Invasiveness of surgical procedures

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"Invasive (medical)" redirects here. For "invasive" as related to abnormal tissue growth, see Cancer.

An invasive procedure is one that penetrates or breaks the skin or enters a body cavity. Examples of invasive procedures include those that involve perforation, an incision, a catheterization, or other entry into the body. Surgery is a typical medical invasive procedure.

Non-invasive procedure[edit]

A medical procedure is strictly defined as non-invasive when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example, deep palpation and percussion is non-invasive but a rectal examination is invasive. Likewise, examination of the ear-drum or inside the nose or a wound dressing change all fall outside the strict definition of non-invasive procedure. There are many non-invasive procedures, ranging from simple observation, to specialised forms of surgery, such as radiosurgery.

For centuries, physicians have employed many simple non-invasive methods based on physical parameters in order to assess body function in health and disease (physical examination and inspection), such as pulse-taking, the auscultation of heart sounds and lung sounds (using the stethoscope), temperature examination (using thermometers), respiratory examination, peripheral vascular examination, oral examination, abdominal examination, external percussion and palpation, blood pressure measurement (using the sphygmomanometer), change in body volumes (using plethysmograph), audiometry, eye examination, and many others.

The discovery of the first modern non-invasive techniques based on physical methods, electrocardiography and X-rays, dates back to the end of the 19th century. Since then, non-invasive methods – which penetrate the body nonetheless, but by electromagnetic or particle radiation rather than a scalpel – have continuously enlarged the scope of medical technology. Non-invasive techniques commonly used for diagnosis and therapy include the following:

Diagnostic images[edit]

A recent advance is the substitution of invasive medical tests, such as colonoscopy by computer-based 3D reconstructions, such as virtual colonoscopy.

Diagnostic signals[edit]

Electrocardiographic tracing

Therapy[edit]

In some cases, non-invasive methods will not work for the intended purpose, so medical technology has developed minimally-invasive methods, such as hypodermic injection (using the syringe), endoscopy, percutaneous surgery, laparoscopic surgery, coronary catheterization, angioplasty, stereotactic surgery and many others. The benefits for the patient are self-evident.

Invasive Procedures[edit]

Open surgery[edit]

Open surgery is any surgical technique where the incision is sufficient of itself to permit the surgical procedure to be carried out under the direct vision of the surgeon (although magnifying aids such as Loupes or microscopes might be used for certain types of procedures). The structures and tissues involved can be seen and touched, and they are directly exposed to the air. Examples of open surgery include herniated disk surgery, the removal of organs, such as the gallbladder (though cholecsytectomy is now mostly done laproscopically) or kidney, and most types of cardiac surgery and neurosurgery.

Large wounds can be painful and take time to heal, as well as restricting certain activities if muscle layers have to be cut through to reach the parts of interest to the surgeon. Over time, minimally invasive techniques have been developed that mean less healthy tissue is damaged to get to the parts or organs of interest.

Minimally invasive procedure[edit]

A minimally invasive procedure (MIP) like newer surgical techniques, such as Minimally Invasive Surgery (MIS), require a simulated learning environment facilitated by intensive cadaveric training. MIP is any procedure (surgical or otherwise) that is less invasive than open surgery used for the same purpose. A minimally invasive procedure typically involves use of arthoscopic (for joints and the spine) or laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or large scale display panel, and is carried out through the skin or through a body cavity or anatomical opening. Interventional radiology may offer techniques that avoid the need for surgery.

By use of a MIP, a patient may require only a band-aid on the incision, rather than multiple stitches or staples to close a large incision. This usually results in less infection, a quicker recovery time and shorter hospital stays, or allow outpatient treatment.[3] However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials. The term was coined by John EA Wickham in 1984, who wrote of it in British Medical Journal in 1987.[4] A minimally invasive procedure is distinct from a non-invasive procedure, such as external imaging instead of exploratory surgery. When there is minimal damage of biological tissues at the point of entrance of instrument(s), the procedure is called minimally invasive.

Minimal incision technique[edit]

Main article: Surgical incision

The minimal incision technique is a specialized surgical technique practiced by some physicians to remove masses or growths with minimal scarring and less recovery time. Most surgeons usually cut along 3/4 to the full length of the mass to access it or remove it. With the minimal incision technique the incision is usually about 1/10 the size of the underlying mass and the surgeon carefully dissects the mass out through this very small incision. A smaller incision forms a much smaller scar and results in less recovery time for the patient. This technique is useful for cysts or lipomas. Patients with such lesions on cosmetically or functionally important areas such as the face can gain great benefit from such techniques.

