What is minimally invasive surgery? Why should I consider it?
The first thing that comes to mind is the size of the incision used to perform a surgery. Through arthroscopic surgery Dr. Barry can perform operations that are both more effective and less traumatic to you as a patient. The arthroscope (the camera that goes inside a joint), is one of the best examples of a highly successful minimally invasive approach. The reason it is so successful is that I can actually see more of your injury and joint with the tiny incision of the arthroscope than through a large open incision.
Open surgery and joint replacement are also technically possible through a minimally invasive approach. The size of the incision is the least important of all when considering what is “minimally invasive”. The most important aspect of all surgery is to perform the operation in a technically correct manner. After that, I avoid cutting any excess muscle or tendon but special retracting techniques and positioning of instruments. Exact knowledge of anatomy and pathology from the xrays and MRI done before the surgery can help minimize any trauma from surgery. Limiting the length of incisions in certain areas can be very important such as in Achilles repair where the incision is made as high as possible to avoid a sensitive scar inside your shoe.
When should I consider avoiding minimally invasive surgery?
Important “minimally invasive” techniques to avoid are those that lead to improper or imperfect treatment of fractures or placement of orthopedic implants. For example making too small of an incision for a total knee replacement (one that does not allow good visualization) could lead to sub-optimal placement of the new prosthetic joint. This could impair the ultimate success of the operation. While it is important to make as small an incision as possible—it should never impair the success of the operation itself!
Same incision size, less invasive for faster recovery
At other times an identical size incision may actually be much less invasive. For instance a new technique, used by Dr. Barry, for replacement of the hip involves preserving the Piriformis and the Quadratus tendons and muscles. The skin incision is the same as traditional posterior hip replacement but your recovery is much faster. Traditional hip replacement can involve a hospital stay of a week to ten days but many of the patients I have treated with this approach are able to go home after only a day or two in the hospital.
ACL reconstruction can be accomplished with only two tiny incisions in the knee and a 1 cm entry site for the new ACL graft. These incisions for knee arthroscopy are placed inside the natural lines in your skin (horizontally) instead of vertically for a better and more comfortable scar. The graft entry site is precisely planned and sequentially larger drills are used instead of starting with the largest size. This allows an incision that is less than half the size of a traditional ACL incision with a more precisely placed ACL graft. Your remaining native ACL attachments are preserved and left in place to blend with your new ACL graft to help in its recovery and return to full strength and function (proprioception).
Minimally invasive treatment of orthopedic trauma (broken bones and tendon injuries) is also possible through various techniques depending on the nature of your injury. Minimally invasive surgery can be more successful than traditional surgery when it is correctly applied.
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