Dubai: Mohammed Imran, 39, a Pakistani cashier in Dubai, had developed a progressive swelling under the jaw on the left side of his neck. Initial investigations suggested this could be a more dormant type of growth of the lymph nodes. Imran underwent a “stealth surgery” through three incisions punched through the hairline behind his left ear.
The puncture marks are now covered as the hair had grown back. The wound had healed. Imran is just one of the growing number of patients who rave about a new surgery procedure, one that leaves virtually no scars.
If you only go by its name, the connotation may be discomfiting at first. But upon closer scrutiny, the truth is that everything about stealth surgery is positive. The technique, a sub-domain of keyhole surgery, leaves little or next-to-nothing scarring.
How is it done?
It's an exciting and new technique, now available in the UAE. It involves a new discipline that allows surgeons to reach areas that were previously not covered by minimally invasive surgery. For instance, a lump in the neck (as in Imran's case) can now be extracted with two or three incisions on the hairline above the ear where the hair grows back, concealing the pinpricks.
What else is possible through this minimal invasive procedure? Here are some:
- Thyroidectomy (removal of the thyroid) through the oral cavity
- Removal of uterus through the birth canal
- Bariatric procedures through the navel
- Gall bladder removal through the navel
- Removal of breast lumps through puncture holes in the armpit
The obvious benefit: procedures are being done under local anaesthesia, or in some cases requiring shorter duration of general anaesthesia. This offers rapid recovery for the patient — an outcome that provides much psychological relief to them. Most of all, it leaves behind practically no unsightly scars.
An upgrade on minimally invasive surgery
Dr J.S. Rajkumar, founder of Lifeline Group of Hospitals for minimally invasive procedures in Chennai, India, is a regular visiting consultant surgeon for hospitals in Dubai. Dr Rajkumar’s experience in stealth surgery is earning him increasing recognition.
In stealth surgery, the incisions are placed as far away from the area of operation as possible, or at a site where they are invisible, for example, using the armpit to access a lump in the breast.
Talking to Gulf News about the exciting new procedures that he has already carried out on patients in UAE, he said: “Stealth surgery is different from the conventional open and laparoscopic surgeries, because it is designed to inflict minimal scarring and incision damage on the patients’ skin. In other words, stealth surgery is about taking minimal invasive surgery to its highest limits of cosmetic satisfaction. In stealth surgery, the incisions are placed as far away from the area of operation as possible, or at a site where they are invisible, for example, using the armpit to access a lump in the breast.”
Benefits of smallest entry point for surgery
The importance of the incision minimisation cannot be overstated. Its true worth goes beyond cosmetic considerations as it addresses the vital concerns regarding wound management and healing, which is an integral part of surgical success. “One of the weakest parts of any surgery is the entry or the incision of the area of operation,” explained Dr Rajkumar. “Reducing the number of incisions, as is done in a single-port surgery, statistically reduces the risk of infection or complications related to the incision,” he added.
“Secondly, even in the remote eventuality that there is a complication in an incision, placing it in an area where it will not be seen is a great advantage for the patient. For example, after a thyroid surgery, having infection in a large incision in the neck is extremely discomfiting for a patient. On the other hand, if the incision were to be within the mouth area, a slightly sore mouth for a few days would be the only discomfort they would experience.”
Dr Rajkumar is one of the pioneers of the technique. Different organs can be compatible with the technique. Dr Raj Kumar said: “I started with scar-less gallbladder and appendix surgery about 10 years ago,” said Dr Rajkumar. “From there, we progressed to heartburn surgery, hysterectomy and bariatric surgeries in a big way."
For the past ten years, he had been doing stealth surgery for thyroid as well. In the initial years, he was conducting [thyroid surgery] through the armpit and the breast. For the past two years, he does thyroid surgeries through the mouth itself. He has also performed colonic resections and spleen surgeries through the stealth technique. "Recently, in the UAE, I have also performed the removal of a sub-mandibular mass in the neck, using the stealth surgery technique from the scalp. In this case, we tunnelled a route from the back of the head to the front of the neck and removed a lump,” he said.
• The surgeon makes use of available natural “portals” in the body. These may include the cavity of the mouth to conduct surgeries of the oesophagus, removal of thyroid gland etc; the navel for the removal of gall bladder, also bariatric surgeries; the birth canal for removal of uterus etc.
• In case there are no natural portals, the surgeon uses places where the tiny puncture holes made or the laproscopic surgery are hidden — in the natural folds of the skin.
The result: much shorter recovery time for patients. “Almost all patients in my series have been home in the next day or two. The surgeries are technologically challenging, but extremely satisfying.”
Dr Rajkumar has conducted nearly 20 stealth surgeries in the UAE over the past year. They include trans-oral thyroidectomy (removing the thyroid through the mouth), trans-axillary breast lumpectomy, sleeve gastrectomy, single-port groin hernia, single-port cholecystectomy, single-port ovarian cystectomy and single-port hysterectomy.
This is the future of surgery. And I am happy to say that this is now available here in the UAE. I have recently commenced robotic surgery as well and the future will see robots perform single-port stealth surgeries.
