Ten Questions Answered on Pinhole Surgery

  1. What is pinhole surgery?
    Any surgery which is catheter based is called pinhole surgery in lay man terms. There is no need for suturing the puncture site. Many problems related to blood vessels in the body can be tackled through pinhole surgery.
  2. What are its advantages?
    Pinhole surgery does not need elaborate preparations like positioning, anesthesia and preparing the area of surgery. It can be done in relatively lesser time when compared to open surgery. It does not need opening the skull and hence one can avoid all the attendant complications of open surgery.
  3. Can pinhole surgery be done without anesthesia?
    Yes. Pinhole surgery can be done without anesthesia in certain situations. This is a very major advantage when one is dealing with patients with multiple life threatening complications. Since the procedure is done under local anesthesia the surgeon can be in direct communication with the patient.
  4. What are the conditions where pinhole surgery can be done?
    In the brain many vascular conditions like aneurysms, arterio venous malformations critical narrowing of blood vessels (stenosis) can be tackled. In case of vascular tumors, blood circulating to those tumors can be blocked with a procedure called embolization. This technique can also be used to open up blood vessels in acute stroke.
  5. Does one need special equipment for pinhole surgery?
    Yes. Pinhole surgery has to be done in a specialized suite called cathlab. The cathlab should have DSA with biplane fluoroscopy facility DSA (digital subtraction angiography) gives a better picture resolution and with biplane facility one can obtain pictures in 2 dimensions with single contrast injection This reduces the damage to renal system. The catheters used in the procedure are another special equipment needed. The DSA machine should have roadmap facility to help one navigate into the area of interest with comfort and ease.
  6. How expensive is pinhole surgery when compared to open surgery?
    Yes. Pinhole surgery is expensive when compared to open surgery. Cathlabs are expensive to maintain and the catheters, coils and other embolic materials are very expensive. But on the flip side post procedure costs like prolonged intensive care stay and overall hospital stay are very minimal. Overall both modalities even out in terms of cost to the patient.
  7. What are the precautions does the patient need to take after pinhole surgery?
    Patients undergoing most of the procedures through pinhole surgery need not take any precautions. They have to be on lifelong medications (blood thinners) if treatment is being done to open up blocked vessels (intra arterial stent placement). One needs to undergo check angiograms at periodic intervals following pinhole surgery.
  8. How long does one need to stay in the hospital following pinhole surgery?
    Following pin hole surgery one can get discharged with in 48 hrs from the hospital. He or she can get back to routine work as soon as they are out of the hospital.
  9. Is pinhole surgery better than open surgery?
    Yes. Many times pinhole surgery is better than open surgery because of lesser operating time, lesser invasiveness, not needing to open the skull and lesser hospital stay. But there are situations where only open surgery can be done. Hence one cannot completely rule out open surgery.
  10. Who does pin hole surgery?
    A person who gets trained in pinhole surgery can do the procedure. Presently neurosurgeons, neurologists and radiologists are in the trade. Ideally a neurosurgeon should be doing this procedure. Since he is also trained in open surgery, he can decide what is good for the patient without any bias.