Minimally invasive orthopaedic
surgeries (Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope) are increasingly popular.
What exactly are they?
A minimally invasive surgery (Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope)is any
surgical procedure that is less
“invasive” than the corresponding
conventional open surgery, both of
which share the same surgical goal.
The enthusiasm for minimally
invasive surgical approach among the
public and medical professionals has
led it to become one of the hot
medical topics found on the Internet
and in the news media.
The Hong Kong Orthopaedic
Association held a scientific
meeting at the Hong Kong Convention
and Exhibition Centre on 29-30
November, 2008. The main theme of
this annual congress was “Minimally
Invasive Surgery in Orthopaedics(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope)”.
The event allowed local orthopaedic
surgeons to share experience with
the world’s leading experts in this
field. In addition to lectures and
discussions, there were exhibits on
the latest surgical microscope and
orthopaedic implants(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope).
Types of Minimally Invasive
Orthopaedic Surgery(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope)
For the past 100 years, it has
always been a fundamental surgical
principle to minimize trauma on a
patient during any surgical
procedure. Recent technological
development in the following areas
have made this possible for certain
areas of medical practice, including orthopaedics and traumatology(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope).
1. Advance in fiber-optics: This
allows light sources to be conducted
to cavities, potential spaces or
lumens in the body. In orthopaedics,
various joint cavities, the pleural
cavity in the chest as well as the
peritoneal space in the abdomen can
be distended (expanded) and
illuminated for surgical procedures.
2.Operation
microscop(kin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope)(: Procedures
can be done with fine details under
suitable magnificatio(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope).
3. Video-assisted procedures:
(Skin and
orthopedic (plastic,face lifting)
operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope)Operations are performed with the
help of a video-camera and
instruments with extended operating
arms.
4. Fluoroscopic monitoring:
Manipulation of body parts, fracture
reduction and fixation, introduction
of implants and more procedures can
be done under X-ray guidance without
visual exposure of the injured body
parts.
5. Key-hole Surgery: Operative
procedures and placement of implants
can be performed through small cut
wounds on the skin. Examples are
placement of intra-articular
sutures(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope), bone anchors, interlocking intramedullary nails, locking
plates, and MIPO plates.
6. Some procedures can be achieved
with the application of a thermal
coil, a focused laser beam or other
physical means through small
puncture wounds on the skin without
full exposure of the injured tissue(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope).
7.Computer navigation: Instruments
and implants are coupled with the
images on body parts on a computer
without exposing the entire surgical
field(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope) for reference. The images on
the computer can either be Fluoro,
i.e. X-ray images or CT-based scans.
Surgeons can follow the procedure
with real-time images shown on the
computer, resulting in a higher
level of precision and accuracy.
Examples of minimally invasive
surgery
For access
Arthroscopic procedures: Special
pen-like surgical microscope(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope) with a
light and a camera lens at the end,
called “arthroscopes”, allows orthopaedic surgeons to approach
some deeply seated target areas
through small “key-holes”. This can
minimise trauma related to surgical
exposure.
The orthopaedic procedure that uses
the arthroscope to look inside a
synovial joint without making a long
surgical incision is called
“arthroscopy”. Since the arthroscope
is capable of capturing images
inside a synovial joint, orthopaedic
surgeons can “look inside the joint”
through a high-definition monitor
connected to the built-in camera on
the arthroscope.
Typical examples of orthopaedic
surgeries(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope) that can benefit from
arthroscopy are procedures involving synovial joints, including the knee,
shoulder, elbow and ankle joints.
With the use of arthroscopic
instruments(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope) and specially designed
implants, corresponding surgical
procedures can be performed through
“key-holes” in a minimally invasive
manner.
Common examples of arthroscopic
procedures are:
Reconstruction of anterior cruciate
ligament (ACL), repair of meniscus
and arthroscopic synovectomy in knee
joints.
Arthroscopic Bankart repair,
arthroscopic acromioplasty and
arthroscopic (Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope)rotator cuff repair in
shoulder joints.
