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Minimally invasive procedures

From Wikipedia, the free encyclopedia

Minimally invasive procedures
Aneurysm endovascular.jpg
Endovascular aneurysm repair -example of minimally invasive procedure
MeSHD019060
eMedicine938198

Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed and so lessen wound healing time, associated pain and risk of infection. Surgery by definition is invasive and many operations requiring incisions of some size are referred to as open surgery, in which incisions made can sometimes leave large wounds that are painful and take a long time to heal. Minimally invasive procedures have been enabled by the advance of various medical technologies. An endovascular aneurysm repair as an example of minimally invasive surgery is much less invasive in that it involves much smaller incisions than the corresponding open surgery procedure of open aortic surgery. This minimally invasive surgery became the most common method of repairing abdominal aortic aneurysms in 2003 in the United States.[1]

The front-runners of minimally invasive procedures were interventional radiologists. By the use of imaging techniques, interventional instruments could be directed throughout the body by the radiologists by way of catheters instead of large incisions needed in traditional surgery, so that many conditions once requiring surgery can now be treated non-surgically.[2]

Diagnostic techniques that do not involve the puncturing of the skin or incision, or the introduction into the body of foreign objects or materials, are known as non-invasive procedures.[3] There are also several treatment procedures that are classed as non-invasive. A major example of a non-invasive alternative treatment to surgery is radiation therapy, also called radiotherapy.[4]

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  • ✪ Minimally Invasive Esophagectomy (MIE) - Mass General Hospital
  • ✪ Minimally invasive surgery: faster recovery and smaller incision
  • ✪ TLIF Back Procedure with Minimally Invasive Spine Surgeon Dr. Michael Rimlawi, D.O.
  • ✪ Minimally Invasive Procedures to Treat Urologic Cancers: Michael Palese, MD, Director
  • ✪ Minimally Invasive Surgery for Hysterectomy

Transcription

Minimally invasive esophagectomy is performed at Massachusetts General Hospital primarily for patients with esophageal cancer, but is occasionally used in treating benign esophageal conditions. During an esophagectomy, the diseased portion of the esophagus is removed, and the stomach is used to reconstruct the esophagus. Performing the surgery in a minimally invasive fashion allows for a quicker recovery with decreased pain. Minimally invasive esophagectomy begins after the patient receives general anesthesia. The surgeon makes five small incisions, known as ports, in the abdomen to perform the laparoscopic portion of the procedure. Using a camera for magnification, instruments are passed through the laparoscopic ports. This process allows the stomach to be moved to replace the esophagus. In cases of esophageal cancer, extensive lymph node dissection is also performed. The portion of the stomach that will be used to reconstruct the esophagus is prepared to move into the chest. The stomach is moved to the chest, replacing the diseased portion of the esophagus. The patient is then turned and the surgeon makes four small incisions in the right side of the chest, avoiding spreading of the ribs. The esophagus is removed, and the stomach is sewn to the remaining esophagus. Lymph nodes may also be removed at this stage. Following the procedure, the patient is awakened and transferred to the post-anesthesia recovery area. Most patients can expect to stay in the hospital for about one week, followed by a recovery period of four to six weeks. Minimally invasive esophagectomy has been shown to decrease length of hospital stay, diminish pain and decrease respiratory complications compared to standard open esophagectomy. For more information on the minimally invasive esophagectomy procedure, visit massgeneral.org/MIE.

Contents

Medical uses

Arthroscopic surgery
Arthroscopic surgery

Minimally invasive procedures were pioneered by interventional radiologists who had first introduced angioplasty and the catheter-delivered stent. 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 of catheters (needles and fine tubes), so that many conditions once requiring open surgery can now be treated non-surgically.[5] A minimally invasive procedure typically involves the use of arthroscopic (for joints and the spine) or laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or large scale display panel, and is carried out through the skin or through a body cavity or anatomical opening. Interventional radiology now offers many techniques that avoid the need for surgery.[6]

By use of a minimally invasive procedure, a patient may require only an adhesive 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 allow outpatient treatment.[7] However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials. The term was coined by John E. A. Wickham in 1984, who wrote of it in British Medical Journal in 1987.[8]

