Minimally Invasive Surgery

There are two main ways to think about minimally invasive surgery: as a collection of minimally invasive surgical procedures and as a way of approaching surgery in general. The term minimally invasive surgery is usually reserved for laparoscopic procedures and other surgeries that only require small incisions in the body, like liposuction. Minimally invasive surgery would apply to endoscopic procedures as well, which is surgery that is done through a natural opening in the body, rather than a surgical incision.

 

 

Minimally invasive surgery encompasses a large number of surgical procedures that create as little surgical trauma to the skin and body as possible. Minimally invasive surgical techniques have been applied to colon and rectal surgery, gynecological surgery, heart surgery, neurosurgery, orthopedic surgery, and urology. In fact, minimally invasive procedures can be found in virtually every field of surgery.

 

Some of the standard minimally invasive procedures have been around for many years including laparoscopic appendectomy (appendix removal), cholecystectomy (gallbladder removal), and liposuction. Various endoscopic procedures have been around for years as well, such as colonoscopy, upper endoscopy, and bronchoscopy. As an aside, “minimally invasive” does not necessarily mean the degree to which the body is penetrated, but the degree to which the skin is broken. For example, a traditional colonoscopy can be quite invasive but, since an incision is not made into the skin, could technically be considered a form of minimally invasive surgery or procedure.

 

In recent years, surgery that would never have been considered possible using a minimally invasive approach is now performed in this way. Most general surgery can now be done laparoscopically. In fact, perhaps the most involved general surgery procedure, a Whipple procedure (pancreaticoduodenectomy), is now offered as a minimally invasive surgery in some larger hospitals.

 

Equally as impressive, heart and brain surgery are now done with minimally invasive techniques. Surgery on the heart valves can be done without opening the breastbone and cracking the ribs. Pituitary brain tumors can be removed by inserting surgical instruments through the nose and the cribriform plate, a thin piece of bone at the base of the front of the skull. Also, by using a stereotactic frame, that is, a frame that holds the head perfectly still, neurosurgeons can perform minimally invasive brain surgery. They use MRI images and other imaging studies to plot the course of surgical instruments inside the skull.

 

While these more technically challenging surgeries can be performed as minimally invasive, not all surgeons and surgical centers currently offer these procedures in a minimally invasive manner.

 

Minimally invasive surgery is also an overarching principle of surgery. As a rule, surgeons will opt for the least invasive surgical approach as possible to achieve a certain endpoint. By minimizing the amount of skin and tissue that is disturbed, the chance of infection is reduced, the post-surgery pain is reduced, and the recovery period is shorter. In other words, patients do better with minimally invasive surgery than with open approaches in most cases.

 

The limiting factor with minimally invasive surgery is the skill and experience of the surgeon. While minimally invasive surgery usually means benefits for the patient, it requires that the surgeon can see and manipulate the surgical field in an enclosed, tight space. If the surgeon cannot effectively operate in this environment, the complications of minimally invasive surgery can outweigh the benefits. Also, the minimally invasive procedure may need to be converted to an open, more invasive surgery, under less than ideal circumstances.