Minimally Invasive surgery (MIS) is a technique in which telescopic (long, narrow) instruments are introduced into the body through one or more small incisions in which a narrow tube called a cannula has been inserted.
The cannula is inserted through the body wall with the aid of a sharp trocar, which fits inside the cannula and is slightly advanced beyond the tip. This is referred to as a trocar-cannula system.
Some systems use a blunt obturator in place of the trocar. The trocar or cannula punctures the body wall and leads the cannula into position. The trocar or obturator is then withdrawn, leaving the cannula which remains in place for the duration of the surgery and receives the telescopic surgical instruments.
The cannula in place is referred to as a port. The cannulas protect the body wall and also maintain a seal between the inside of the body and the outside environment.
To perform surgery inside the body, the surgeon inserts a slender optical telescope through one of the cannulas. The image seen through the endoscope is projected and enlarged onto one or more flat screen image systems.
Surgery is performed by adjusting the endoscope to obtain different views and by manipulating the telescopic instruments as they appear on the screen.
Five types of MIS are now commonly used:
- Multiple-Incision MIS
- Single-Incision Laparoscopic Surgery
- Video-Assisted Thoracoscopic Surgery (VATS)
- Natural Orifice Transluminal Endoscopic Surgery (NOTES)
- Robotic Surgery
Advantages to Minimally-Invasive Surgery:
- Reduced tissue trauma
- Less blood loss
- Less pain
- Faster recovery and return to normal activities
- Can be done as outpatient surgery in many cases
- Reduced postoperative pain
- Increased patient satisfaction
- Less costly
Disadvantages to MIS:
- Not all patients are suitable for MIS
- Patients who have undergone previous abdominal procedures are at high risk of abdominal adhesions.
- Unintentional perforation of abdominal viscera is the most common complication to abdominal laparoscopic surgery.
Other limitations include:
- Highly advance technological features require steep learning curves for new perioperative staff members, including surgeons.
- Vision system errors and failures can result in sudden surgical complications.
- MIS instruments and equipment are expensive to lease, purchase and maintain.
- Instruments have limited range of motion.
- Some procedures take longer than open surgery.
- The operative site is projected as a two-dimensional picture rather than the natural three-dimensional view of the eye.
As with anything, there are pros and cons, but your surgeon knows what’s best.