In the past couple of years Minimally Invasive Surgery (MIS)
has become popular in most surgical specialties. For example, within general
surgery, laparoscopic surgery is now mainstay. In orthopedic surgery,
arthroscopic knee and shoulder surgery is very common. In foot and ankle
surgery, MIS is becoming very common and popular. In this blog I will discuss
some indications for these type of surgeries and the pros and cons as well.
How is MIS applied to
foot surgery?
There are a few types of foot and ankle surgeries that
traditionally are performed with MIS techniques. For example, ankle arthroscopy
is commonly used to clean out arthritis from the ankle joint. In addition,
ankle arthroscopy can be used to remove a talar dome lesion (which is a when a
flake of bone gets detached from the talar bone). Traditionally, these 2 types
of surgeries were done with large incisions and extensive healing time. Due to
arthroscopic ankle surgery, surgery requires a few small stab incisions with a
short healing time.
Traditionally, surgery for plantar fasciitis was thru a
large incision. More recently it has been replaced with endoscopic surgery. This
type of instrument is used to perform the surgery and requires one or two
incisions less than an inch long. By using an endoscopic camera and appropriate
instrumentation, podiatrist are able to decrease the size of their incision. In
addition, there is less damage to the surrounding tissue with this type of
surgery.
What are the
advantages to this type of surgery?
The most obvious advantage is that with a smaller incision
there is a significant reduction in healing time. If bony work is performed
that will take the same amount of time to heal, but the skin incisions will
heal in a shorter period of time. In many instances these types of surgeries
can be performed in a same day surgical suite due to the MIS aspect of the
surgery. This type of surgery may have less pain in the post-operative period.
What are the
downfalls to this type of surgery?
Due to the fact that these types of surgeries require small
incisions, some argue that it can be hard to visualize the appropriate anatomic
structures to properly perform the procedure. This can be true in MIS bunion
and joint fusion types of surgery. In addition, many times in these types of
surgery using x-rays during surgery is typically required. This exposes the
patient to more radiation than may be necessary with a larger incision. Some
argue that due to small incisions, the surgeon may not be able to see all the
vital structures and therefore, there can be damage to important structures
during the procedure.
In conclusion, each patient and their surgeon need to
discuss what type of surgery is right for them. In addition, there is more data
and evidence that certain type of surgeries work better with a large versus
small incision and vice versa. Appropriate consultation with your surgery prior
to surgery to discuss these matters will determine whether or not you qualify
for MIS.
For more information, please visit our website at www.footnj.com
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