These are examples of “access
surgery”, in which there is less
iatrogenic surgical trauma through
“key-holes” approaches approaches
For surgical target
New treatment principles are being
developed for treating long bone
fractures.
With the help of corresponding
outriggers and jigs and the use of
fluoroscopy for guidance and
monitoring, orthopaedic surgeons (Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope)are
now able to pass the locking plates
and nails through tiny skin wounds,
insert them under the skin or
muscles and apply them on the
surface or intramedullary space of
long bones for fixation of long bone
fractures. – a procedure known as
minimally invasive percutenous plate
osteosynthesis (MIPPO).
The fluoroscopy system enables
orthopaedic surgeons to “see”
through the surrounding soft tissues
and to ensure proper reduction of
the fracture and placement of the
implant, without the need of making
a long incision for a full exposure
of the fracture site. It is an
example of a “target surgery” in
which new developments in management
principles allow clinical
applications in a minimally invasive
approach.
There are minimally invasive
procedures emphasising(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope) both the
“access” and “target” aspects of
surgery, allowing surgical
procedures to be done in a minimally
invasive manner. Spinal
decompression(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope), fusion and
instrumentation is an example of
combining the access and surgical
targets with a minimally invasive
approach and instrumentation.
Advantages
For patients, minimally invasive
surgery may mean fewer surgical
insults to the body, less blood loss
and smaller surgical scars(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope). Less
post-operative pain medication may
be required. Patients who have
undergone this type of surgery may
be able to leave the hospital sooner
than if they were to undergo
conventional open surgery.
Limitations
On the other hand, there are
limitations associated with
minimally invasive surgery.
First, not all orthopaedic (Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope)conditions are suitable for
minimally invasive surgery.
Second, minimally invasive surgery(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope)
is not equivalent to minor surgery.
In fact, a minimally invasive
“major” surgery is still a major
surgery, carrying definite risks.
Third, minimally invasive surgery is
not completely safe(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope). There are
common complications, ranging from
infection to death, similar to any
open surgical procedure. There are
also additional specific
procedure-related complications.
Fourth, these procedures require
specific instruments(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope), implants and
equipment. This may result in higher
costs compared with the
corresponding open procedure.
Fifth, minimally invasive procedures
may take longer to perform than the
corresponding open procedure.
Sixth, some minimally invasive
procedures require the use of the
fluoroscopy system. This carries
additional risks associated(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope) with an
increased exposure to irradiation.
Seventh, minimally invasive
surgeries does not mean that only
regional anesthesia is required. In
fact, most of these procedures still
require general anesthesia to be
administered.
Eighth, during any minimally
invasive surgery, your orthopaedic
surgeon (Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope)may find open procedures to
be more suitable, and will choose to
continue with open techniques.
Last but not the least, some
minimally invasive procedures are
still under scientific
investigations and there is a lack
of solid evidence on their long-term
benefits. For example, only a few
literatures have validated the
long-term advantages of fixation
with locking plates. Carefully
conducted clinical trials in the
coming years are necessary to
provide scientific evidence.
Conclusion
Certain considerations need to be
reviewed carefully before offering
any surgical procedure. Minimally
invasive surgery may not be possible
or suitable for your orthopaedic
condition(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope,The cosmetic skin Branch
surgical (operation,surgery,operating)
microscope). It is of utmost
importance to discuss in details
with your orthopaedic(Skin
and orthopedic (plastic,face
lifting) operation (surgery,surgical,operating)
microscope) surgeon what
particular procedure is appropriate
for you and your conditions.
Referencess
1) Wade R. Smith, Bruce H. Ziran,
Jeff O. Anglen, and Philip F.
Stahel. Locking Plates: Tips and
Tricks. The Journal of Bone & Joint
Surgery 2007;89-A (10):2297-2307
2) Mayer HM (ed) (2006) Minimally
Invasive Spine Surgery- A Surgical
Manual. 2nd edition. Springer,
Berlin Heidelberg New York..
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