Endoscopic Surgery

Endoscopy is a surgical technique that involves the use of an endoscope, a special viewing instrument that allows Dr. Fisher 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. As important research continues, endoscopy is being used on a limited basis for both cosmetic and reconstructive procedures.

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, Dr. Fisher watches the screen while moving the tube of the endoscope through the surgical area.

It is 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.

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 Dr. Fisher 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.

Cosmetic surgery

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 Dr. Fisher 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.

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 may also assist in the positioning of cheek and chin implants.

Forehead lift – Of all the cosmetic procedures that use endoscopy, the forehead lift is the one which is more commonly performed. Instead of the usual ear-to-ear incision, three or more “puncture-type” incisions are made just at the hairline. The endoscope helps guide Dr. Fisher, who removes the muscles that produce frown lines and repositions the eyebrows at a higher level.

Reconstructive surgery

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, Dr. Fisher 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 Dr. Fisher 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, Dr. Fisher 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.