Minimally Invasive Surgery

from Wikipedia, the free encyclopedia

Minimally invasive surgery ( MIS ) is the generic term for surgical interventions with the least possible trauma ( tissue damage ). These include laparoscopic surgery , thoracoscopic surgery, and endoscopic surgery through natural openings ( NOTES ). With NOTES, the instruments are inserted through the mouth, anus, vagina or urethra and only then are minimally invasive cuts made.

To simplify and illustrate, the term keyhole surgery is used because the surgical opening is only very small .

history

Minimally invasive surgery began with laparoscopic surgery. After the benefits of this method were recognized, the techniques were extended to other areas such as thoracoscopy. In 1986 the urologist John Wickham coined the term “minimally invasive” and in 1989 “minimally invasive surgery” (English minimally invasive therapy ) for operations that only require a small incision , where open operations were performed in the past.

meaning

The aim of surgical treatment has always been to initiate a quick recovery with minor discomfort after the operation. At the beginning of the 1990s, laparoscopic surgery was first established for surgical resection of the gallbladder , and later also for performing more complex operations in the abdominal cavity.

Initially, the terms minimally invasive surgery and laparoscopic surgery were used almost synonymously . After the advantages of a surgical technique with only small incisions in the skin and other soft tissues with regard to the recovery of the patient became more and more obvious, the development of so-called minimally invasive surgical procedures began in other areas as well . Examples of this are thoracoscopic operations , endoscopic splitting of the flexor retinaculum in carpal tunnel syndrome , minimally invasive approaches for hip replacement ( endoprosthesis ) (e.g. Yale technique ) or operations to stabilize bone and minimally invasive foot surgery . There is also a tendency towards minimally invasive approaches in thyroid operations , but these have not yet become widely accepted. Another field of work for the MIS is cosmetic surgery (e.g. forehead lift), as this is where the advantage of small scars comes into play.

Smaller cuts and minor injuries to the soft tissues at the point of access usually lead to less pain after the operation and usually also to faster recovery and mobilization . On the other hand, there is often (but not always) the disadvantage of a poor overview of the surgical field, the mostly asymptomatic but existing major soft tissue injuries, the extended operating time and the delayed accessibility in the event of a threatening complication such as B. Heavy bleeding in the surgical field. However, this view can be debated controversially. An experienced laparoscopist will say that he has a better overview and that he needs less time for the operation than for the corresponding open operation.

In recent years, minimally invasive surgical techniques have become firmly established and have replaced many conventional surgical procedures (with a more extensive incision) that have been the " gold standard " for decades .

Up until now, these specialized operations were mainly carried out in an inpatient setting. Only the knee joint endoscopy was more often done on an outpatient basis . Due to the lower postoperative pain with optimized technology, these procedures are increasingly performed on an outpatient basis. In a few centers in Germany, even laparoscopic gallbladder removal , stomach reductions, sleeve stomach , gastric band and abdominal wall hernias are treated on an outpatient basis.

Arthroscopy has become widespread as a minimally invasive technique for examining joints and treating injuries.

Laparoscopic or thoracoscopic surgical procedures also offer the possibility, if the findings are unclear, to carry out a more extensive inspection of the abdomen or chest than would otherwise be possible with a conventional approach.

In some cases, a laparoscopy is also performed before a complex and extensive operation such as the removal of the stomach in order to assess the status and to be able to better plan the further therapeutic, including operative, procedure. It is repeatedly discussed whether the laparoscopic operation of a malignant tumor such as B. in colon cancer can be carried out with the same necessary radicalism as with conventional approaches. Overall, the choice of the surgical procedure (minimally invasive or conventional or open) must always be made individually. As minimally invasive surgery is in open surgery abdomen before the beginning of each procedure, the exact knowledge of the situs essential.

literature

Web links

Individual evidence

  1. ^ Sally Frampton, Roger L. Kneebone: John Wickham's New Surgery: 'Minimally Invasive Therapy', Innovation, and Approaches to Medical Practice in Twentieth-Century Britain . In: Social History of Medicine . Volume 30, No. 3 , 2017, p. 544-566 , doi : 10.1093 / shm / hkw074 .
  2. Nicole Schaenzler: "As little invasive as possible": the maxim of modern surgery . In: Forum Top Medicine . Special advertisement in the Süddeutsche Zeitung. June 29, 2017, p. 4 ( PDF ( memento of July 3, 2017 in the Internet Archive )).