Editing Minimally invasive procedure

{{Short description|Surgical technique that limits size of surgical incisions needed}}
{{Redirect2|Invasiveness|Invasive (medical)|"invasive" as related to abnormal tissue growth|Cancer|other uses|Invasive (disambiguation)}}
{{Redirect|Minimally Invasive Surgery|the journal|Minimally Invasive Surgery (journal)}}
{{Infobox medical intervention
| name         = Minimally-invasive procedure
| image        = Aneurysm endovascular.jpg|
| caption      = Endovascular aneurysm repair - example of minimally invasive procedure
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| MeshID       = D019060
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| MedlinePlus  =
| eMedicine    = 938198
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'''Minimally invasive procedures''' (also known as '''minimally invasive surgeries''') encompass [[Surgery|surgical]] techniques that limit the size of incisions needed, thereby reducing [[wound healing]] time, associated pain, and risk of infection. Surgery by definition is invasive, and many operations requiring [[surgical incision|incisions]] of some size are referred to as ''open surgery''. Incisions made during open surgery can sometimes leave large wounds that may be painful and take a long time to heal. Advancements in [[medical technologies]] have enabled the development and regular use of minimally invasive procedures. For example, [[endovascular aneurysm repair]], a minimally invasive surgery, has become the most common method of repairing [[abdominal aortic aneurysm]]s in the US as of 2003. The procedure involves much smaller incisions than the corresponding [[cardiac surgery#open surgery|open surgery]] procedure of [[open aortic surgery]].<ref>{{Cite journal |vauthors=Sethi RK, Henry AJ, Hevelone ND, Lipsitz SR, Belkin M, Nguyen LL |date=September 2013 |title=Impact of hospital market competition on endovascular aneurysm repair adoption and outcomes. |journal=J. Vasc. Surg. |volume=58 |issue=3 |pages=596–606 |doi=10.1016/j.jvs.2013.02.014 |pmid=23684424 |doi-access=free}}</ref>

[[interventional radiology|Interventional radiologists]] were the forerunners of minimally invasive procedures. Using [[medical imaging|imaging]] techniques, radiologists were able to direct interventional instruments through the body by way of [[catheter]]s instead of the large incisions needed in traditional surgery. As a result, many conditions once requiring surgery can now be treated non-surgically.<ref name="auto">{{Cite journal |date=Aug 2010 |title=Global Statement Defining Interventional Radiology |journal=Journal of Vascular and Interventional Radiology |language=en |volume=21 |issue=8 |pages=1147–1149 |doi=10.1016/j.jvir.2010.05.006 |doi-access=free}}</ref>

Diagnostic techniques that do not involve incisions, puncturing the skin, or the introduction of foreign objects or materials into the body are known as [[non-invasive procedure]]s.<ref>{{Cite book |last=Dorland's |url=https://books.google.com/books?id=nHKj1FyrSW4C&pg=PA955 |title=Dorland's Illustrated Medical Dictionary |date=2012 |publisher=Elsevier |isbn=978-1-4160-6257-8 |edition=32nd |page=955}}</ref> Several treatment procedures are classified as non-invasive. A major example of a non-invasive alternative treatment to surgery is [[radiation therapy]], also called radiotherapy.<ref>{{Cite book |last=Daniel Albert |url=https://books.google.com/books?id=nHKj1FyrSW4C&pg=PA1573 |title=Dorland's illustrated medical dictionary. |date=2012 |publisher=Saunders/Elsevier |isbn=978-1-4160-6257-8 |edition=32nd |location=Philadelphia, PA |page=1573}}</ref>

== Medical uses ==
[[File:Lateral meniscus damaged tibial cartilage.jpg|thumb|left|Arthroscopic surgery]]
Minimally invasive procedures were pioneered by [[interventional radiology|interventional radiologists]] who had first introduced [[angioplasty]] and the catheter-delivered [[stent]]. Many other minimally invasive procedures have followed where images of all parts of the body can be obtained and used to direct interventional instruments by way of [[catheter]]s (needles and fine tubes), so that many conditions once requiring open surgery can now be treated non-surgically.<ref name="auto" /> A minimally invasive procedure typically involves the use of [[arthroscopic]] (for joints and the spine) or [[Laparoscopic surgery|laparoscopic]] devices and remote-control manipulation of instruments with indirect observation of the surgical field through an [[endoscopy|endoscope]] or large scale display panel, and is carried out through the [[skin]] or through a [[body cavity]] or anatomical opening. [[Interventional radiology]] now offers many techniques that avoid the need for surgery.<ref name="auto" />

