY
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.
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
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
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
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
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
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
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
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
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
If performed by an experienced, well-trained plastic surgeon, endoscopic
procedures may provide the same results as open-method procedures but with less
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.
Автоматический перевод на русский язык