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Minimally invasive procedure

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A minimally invasive procedure is any procedure (surgical or otherwise) that is less invasive than open surgery used for the same purpose. A minimally invasive procedure typically involves use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device, and are carried out through the skin or through a body cavity or anatomical opening. This may result in shorter hospital stays, or allow outpatient treatment.[1] However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials. The term was coined by John EA Wickham in 1984, who wrote of it in British Medical Journal in 1987 [1].

A minimally invasive procedure is distinct from a non-invasive procedure such as external imaging instead of exploratory surgery.

The minimal incision technique is a specialized surgical technique practiced by some physicians to remove masses or growths with minimal scarring and less recovery time. Most surgeons usually cut along 3/4 to the full length of the mass to access it or remove it. With the minimal incision technique the incision is usually about 1/10 the size of the underlying mass and the surgeon carefully dissects the mass out through this very small incision. A smaller incision forms a much smaller scar and results in less recovery time for the patient. This technique is useful for cysts or lipomas. Patients with such lesions on cosmetically or functionally important areas such as the face can gain great benefit from such techniques.

Contents

Specific procedures

Many medical procedures are called minimally invasive, such as hypodermic injection, air-pressure injection, subdermal implants, endoscopy, percutaneous surgery, laparoscopic surgery, arthroscopic surgery, cryosurgery, microsurgery, keyhole surgery, endovascular surgery (such as angioplasty), coronary catheterization, permanent spinal and brain electrodes, stereotactic surgery, The Nuss Procedure, radioactivity-based medical imaging methods, such as gamma camera, Positron emission tomography and SPECT (single photon emission tomography). Related procedures are image-guided surgery, robotic surgery and interventional radiology.

Benefits

Minimally invasive surgery should have less operative trauma for the patient than an equivalent invasive procedure. It may be more or less expensive. Operative time is longer, but hospitalization time is shorter. It causes less pain and scarring, speeds recovery, and reduces the incidence of post-surgical complications, such as adhesions. Some studies have compared heart surgery.[2] However, minimally invasive surgery is not necessarily minor surgery that only regional anesthesia is required. In fact, most of these procedures still requires general anesthesia to be administered beforehand.

Risks

Minimally invasive procedures are not completely safe, and some have complications ranging from infection to death. Risks and complications include the following:

  • Anesthesia or medication reactions
  • Bleeding
  • Infection
  • Internal organ injury
  • Blood vessel injury
  • Vein or lung blood clotting
  • Breathing problems
  • Death (rare)[3]

All of these risks are present also in open, more invasive surgery.

There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of heated and humidified CO2 may reduce this risk.[4]

Prevalence

Due to these advantages, surgeons are attempting to perform more procedures as minimally invasive procedures. Some procedures, such as gall bladder removal, can be done very effectively as minimally invasive surgery.[citation needed] Other procedures, such as endarterectomy, have a higher incidence of strokes in some studies.[citation needed] The first successful minimally invasive aortic aneurysm surgery was performed by Dr. Michael L. Marin at Mount Sinai Hospital, New York.[5]

"Lapraroscopic surgery has been around for a long time. We've been using laparoscopy for appendectomies, for taking out gall bladders and for removing cysts on the ovaries. But it's been in very limited use for hysterectomies."[6] Laparoscopic hysterectomy, with incisions measuring less than 10 mm, is used for less than 10% of the roughly 800,000 hysterectomies annually performed in the United States, according to the American Association of Gynecological Laparoscopists (AAGL).

Equipment

Special medical equipment may be used, such as fiber optic cables, miniature video cameras and special surgical 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 external video monitor and the surgeon has the possibility of making a diagnosis, visually identifying internal features and acting surgically on them.

See also

References

1. Wickham JEA. The new surgery. Br Med J 1987;29:1581–1582.

Notes

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