By use of a minimally invasive procedure, a patient may require only an [[adhesive bandage]] 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.<ref>{{Cite web |title=Minimally Invasive Surgical Procedures |url=https://www.ncbi.nlm.nih.gov/mesh?cmd=Retrieve&list_uids=68019060 |url-status=live |archive-url=https://web.archive.org/web/20230929024349/https://www.ncbi.nlm.nih.gov/mesh?cmd=Retrieve&list_uids=68019060 |archive-date=Sep 29, 2023 |website=MeSH - NCBI}}</ref> However, the safety and effectiveness of each procedure must be demonstrated with [[randomized controlled trial]]s. The term was coined by [[John Wickham (urologist)|John E. A. Wickham]] in 1984, who wrote of it in ''[[British Medical Journal]]'' in 1987.<ref>{{Cite journal |last=Wickham JE' |date=1987-12-19 |title=The new surgery |journal=Br Med J |volume=295 |issue=6613 |pages=1581–1582 |doi=10.1136/bmj.295.6613.1581 |pmc=1257475 |pmid=3121078 |doi-access=free}}</ref>

==Specific procedures==
[[File:Flexibles Endoskop.jpg|thumb|Flexible endoscope]]
Many medical procedures are called minimally invasive; those that involve small incisions through which an endoscope is inserted, end in the suffix ''-oscopy'', such as [[endoscopy]], [[laparoscopy]], [[arthroscopic surgery|arthroscopy]]. Other examples of minimally invasive procedures include the use of [[syringe|hypodermic injection]], and air-pressure injection, [[subdermal implant]]s, [[refractive surgery]], [[percutaneous]] surgery, [[cryosurgery]], [[microsurgery]], [[keyhole surgery]], [[endovascular surgery]] using [[interventional radiology]] (such as [[angioplasty]] or [[Hemorrhoidal artery embolization|embolization]]), [[coronary catheterization]], permanent placement of [[vertebral column|spinal]] and [[brain]] [[electrodes]], [[stereotactic surgery]], [[Nuss procedure|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]], and [[robot-assisted surgery]].<ref>{{Cite journal |vauthors=Ahmed K, Khan MS, Vats A, etal |date=October 2009 |title=Current status of robotic assisted pelvic surgery and future developments |journal=International Journal of Surgery |volume=7 |issue=5 |pages=431–40 |doi=10.1016/j.ijsu.2009.08.008 |pmid=19735746 |doi-access=free}}</ref>

== Equipment ==
Special [[medical equipment]] may be used, such as [[fiber optic]] cables, miniature [[video camera]]s 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 [[medical diagnosis|diagnosis]], visually identifying internal features and acting surgically on them.<ref name="Belzberg2020">{{Cite journal |last1=Belzberg |first1=Micah |last2=Mahapatra |first2=Smruti |last3=Perdomo-Pantoja |first3=Alexander |last4=Chavez |first4=Francisco |last5=Morrison |first5=Kyle |last6=Xiong |first6=K. Timothy |last7=Gamo |first7=Nao J. |last8=Restaino |first8=Stephen A. |last9=Thakor |first9=Nitish |last10=Yazdi |first10=Youseph |last11=Iyer |first11=Rajiv |last12=Tyler |first12=Betty |last13=Theodore |first13=Nicholas |last14=Luciano |first14=Mark G. |last15=Brem |first15=Henry |year=2020 |title=Minimally invasive therapeutic ultrasound: Ultrasound-guided ultrasound ablation in neuro-oncology |journal=Ultrasonics |volume=108 |issue=12 |pages=106210 |doi=10.1016/j.ultras.2020.106210 |pmc=8895244 |pmid=32619834 |doi-access=free |last16=Groves |first16=Mari |last17=Cohen |first17=Alan R. |last18=Manbachi |first18=Amir}}</ref>

==Benefits==
Minimally invasive [[surgery]] should have less operative [[Physical trauma|trauma]], other [[complication (medicine)|complications]] and [[adverse effects]] than an equivalent open surgery. 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 four–six months<ref>{{Cite journal |vauthors=Topalo V, Chele N |date=March 2012 |title=Minimally invasive method of early dental implant placement in two surgical steps |url=http://www.revistaomf.ro/(1)Colectia-pe-ani/(56)Anul-2012/(57)Numarul-1-2012/(60)Metoda-mini-invaziva-de-instalare-timpurie-a-implantelor-dentare-in-doi-timpi-chirurgicali |url-status=dead |journal=[[Revista de chirurgie oro-maxilo-facială și implantologie]] |language=ro |volume=3 |issue=1 |pages=16–23 |issn=2069-3850 |id=60 |archive-url=https://web.archive.org/web/20160402005556/http://revistaomf.ro/(1)Colectia-pe-ani/(56)Anul-2012/(57)Numarul-1-2012/(60)Metoda-mini-invaziva-de-instalare-timpurie-a-implantelor-dentare-in-doi-timpi-chirurgicali |archive-date=2016-04-02 |access-date=2012-08-19}}(webpage has a translation button)</ref>). Operative time is longer, but hospitalization time is shorter. It causes less [[pain]] and [[scar]]ring, speeds recovery, and reduces the incidence of post-surgical complications, such as [[Adhesion (medicine)|adhesions]] and [[wound dehiscence|wound rupture]]. Some studies have compared [[heart surgery]].<ref>{{Cite journal |vauthors=Kilger E, Weis FC, Goetz AE, etal |date=March 2001 |title=Intensive care after minimally invasive and conventional coronary surgery: a prospective comparison |journal=Intensive Care Medicine |volume=27 |issue=3 |pages=534–9 |doi=10.1007/s001340000788 |pmid=11355122 |s2cid=23157051 |doi-access=free}}</ref>

