| Minimally invasive surgery | |
|---|---|
 Endovascular aneurysm repair - example of minimally invasive procedure | |
| MeSH | D019060 |
| eMedicine | 938198 |
Minimally invasive surgery (also known asminimally invasive procedure) encompasssurgical techniques that limit the size of incisions needed, thereby reducingwound healing time, associated pain, and risk of infection. Surgery by definition is invasive, and many operations requiringincisions of some size are referred to asopen surgery. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements inmedical technologies have enabled the development and regular use of minimally invasive procedures. For example,endovascular aneurysm repair, a minimally invasive surgery, has become the most common method of repairingabdominal aortic aneurysms in the US as of 2003. The procedure involves much smaller incisions than the correspondingopen surgery procedure ofopen aortic surgery.[1]
Interventional radiologists were the forerunners of minimally invasive procedures. Usingimaging techniques, radiologists were able to direct interventional instruments through the body by way ofcatheters instead of the large incisions needed in traditional surgery. As a result, many conditions once requiring surgery can now be treated non-surgically.[2]
Diagnostic techniques that do not involve incisions, puncturing the skin, or the introduction of foreign objects or materials into the body are known asnon-invasive procedures.[3] Several treatment procedures are classified as non-invasive. A major example of a non-invasive alternative treatment to surgery isradiation therapy, also called radiotherapy.[4]
Minimally invasive procedures were pioneered byinterventional radiologists who had first introducedangioplasty and the catheter-deliveredstent. Many other minimally invasive procedures have followed where images of all parts of the body can be obtained and used to direct interventional instruments by way ofcatheters (needles and fine tubes), so that many conditions once requiring open surgery can now be treated non-surgically.[2] A minimally invasive procedure typically involves the use ofarthroscopic (for joints and the spine) orlaparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through anendoscope or large scale display panel, and is carried out through theskin or through abody cavity or anatomical opening.Interventional radiology now offers many techniques that avoid the need for surgery.[2]
By use of a minimally invasive procedure, a patient may require only anadhesive bandage on the incision, rather than multiple stitches or staples to close a large incision. This usually results in less infection, a quicker recovery time and shorter hospital stays, or allowoutpatient treatment.[5] However, the safety and effectiveness of each procedure must be demonstrated withrandomized controlled trials. The term was coined byJohn E. A. Wickham in 1984, who wrote of it inBritish Medical Journal in 1987.[6]
Many medical procedures are called minimally invasive; those that involve small incisions through which an endoscope is inserted, end in the suffix-oscopy, such asendoscopy,laparoscopy,arthroscopy. Other examples of minimally invasive procedures include the use ofhypodermic injection, and air-pressure injection,subdermal implants,refractive surgery,percutaneous surgery,cryosurgery,microsurgery,keyhole surgery,endovascular surgery usinginterventional radiology (such asangioplasty orembolization),coronary catheterization, permanent placement ofspinal andbrainelectrodes,stereotactic surgery,the Nuss procedure,radioactivity-basedmedical imaging methods, such asgamma camera,positron emission tomography andSPECT (single photon emission tomography). Related procedures areimage-guided surgery, androbot-assisted surgery.[7]
Specialmedical equipment may be used, such asfiber optic cables, miniaturevideo cameras and specialsurgical instruments handled via tubes inserted into the body through small openings in its surface. The images of the interior of the body are transmitted to an externalvideo monitor and the surgeon has the possibility of making adiagnosis, visually identifying internal features and acting surgically on them.[8]
Minimally invasivesurgery should have less operativetrauma, othercomplications andadverse effects than an equivalent open surgery. It may be more or less expensive (for dental implants, a minimally invasive method reduces the cost of installed implants and shortens the implant-prosthetic rehabilitation time with four–six months[9]). Operative time is longer, but hospitalization time is shorter. It causes lesspain andscarring, speeds recovery, and reduces the incidence of post-surgical complications, such asadhesions andwound rupture. Some studies have comparedheart surgery.[10]
Risks and complications of minimally invasive procedures are the same as for any othersurgical operation, among the risks are: death, bleeding,infection, organ injury, andthromboembolic disease.[11]
There may be an increased risk ofhypothermia and peritoneal trauma due to increased exposure to cold, dry gases duringinsufflation. The use ofsurgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, may reduce this risk.[12]
Sometimes the use of non-invasive methods is not an option, so that the next level of minimally invasive techniques are looked to. These include the use ofhypodermic injection (using thesyringe), anendoscope,percutaneous surgery which involves needle puncture of the skin,laparoscopic surgery commonly calledkeyhole surgery, acoronary catheter,angioplasty andstereotactic surgery.[citation needed]
"Open surgery" is any surgical procedure where theincision made is enough to allow the surgery to take place. With tissues and structures exposed to the air, the procedure can be performed either with the unaided vision of the surgeon or with the use ofloupes ormicroscopes. Some examples of open surgery used are forherniated disc commonly called a "slipped disc", and most types ofcardiac surgery andneurosurgery.[medical citation needed]
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for adults.
International Pediatric Endosurgery Group (IPEG) for pediatrics.
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