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There was a dark chapter in the history of the profession (more so in the US in the 80's) when MIS (minimally invasive/incision surgery) was blindly and widely adopted and lead to some pretty disastrous outcomes. In the UK, it was seen as a shortcut to doing surgery without completing the appropriate surgical qualification. In continental Europe, they appeared oblivious to the problems in the USA and have been doing it successfully for years. However, many want to put that chapter behind us and confine it to the history books as a footnote. However, it was still being practiced on the fringe in many countries.

Going back, we have had some threads on the topic:
Debate re minimal invasive surgery
Minimal Invasive Surgery cadaver training
Percutaneous minimally invasive surgery for HV
The College of Minimal Invasive Foot & Ankle Surgery
Lesser toe surgery

In those threads you see the issues I mentioned above coming through.

Having said that, I have been noticing more conference presentations, more research being published and more discussion of MIS ..

....is it making a comeback into the mainstream?

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Craig Payne
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I have had a fair few of my patients choose to have procedures via minimal incision surgery. I know of two Pod Surgeons in Australia actively doing it. The results I have seen thus far have been very very encouraging to say the least. Successful outcomes, patients are happy with the outcome post operatively and ones I have seen over a year out now are very happy they had it done. Im not advocating or endorsing it in any way shape or form - however with the data showing some good outcomes I think MIS has its place in the surgical system.

I am very well read in some areas, and totally ignorant in others. Please would someone care to give me a 1-2 sentence definition and description of what we mean by minimal incision surgery? Are talking about things like tenotomies? Rob

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Honorary Research Associate, Institute for Human Evolution, University of Witwatersrand

Adjunct Associate Professor (Human and Comparative Anatomy), University of Western Sydney

Fellow of The Centre For Human Biology, The University of Western Australia

"Please God, deliver me whole from Creationists......."

Rob:

Minimal incision surgery (MIS), specific to podiatry, is the use of small skin incisions to do surgery, basically, by feel, not by seeing the structure that is being operated on. Typically, in podiatry, MIS refers to using a Shannon #44 rotary side-cutting burr (see photo) to perform osteotomies and other osseous procedures through skin incisions about 3 mm in length (i.e. a minimal incision).

When I was a surgical resident in 1983-1984, I was trained on MIS by a very good MIS surgeon. However, I preferred open surgery since MIS was becoming frowned upon by the most well-known and politically powerful surgeons in the US due to the widespread overuse of this type of surgery by podiatrists who were not residency trained in surgery, and the complications they supposedly created.

When in lectured in Rome, Italy a few years ago, I was surprised to see lectures on MIS again even though the surgeons in the US made a big stink about it during the 1980s. I find it somewhat odd, but funny, to see MIS making a comeback since I remember the time during the 1980s when anyone who did this surgery was considered as a lesser surgeon than those that did open surgery.

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shannon44.jpg (17.8 KB, 91 views)

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Kevin

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Kevin A. Kirby, DPM
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California School of Podiatric Medicine at Samuel Merritt College

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Thank you for that lucid reply. It rather reminds me of when I was a Pod student in the early 70's. My Dad was a GP, but did surgical internships; I asked him what the advances in surgery would be over the next few years. The answer - less, little or no surgery. His thought was that the less surgery that was being done, was for the best from a quality assurance point of view; removing the need for surgery was hs surgical aim...............

__________________
Honorary Research Associate, Institute for Human Evolution, University of Witwatersrand

Adjunct Associate Professor (Human and Comparative Anatomy), University of Western Sydney

Fellow of The Centre For Human Biology, The University of Western Australia

"Please God, deliver me whole from Creationists......."

There are many still performing these types of procedures in the US, and I have no doubt that with the benefit of improved instrumentation and techniques that this approach proves successful for many people. However, now, as was the case in the 80's, the best results come from the best trained hands- surgeons who receive traditional comprehensive residency based experiences may well adopt minimally invasive strategies with positive outcomes. It will always be true that it isn't whether the procedure is done open or closed, it's the planning and execution that matters. in the 80's, many of those "trained" in MIS were very poorly prepared to undertake surgery of any kind.

Very true response - its all in the hands of the right person! Ive seen plenty of botch jobs with open procedures as well.

Interesting-
I have heard negative things about MIS- and the practitioners I've known to perform MIS were older docs without residency training. I have seen some bad outcomes with MIS bunionectomy procedures... it still doesn't make sense to me HOW a surgeon could possibly perform such a surgery without actually seeing everything. Is the metatarsal head, capsule, and associated soft tissue structure just mashed up into a paste of some sort? I suppose I need to do some research. Anyone with info/experience regarding this?

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Dr. John G. Fasick II
Clinical Insructor, LSU School of Medicine
Advanced Foot & Ankle Center of East Jefferson
footankledoc2@gmail.com