March 01, 2005
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Minimally invasive surgery popularity soars

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As patients become more educated on their conditions and treatment options, and as direct-to-consumer advertising picks up steam, there is an increased push for more minimally invasive surgery (MIS) in the orthopedic OR. Computer-assisted surgery (CAS) and navigation technologies grow in popularity largely as a result of this trend.

“MIS has got a life of its own. The marketing of it has created a groundswell of wanting [this type of] surgery. And it makes sense. If you say to me, ‘Look, I can do this through an 8-inch incision which is our standard approach, or I can do this through a 4-inch incision, which do you want?’ Well, that’s a ‘no-brainer,’” said William Bargar, MD, of Joint Surgeons of Sacramento.

MIS techniques for hip and knee replacement operations can shorten recovery time, but some surgeons find it difficult to maintain accuracy when the smaller incision provides limited visibility. As a result, CAS may be useful.

“They are complementary to each other,” said Richard Laskin, MD, of the Hospital for Special Surgery in New York. “The people who don’t like MIS, who feel limited in what [they] can see or feel, always say if you can put CAS with it I’d feel much more comfortable because now there is something on the screen as well as tactile sensation. I think [MIS and CAS] are a natural complement to each other. I don’t think you need them for each other, but they naturally work together very well.”

Some surgeons caution that while MIS may speed recovery time in the short term, the downsides of CAS – more operating time and complexity with potentially more morbidity – may mean it’s just not worth it yet.

“I tell my patients that we’re in it for the long run, not for a few faster days of recovery. We’re in it for hopefully many years of success,” said Richard Scott, MD, an orthopedic surgeon at Brigham and Women’s Hospital in Boston.