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Minimally Invasive Surgery:
In light of recent reform efforts, the health care industry is increasingly becoming an ideal environment for the continued growth and development of MIS.
While procedural effectiveness is on par with many more open techniques, MIS typically results in shorter recovery periods. More efficient recovery means fewer resources are used while the patient regains his or her health, including less blood for transfusions and reduced manpower for physician follow-up sessions due to shorter hospital stays.
“The relationship of minimally invasive surgery to the health care industry is changing,” says Joe Flower, CEO of The Change Project, Inc., a health care futurist and policy specialist. “Surgery is becoming part of a larger arc of patient care designed to get and keep patients well.”
Outcomes-driven incentives may help give MIS the push it needs to expand more rapidly.
“Currently, many facilities incentivize in cost centers,” says William Taylor, M.D., co-founder of the Society for Minimally Invasive Spine Surgery and professor of neurosurgery at UCSD Medical Center in San Diego, CA. “Hospitals may incentivize less expensive open procedures because the instrumentation costs are reduced, saving money in a single cost center. However, when you consider the additional expense spent on longer recoveries, intensive care unit stays, physical therapy and blood transfusions, the slightly more expensive, yet more effective, minimally invasive procedure has the potential to reduce the overall cost for the hospital and benefit the patient.”
Patient-Driven Demand and the Learning Curve
The field of MIS owes its rate of expansion in part to growing consumer demands as news of these procedures spread through word of mouth and aggressive marketing campaigns conducted by developers.
“We are seeing a growing population of young, active patients who want to stay active and aren’t interested in losing quality of life to conditions that can be treated through MIS,” Dr. Taylor says. “The same can be said for older groups of patients ages 65, 70 or 80 who are still active and aren’t willing to give that up.”
MIS techniques also continue to gain ground as more physicians who are trained to use them during residencies or fellowships join the workforce. For practitioners interested in developing these skills, additional training is often available remotely via teleconference.
Compared to open procedures, minimally invasive surgery (MIS) is linked to decreased risk of infection and other complications, as well as reduced blood loss in a wide variety of procedures from posterior approach total hip arthroplasty to minimally invasive aortic valve surgery.
“At this time, the 20% of spine surgery procedures being completed with MIS are more about minimal incisions, with the anatomy still in view. The next steps include introducing endoscopic or navigation systems to produce three-dimensional images on screens and revisiting the concept of even smaller incisions.”
— William Taylor, M.D., co-founder of the Society for Minimally Invasive Spine Surgery and professor of neurosurgery at UCSD Medical Center in San Diego
LESS Is More
In a recent study conducted at the University of California San Diego School of Medicine, emerging laparoendoscopic single-site surgery, also known as the LESS technique, was shown to result in less pain for kidney cancer patients than conventional laparoscopic removal procedures.
While the procedures took approximately the same amount of time and resulted in similar amounts of blood loss, patients rated the LESS procedure as 40% less painful using the visual analog pain (VAP) comfort test.
Incidents of kidney cancer are on the rise in the United States, with more than 64,000 new cases diagnosed each year. With LESS, a single incision is used to remove tumors, compared to between four and six incisions needed for the procedure’s laparoscopic equivalent.
Endoscopic Vein Harvesting Given the OK
In a study of approximately 236,000 Medicare patients, the Duke University Medical Center found that endoscopic vein harvesting (EVH) of the saphenous vein for use as a bypass graft results in similar outcomes as traditional ankle-to-groin incisions.
Previous concerns linked EVH to narrowed grafts, however the five-year study with a three-year follow up showed no difference in mortality rates or incidents of revascularization and heart attacks.
Patients who underwent the EVH procedure experienced reduced on-site pain and swelling. They also had fewer complications and readmissions and were able to walk sooner after the procedure.
EVH requires between one and three 1-inch incisions and generally results in less tissue and muscle damage as well as reduced scarring compared to ankle to groin incisions. It is often recommended for patients with vascular issues who are at risk for leg wound complications.
Source: MD News Jan. 2013, Long Island Edition