“This is the future of surgery,” said Dr Rajkumar. “And I am happy to say that this is now available here in the UAE. I have recently commenced robotic surgery as well and the future will see robots perform single-port stealth surgeries,” he added.
Is it affordable?
Adding to the several advantages of stealth surgery is its optimal cost. “With no extra devices and instrumentation, but with a definite learning curve, using the available standard laparoscopic instruments, it is possible to do most of the stealth surgeries (at no extra cost than the conventional option),” explained Dr Rajkumar.
I has several scientific publications attesting to this fact. “This is the beauty of the technique. In an era where one needs to consider the cost to the individual, as well as to the state, this is a particularly important consideration.”
• Another is the use of the natural hairline to remove tumours on the spine or the neck — when the hair grows back, the hairline conceals the puncture marks.
• In short, it is “virtually scarless”. It can can be done with regional and local anaesthesia. The biggest advatage: quick recovery rate, as the patient does not undergo any opening up with scalpel on the surgeon’s table.
What about insurance coverage?
It is only a matter of time before insurance companies recognise the advantages of stealth surgery, the expert said. “I do hope that they will permit more patients to avail of its benefits,” he added. “There is no added cost to insurance companies, even as it offers a huge advantage to the patient. Slowly, as the need for less scars and less pain in surgical approaches earns its priority, everyone will understand that this is a very beneficial technique. Some of the patients who underwent stealth surgeries were from Africa, and the UAE can become a hub for boosting medical tourism in this field.”
Most of the stealth surgeries carried out Dr Rajkumar were done at the Burjeel group of hospitals or at Dubai London Hospital.
Case studies and patients speak
‘She did not want a surgery scar on her breast’
Patient: Angeline Cartiaga Mena, a young saleslady in Dubai, noticed a lump in her breast last year. After some investigations, it was confirmed to be noncancerous. For Angeline, the sensation of having a large lump in the breast and the nagging worry that it might one day turn out to be malignant was causing her a great deal of stress. Upon examination, Dr Rajkumar surmised that she was an ideal patient for stealth lumpectomy as her tumour was benign.
“The young lady had a fibrodenoma that warranted excision. Angeline was only 19 years old and did not want to have an incision scar on her breast, as it seemed during her initial consultations with doctors. I explained to her about stealth surgery and she decided to go ahead with it. I removed the lump through the armpit, giving her a scar-less experience. She now has remained free of problems for more than a year.”
‘We tunnelled our way from the back to the front of the neck’
In the case of Mohammed Imran, 39, following Initial investigations which showed he had a dormant lymph node growth, he underwent a sub-mandibular mass stealth surgery. Three holes were punched on his hairline behind his left ear. A sample was taken, and he was diagnosed with a malignant lymphoma.
I was surprised at how painless the procedure was. I have no scars as at all, I was discharged on the second day of the surgery.
Speaking to Gulf News from Pakistan, Imran, who is currently undergoing radiation, said: “I was surprised at how painless the procedure was. I have no scars as at all, I was discharged on the second day of the surgery. The place where the puncture marks were made on my hairline, the hair has grown back. When I reached home, my wife and family members could not even believe I had a surgery as the wound had healed without leaving a scar. I am very happy and my radiation has been smooth. I am hoping to be back in the UAE soon,” said the father of two toddler sons.
Dr Rajkumar explained: “I suggested a removal of the entire nodes in the neck to get the right pathological diagnosis and start chemotherapy. I discussed the advantages of stealth surgery with the patient and the management of Burjeel Hospital were very cooperative in permitting the surgery.
"After shaving back his hairline behind the ear, we made three tiny incisions on his scalp and 'tunnelled' our way up to the front of the neck. Then we were able to take a large chunk of the lymph nodes for pathological examination, and he is now being referred for the appropriate treatment. He underwent the entire surgery with no scars, as the regrowth of the hair in the scalp has completely hidden the incisions that we deployed.”
There are more success stories. Abdul Aziz, a young 29-year-old Emirati who weighed more than 180kg underwent a stealth bariatric surgery through his navel, in September 2020. Aziz told Gulf News: “I am very happy with the outcome of this surgery as I did not have to undergo any cut or worry about an ugly scar across my abdomen, post the surgery. The doctor did the surgery through my navel. What’s more, in the last four months, I have lost nearly 50kg and the weight keeps falling. My target is to weigh 80kg and I am steadily progressing towards that point.
Gall bladder removal
Syed Hassnain Abbas, 39, an Indian expatriate banking executive from Dubai, woke up with a pain so sharp in his abdomen one night that he had to be rushed to the emergency section. Doctors diagnosed him with a swollen gall bladder that required to be excised.
I did not want an ugly scar running across my stomach.
“I did not want an ugly scar running across my stomach. I had known about Dr Rajkumar’s stealth procedures and consulted him. He advised a gall bladder removal through the navel, as there was a fear of rupture of the organ. I immediately agreed as this felt to be the best option for me. I was operated at Burjeel Hospital and was back on my feet in two days. I have never felt better in life.”