What is Minimally Invasive Surgery?

  • A surgical procedure that can be performed for diagnosis and/or treatment of joint abnormalities.
  • Usually an outpatient procedure with faster recovery and healing with less pain
  • Better cosmetic results from smaller skin incisions (sometimes as small as 2 centimeters)

Surgeons who are trained in minimally invasive surgery use a variety of techniques to operate with less injury to the body than with open surgery. Overall, the surgery is safer than the more traditional open surgery and allows faster recovery and healing with less pain and scarring. Minimally invasive surgery is generally done on an outpatient basis or requires only a short hospital stay.

Endoscopy, one of the first types of minimally invasive surgery, uses a technique where surgery is done through one or more small incisions, using small tubes and tiny video cameras and surgical instruments.

Robotic surgery is another type of minimally invasive surgery that uses a  magnified, 3-D view of the surgical site, giving the surgeon great precision, flexibility and control.

Arthroscopy is a surgical procedure orthopedic surgeons use to visualize, diagnose, and treat problems inside a joint.

Why is Minimally Invasive Surgery necessary?

Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as magnetic resonance imaging (MRI) or computed tomography (CT) also scan may be needed. Through the arthroscope, a final diagnosis is made, which may be more accurate than through “open” surgery or from X-ray studies.

Disease and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are:

Inflammation

For example, synovitis is an inflammation of the lining in the knee, shoulder, elbow, wrist, or ankle.

Acute or Chronic Injury

  • Shoulder: Rotator cuff tendon tears, impingement syndrome, and recurrent dislocations
  • Knee: Meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability
  • Wrist: Carpal tunnel syndrome
  • Loose bodies of bone and/or cartilage: for example, knee, shoulder, elbow, ankle, or wrist

Some problems associated with arthritis also can be treated. Several procedures may combine arthroscopic and standard surgery.

  • Rotator cuff surgery
  • Repair or resection of torn cartilage (meniscus) from knee or shoulder
  • Reconstruction of anterior cruciate ligament in knee
  • Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle
  • Release of carpal tunnel
  • Repair of torn ligaments
  • Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist.

Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As advances are made in fiberoptic technology and new techniques are developed by orthopaedic surgeons, other joints may be treated more frequently in the future.

Our Treatment Approach

Minimally Invasive Surgery, although much easier in terms of recovery than “open” surgery, still requires the use of anesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anesthetic, depending on the joint or suspected problem.

A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Several other incisions may be made to see other parts of the joint or insert other instruments.

When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Initially, it was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.

For instance, most meniscal tears in the knee can be treated successfully with Minimally Invasive Surgery.

After surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications

Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.

The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during surgery, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The extensive “open” surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.

Why is Minimally Invasive Surgery necessary?

Although uncommon, complications do occur occasionally during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in far less than 1 percent of all arthroscopic procedures.

As with any operation, there are potential risks including:

  • Infection. Antibiotics are regularly given to the patient before, during, and often after surgery to lessen the risk of infections.
  • Bleeding. A certain amount of bleeding is expected, but this is not typically significant..
  • Recurring symptoms. Some patients may experience a recurrence of their original symptoms.
  • Nerve damage. It is possible that the nerves or blood vessels may be injured during these operations. These complications are very rare.
  • Blood clots. Another uncommon complication is the formation of blood clots in the legs. These pose significant danger if they break off and travel to the lungs.

What are the advantages?

Although Minimally Invasive Surgeryhas received a lot of public attention because it is used to treat well-known athletes, it is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than “open” surgery. Most patients have their Minimally Invasive Surgeryas outpatients and are home several hours after the surgery.

What is recovery like after Minimally Invasive Surgery?

Minimally invasive procedures can shorten hospital stays. The exact length of time needed in the hospital will vary with each patient and individual procedure.

Because minimally invasive techniques do not disrupt muscles and soft tissues, it is believed that post-operative pain is less than pain after traditional, open procedures. You should still expect to feel some discomfort, however, advancements in pain control now make it easier for your doctor to manage and relieve pain.

To help you regain strength and speed your recovery, your doctor may recommend physical therapy. This will depend on the procedure you have had and your general physical condition. Specific exercises will help you become strong enough to return to work and daily activities.

How long it will take to return to your daily activities after MISS depends upon your individual procedure and condition. Your doctor will evaluate you after your surgery to make sure that your recovery is progressing as expected.

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