Specific procedures

Flexible endoscope
Flexible endoscope

Many medical procedures are called minimally invasive; those that involve small incisions through which an endoscope is inserted, end in the suffix -oscopy, such as endoscopy, laparoscopy, arthroscopy. Other examples of minimally invasive procedures include the use of hypodermic injection, and air-pressure injection, subdermal implants, refractive surgery, percutaneous surgery, cryosurgery, microsurgery, keyhole surgery, endovascular surgery using interventional radiology (such as angioplasty), coronary catheterization, permanent placement of 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, and robot-assisted surgery.[9]

Benefits

Minimally invasive surgery should have less operative trauma, other complications and adverse 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 4–6 months[10]). 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 and wound rupture. Some studies have compared heart surgery.[11]

Risks

Risks and complications of minimally invasive procedures are the same as for any other surgical operation, among the risks are: death, bleeding, infection, organ injury, and thromboembolic disease[12]

There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, may reduce this risk.[13]

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.[citation needed]

Invasive procedures

Angioplasty
Angioplasty

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 of hypodermic injection (using the syringe), an endoscope, percutaneous surgery which involves needle puncture of the skin, laparoscopic surgery commonly called keyhole surgery, a coronary catheter, angioplasty and stereotactic surgery.[citation needed]

Open surgery

"Open surgery" is any surgical procedure, where the incision 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 of loupes or microscopes. Some examples of open surgery used, are for herniated disc commonly called a "slipped disc", and most types of cardiac surgery and neurosurgery.[medical citation needed]

See also

References

  1. ^ Sethi RK, Henry AJ, Hevelone ND, Lipsitz SR, Belkin M, Nguyen LL (September 2013). "Impact of hospital market competition on endovascular aneurysm repair adoption and outcomes". J. Vasc. Surg. 58 (3): 596–606. doi:10.1016/j.jvs.2013.02.014. PMID 23684424.
  2. ^ Society of Interventional Radiology -- Global Statement Defining Interventional radiology. "Archived copy" (PDF). Archived from the original (PDF) on 2011-07-28. Retrieved 2010-07-17.
  3. ^ Dorland's (2012). Dorland's Illustrated Medical Dictionary (32nd ed.). Elsevier. p. 955. ISBN 978-1-4160-6257-8.
  4. ^ Daniel Albert (2012). Dorland's illustrated medical dictionary (32nd ed.). Philadelphia, PA: Saunders/Elsevier. p. 1573. ISBN 978-1-4160-6257-8.
  5. ^ Society of Interventional Radiology -- Global Statement Defining Interventional radiology. "Archived copy" (PDF). Archived from the original (PDF) on 2011-07-28. Retrieved 2010-07-17.
  6. ^ Society of Interventional Radiology -- Global Statement Defining Interventional radiology. "Archived copy" (PDF). Archived from the original (PDF) on 2011-07-28. Retrieved 2010-07-17.
  7. ^ NCBI, National Center for Biotechnology Information,  NCBI, MeSH, Medical SubHeadings, NLM, National Library of Medicine
  8. ^ Wickham JE' (1987-12-19). "The new surgery". Br Med J. 295 (6613): 1581–1582. doi:10.1136/bmj.295.6613.1581.
  9. ^ Ahmed K, Khan MS, Vats A, et al. (October 2009). "Current status of robotic assisted pelvic surgery and future developments". International Journal of Surgery. 7 (5): 431–40. doi:10.1016/j.ijsu.2009.08.008. PMID 19735746.
  10. ^ Topalo V, Chele N (March 2012). "Minimally invasive method of early dental implant placement in two surgical steps". Revista de chirurgie oro-maxilo-facială și implantologie (in Romanian). 3 (1): 16–23. ISSN 2069-3850. 60. Retrieved 2012-08-19.(webpage has a translation button)
  11. ^ Kilger E, Weis FC, Goetz AE, et al. (March 2001). "Intensive care after minimally invasive and conventional coronary surgery: a prospective comparison". Intensive Care Medicine. 27 (3): 534–9. doi:10.1007/s001340000788. PMID 11355122.
  12. ^ "Minimally Invasive Surgery. Keyhole Surgery information". patient.info. Retrieved 2017-05-25.
  13. ^ Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). "Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations". The Journal of Surgical Research. 151 (1): 40–7. doi:10.1016/j.jss.2008.03.039. PMID 18639246.

Further reading

External links

This page was last edited on 8 January 2019, at 22:26
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