Surgery With Small Incisions

Are surgeries done through small incisions better?

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Over the past few decades, one of the most significant advances in orthopedic surgery is the advent of techniques used to minimize the size of incisions and the amount of tissue dissection. Two of the most common types of surgeries that minimize incision size are arthroscopic procedures and minimally invasive joint replacement surgery. There are also other types of surgery, such as endoscopic carpal tunnel surgery, or needle aponeurotomy for Dupuytren's disease, that use minimally invasive techniques to achieve improved results with less disruption to normal parts of the body.

The goal of any surgical procedure is to correct an identified problem or condition. Hip replacements are done to alleviate arthritis pain. Rotator cuff repairs are done to reduce shoulder pain and improve motion. These surgeries, first and foremost, are not cosmetic. They are performed to correct a problem that is causing pain or limitation in function (or often both). However, these procedures are not performed with a focus on the size of the incision.

However, surgery can be done in more appealing ways, and with the advent of arthroscopic surgery and other less-invasive surgical techniques, surgical scars are getting smaller. But it is more important to do the surgery correctly rather than keep the incision small. After all, small incisions are worthless if the problem is not properly treated.

Should I Undergo Less-Invasive Surgery?

These types of less-invasive surgery are not necessarily bad.

Many arthroscopic procedures have become the standard for proper care. For example, arthroscopic treatment of meniscus tears in the knee is now the standard treatment; traditional 'open meniscectomies,' where the meniscus is removed through an incision is a procedure no longer performed.

One advantage of less-invasive surgery is less disruption not only to the skin (size of the surgical scar) but also less disruption to the soft tissues that surround the area requiring surgery.

This may mean less damage to muscles, tendons and ligaments, and it may also mean less scar tissues. The avoidance of this collateral tissue damage may be important to prevent stiffness and pain after surgery.

However, some surgeons do not feel minimally invasive procedures best treat some specific problems. Because of this, a surgeon may recommend against a procedure such as a mini-hip replacement or arthroscopic rotator cuff repair. This does not mean the surgeon is naive or behind the times, it may just mean your surgeon doesn't believe your condition can adequately be addressed with one of these less-invasive procedures.

Now I'm unsure! Should I have minimally invasive surgery?

As stated, minimally invasive surgery can be good for patients because it minimizes pain, shortens rehab time, and preserves normal tissue. If you were told you should have a certain type of procedure, but you are unsure, get a second opinion.

While not all opinions will necessarily agree, it will help you understand the different perspectives, and appreciate that there is not always just one answer to a problem.

As said before, less invasive surgery is not always the best treatment for a particular problem, and often the most experienced and best-known surgeons will prefer a more traditional approach to addressing an orthopedic condition. 

My one caution to patients is to be especially careful of surgeons who use a less-invasive approach as a marketing tool. The surgeon should promote their ability to correct a problem first and foremost. If he or she can accomplish this through a less-invasive approach and still achieve equal results, that's terrific. If the goal of marketing is simply to advertise a smaller incision, then I would be careful with that approach!

Sources:

American Academy of Orthopaedic Surgeons; 71st Annual Meeting , March 10-14 2004, San Francisco. News release, America Academy of Orthopaedic Surgeons.

Porucznik, MA "Award-winning study debunks advantages of two-incision THA" AAOS Now; American Academy of Orthpaedic Surgeons Vol 1, No 1, Jan/Feb 2007, page 45.

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