Minimally Invasive Surgery
Over the past few decades, research and technologies have led to improved methods in all medical specialties, and orthopedics is no exception. These new technologies aim for continuous improvement in patient care and low post-operative patient morbidity. Minimally invasive surgeries (MIS) are one of those techniques that aim to meet the surgical needs of the patient while causing less damage to the surgical area and a faster recovery. Most of the traditional open surgery procedures have been replaced with MIS techniques. MIS is recommended to treat various musculoskeletal conditions, including injuries to the bones, joints, muscles, ligaments, or tendons, and medical conditions like arthritis and osteoporosis.
What is minimally invasive surgery?
Minimally invasive surgery, as the name indicates, is a surgical procedure that is performed by making minimal surgical incisions (cuts). The procedure is performed using a scope (a thin fiber-optic tube) mounted with a video camera and specialized instruments. Unlike open surgeries, MIS procedures involve smaller incisions, resulting in reduced postoperative pain and minimal damage to the healthy tissues. The scope visually guides the surgery as it transmits real-time internal images during the procedure. Small surgical instruments are inserted through other incisions to repair the defects.
Minimally invasive techniques can thus be used to visualize inside the body, diagnose the condition, and treat the condition.
Types of minimally invasive orthopedic surgeries
The minimally invasive surgical procedures in orthopedics are:
Minimally invasive spine surgeries (MISS): Spine surgeries are performed to treat conditions like spinal instability, bone spurs, herniated discs, and spinal tumors. The spine surgeries are usually performed as "open surgeries," where larger incisions are made to access the affected area. However, minimally invasive surgical approaches are now recommended to treat back and neck conditions. MISS aims to stabilize the vertebral bones and spinal joints and relieve pressure on the spinal nerves with fewer post-surgery complications. MISS is performed under anesthesia. Common MISS procedures are lumbar discectomy, laminectomy, and spinal fusion.
MISS uses an instrument known as a tubular retractor (a specialized instrument for neurosurgeries). The tubular retractor will create a tunnel to the defective area of the spine, through which the other instruments are inserted. A special camera is inserted through other openings, which provide real-time images of the spine.
Arthroscopy is a commonly used minimally invasive surgery. It is used to visualize, diagnose, and treat various joint problems. Arthroscopy is recommended to diagnose and treat various problems inside the joints like the shoulder, hip, knee, ankle, wrist, and elbow.
The procedure involves making two or more small incisions in the skin above the affected joint. A tool called an arthroscope (a thin, flexible tube with a mounted video camera) is inserted through one of these incisions. The view of the arthroscope is transmitted to an external monitor, which helps the surgeon visualize the interior of the joint. Based on the initial diagnosis, surgical tools are inserted through the other incisions to repair the joint. The entire process is carried out while sedated.
Minimally invasive surgeries for fracture management: Open reduction and internal fixation (ORIF) is a commonly used method in the treatment of traumatic fractures. As it is associated with deep invasion and an increased incidence of infections post-surgery, MIS has gained popularity in fracture management. The best examples of MIS in fracture management are the treatment of diaphyseal fractures (fractures involving the radius and ulna) and fractures that extend into the bone shaft.
The procedure involves making a small incision in the soft tissues to insert implants and other instruments. A specialized scope is inserted through one of these incisions, which guides the surgeon by transmitting the internal images on the external screen. The reduction of fractures is achieved via indirect closed reduction. Fracture and further soft tissue damage from MIS are rather minor.
Minimally invasive total joint replacement (MIS): MIS joint replacement surgery is a surgical approach that aims to replace damaged or worn joint surfaces with artificial implants through small incisions and less invasive techniques. The procedure has a speedy recovery and fewer post-operative complications compared to traditional open surgeries. The most common minimally invasive joint replacement surgeries are hip arthroplasty and knee arthroplasty.
During the procedure, smaller incisions with less disruption of muscles and tissues are made compared to traditional open surgeries. As the procedure provides limited visualization of the surgical site, fluoroscopic assistance is required. A minimally invasive total joint replacement often takes place under general or spinal anesthesia.
What are the benefits of minimally invasive surgeries?
When compared to open surgery, an MIS offers a number of benefits.
- Smaller incisions and less pain: As the incisions made for the procedure are smaller, minimally invasive surgery is less painful than open surgery. In most cases, patients need fewer pain medications and recover more quickly.
- Decreased risk of complications: The smaller incisions result in less blood loss and cause minimal injury to the soft tissues near the surgical site. Because of the smaller wounds, the risk of infection is also very low.
- Quicker recovery with short hospital stays: The recovery time may vary depending on the procedure. As a result of smaller incisions and fewer stitches, the healing time is shorter compared to other surgical procedures. MIS allows for a shorter hospital stay, and in most cases, patients can return on the day of their procedure.
- Reduced scarring: Traditional open surgery can cause adhesions or scarring on the surgical site, which can cause pain and other complications. MIS causes less scarring of the tissues.
- Less expensive than traditional surgery: As MIS procedures have minimal hospital visits before the procedure and short hospital stays, the overall costs associated with MIS are lower compared to traditional surgeries.
Prognosis
Minimally invasive surgeries offer numerous benefits, like faster recovery, reduced pain, etc. The procedure is less risky, and the surgeon can perform it with greater precision. The MIS procedure causes less stress on the body compared to traditional open surgeries. These procedures are beneficial to elderly patients and those who are prone to infection and complications. Furthermore, MIS procedures pave the way for future surgical procedures and provide a learning curve for surgeons.