What is minimally invasive surgery?
In the strict sense, the concept of minimally invasive surgery is in constant evolution. Less invasive techniques (Less Invasive Surgery = LIS) has routinely used in Orthopaedic Surgery for more than 40 years.
With minimal surgical (MIS) or less aggressive (LIS) we can significantly avoid sectioning the muscles and thus avoid excessive bleeding and the need for reconstruction of tissues therefore helping control pain.
What are its origins?
The idea of trying to reduce the surgeon's aggression on the soft tissues during an operation was popularized in the U.S. in 1990. Its promoters were cardiologists and radiologists who were trying to reduce vascular complications related to examinations and treatments on coronary arteries. Later this idea has expanded its applications to foot surgery, spine surgery, arthroscopic surgery and, ultimately, to the treatment of fractures.
What are the advantages and disadvantages of minimally invasive surgery?
- Reduces the trauma to soft tissue (muscles, tendons, joint capsule ...).
- Decreases blood loss, less pain and a faster recovery. By damaging fewer muscles, tendons or ligaments it helps control blood loss when performing a joint replacement. Postoperative pain is less, and the process of healing and rehabilitation are faster.
- Better stability of the components. A prosthesis consists of two or more separate pieces that are supported by muscles and tendons that surround it. With minimally invasive surgery, these soft tissues have a lower damage, and can best support the function of prosthetic components.
- Better cosmetic results. The size of the incision (and therefore scar) in a hip prosthesis implanted according to LIS criteria (mini-incision) is about 9 cm. compared to the 20 cm incision in conventional techniques.
On the other hand minimally invasive surgery also involves some drawbacks compared to conventional surgery. The surgeon has a more limited view and it is more difficult to orientate the components of the prosthesis and requires advanced experience in surgical technique.
Can all interventions in orthopedic surgery be done with minimally invasive techniques?
Theoretically yes. As a new technique, its use is spreading exponentially. To date, the most common procedures that are performed with minimally invasive techniques in Orthopaedic Surgery are:
- Spine surgery (removal of hernias)
- Foot surgery (bunion)
- Arthroscopy of the knee, shoulder, hip, ankle, elbow and wrist
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