Specific procedures[edit]

Many medical procedures are called minimally invasive, such as hypodermic injection, air-pressure injection, subdermal implants, Refractive surgery, endoscopy, percutaneous surgery, laparoscopic surgery, arthroscopic surgery, cryosurgery, microsurgery, keyhole surgery, endovascular surgery (such as angioplasty), coronary catheterization, permanent spinal and brain electrodes, stereotactic surgery, The Nuss Procedure, radioactivity-based medical imaging methods, such as gamma camera, Positron emission tomography and SPECT (single photon emission tomography). Related procedures are image-guided surgery, robotic surgery[5] and interventional radiology.

Benefits[edit]

Minimally invasive surgery should have less operative trauma for the patient than an equivalent invasive procedure. It may be more or less expensive (for dental implants, a minimally invasive method reduces the cost of installed implants and shortens the implant-prosthetic rehabilitation time with 4–6 months[6]). Operative time is longer, but hospitalization time is shorter. It causes less pain and scarring, speeds recovery, and reduces the incidence of post-surgical complications, such as adhesions. Some studies have compared heart surgery.[7] However, minimally invasive surgery is not necessarily minor surgery that only regional anesthesia is required. In fact, most of these procedures still require general anesthesia to be administered beforehand.

Risks[edit]

Minimally invasive procedures are not completely safe, and some have complications ranging from infection to death. Risks and complications (also present in open, more invasive surgery) include the following:

There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of Surgical Humidification therapy, which is the use of heated and humidified CO2 for insufflation, may reduce this risk.[10]

Equipment[edit]

Special medical equipment may be used, such as fiber optic cables, miniature video cameras and special surgical instruments handled via tubes inserted into the body through small openings in its surface. The images of the interior of the body are transmitted to an external video monitor and the surgeon has the possibility of making a diagnosis, visually identifying internal features and acting surgically on them.

See also[edit]

References[edit]

  1. ^ Yokoyama T, Fujita O, Nishiguchi J, et al. (August 2004). "Extracorporeal magnetic innervation treatment for urinary incontinence". International Journal of Urology 11 (8): 602–6. doi:10.1111/j.1442-2042.2004.00857.x. PMID 15285749. 
  2. ^ Santana-Blank LA, Rodríguez-Santana E, Santana-Rodríguez KE (August 2005). "Photo-infrared pulsed bio-modulation (PIPBM): a novel mechanism for the enhancement of physiologically reparative responses". Photomedicine and Laser Surgery 23 (4): 416–24. doi:10.1089/pho.2005.23.416. PMID 16144487. 
  3. ^ NCBI, National Center for Biotechnology Information, NCBI, MeSH, Medical SubHeadings, NLM, National Library of Medicine
  4. ^ Wickham JE' (1987-12-19). "The new surgery". Br Med J 295: 1581–1582. doi:10.1136/bmj.295.6613.1581. 
  5. ^ Ahmed K, Khan MS, Vats A, et al. (October 2009). "Current status of robotic assisted pelvic surgery and future developments". International Journal of Surgery 7 (5): 431–40. doi:10.1016/j.ijsu.2009.08.008. PMID 19735746. 
  6. ^ Valentin Topalo, Nicolae Chele (Mar 2012). "Minimally invasive method of early dental implant placement in two surgical steps". Rev. chir. oro-maxilo-fac. implantol. (in Romanian) 3 (1): 16–23. ISSN 2069-3850. 60. Retrieved 2012-08-19. (webpage has a translation button)
  7. ^ Kilger E, Weis FC, Goetz AE, et al. (March 2001). "Intensive care after minimally invasive and conventional coronary surgery: a prospective comparison". Intensive Care Medicine 27 (3): 534–9. doi:10.1007/s001340000788. PMID 11355122. 
  8. ^ Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). "Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations". The Journal of Surgical Research 151 (1): 40–7. doi:10.1016/j.jss.2008.03.039. PMID 18639246. 
  9. ^ “Risks and Complications"
  10. ^ Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (January 2009). "Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations". The Journal of Surgical Research 151 (1): 40–7. doi:10.1016/j.jss.2008.03.039. PMID 18639246. 

Sources[edit]

Minimally invasive procedure[edit]

Non-invasive procedure[edit]