Minimally invasive procedure

Minimally invasive surgical procedures avoid open invasive surgery in favor of closed or local surgery with less trauma. These procedures involve 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.

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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, 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]

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]}

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

• Endoscopy
• Surgery
• Anesthesia
• ASA score or pre-operative physical fitness
• Medicine
• Traumatology

References

• Minimally invasive heart surgery. Medical Encyclopedia, MedlinePlus.
• Minimally invasive aortic valve surgery. CTSNet article.
• Minimally invasive surgery yields benefits. The American Academy of Orthopedic Surgeons. Febr. 2003.
• Minimally invasive cancer treatments highlighted. Science Daily. Nov. 2005.
• Minimal Parathyroid Surgery. The minimally invasive technique utilizing intraoperative nuclear mapping, slso called Minimally Invasive Radioguided Parathyroidectomy, or "MIRP". EndocrineWeb. June 20, 2005.
• Kilger E, Weis FC, Goetz AE, Frey L, Kesel K, Schutz A, Lamm P, Uberfuhr P, Knoll A, Felbinger TW, Peter K. Intensive care after minimally invasive and conventional coronary surgery: a prospective comparison. Intensive Care Med. 2001 Mar;27(3):534-9. PMID 11355122

Notes