==Risks==
Risks and complications of minimally invasive procedures are the same as for any other [[surgery|surgical operation]], among the risks are: death, bleeding, [[infection]], organ injury, and [[thromboembolic disease]].<ref>{{Cite web |title=Minimally Invasive Surgery. Keyhole Surgery information. |url=https://patient.info/doctor/minimally-invasive-surgery |access-date=2017-05-25 |website=patient.info |language=en-GB}}</ref>

There may be an increased risk of [[hypothermia]] and peritoneal trauma due to increased exposure to cold, dry gases during [[Insufflation (medicine)|insufflation]].  The use of [[surgical humidification]] therapy, which is the use of heated and humidified CO<sub>2</sub> for insufflation, may reduce this risk.<ref>{{Cite journal |vauthors=Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B |date=January 2009 |title=Heated and humidified CO<sub>2</sub> prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations |journal=The Journal of Surgical Research |volume=151 |issue=1 |pages=40–7 |doi=10.1016/j.jss.2008.03.039 |pmid=18639246}}</ref>

== Invasive procedures ==
[[File:Angioplasty - Balloon Inflated with Stent.png|100 px|left|thumb|Angioplasty]]
Sometimes the use of non-invasive methods is not an option, so that the next level of minimally invasive techniques are looked to. These include the use of [[hypodermic needle|hypodermic injection]] (using the [[syringe#Medical syringe)|syringe]]), an [[endoscopy|endoscope]], [[percutaneous|percutaneous surgery]] which involves needle puncture of the skin, [[laparoscopic surgery]] commonly called ''keyhole surgery'', a [[coronary catheterization|coronary catheter]], [[angioplasty]] and [[stereotactic surgery]].{{citation needed|date=July 2015}}

=== Open surgery ===
{{See also|General surgery}}
"Open surgery" is any surgical procedure where the [[Surgical incision|incision]] made is enough to allow the surgery to take place. With tissues and structures exposed to the air, the procedure can be performed either with the unaided vision of the surgeon or with the use of [[loupe]]s or [[microscopes]]. Some examples of open surgery used are for [[spinal disc herniation|herniated disc]] commonly called a "slipped disc",  and most types of [[cardiac surgery]] and [[neurosurgery]].{{medical citation needed|date=July 2015}}

==Associations==

[[Society of American Gastrointestinal and Endoscopic Surgeons]] (SAGES) for adults.

International Pediatric Endosurgery Group (IPEG) for pediatrics. 

== See also ==
{{cols}}
* [[Anesthesia]]
* [[ASA physical status classification system]]
* [[Medicine]]
* [[Natural orifice translumenal endoscopic surgery]]
* [[Traumatology]]
* [[Biomedical engineering]]
* [[Molecular imaging]]
* [[Venipuncture]]
{{colend}}

==References==
{{Reflist|30em}}

==Further reading==
{{col-list|colwidth=30em|
* {{Cite web |date=November 28, 2005 |title=Minimally Invasive Cancer Treatments Highlighted |url=https://www.sciencedaily.com/releases/2005/11/051128081619.htm |access-date=2015-08-03 |website=www.sciencedaily.com}}
* {{Cite journal |last=Tachibana K |date=March 2004 |title=Emerging technologies in therapeutic ultrasound: thermal ablation to gene delivery |journal=Human Cell |volume=17 |issue=1 |pages=7–15 |doi=10.1111/j.1749-0774.2004.tb00015.x |pmid=15369132 |s2cid=19482620}}
* {{Cite journal |vauthors=Kim PE, Singh M |date=July 2003 |title=Functional magnetic resonance imaging for brain mapping in neurosurgery |journal=Neurosurgical Focus |volume=15 |issue=1 |pages=E1 |doi=10.3171/foc.2003.15.1.1 |pmid=15355003 |doi-access=free}}
* {{Cite journal |last=Richie RC |year=2002 |title=Non-invasive assessment of the risk of coronary heart disease |journal=Journal of Insurance Medicine |volume=34 |issue=1 |pages=31–42 |pmid=15303592}}
* {{Cite journal |last=Golder W |date=June 2004 |title=Magnetic resonance spectroscopy in clinical oncology |journal=Onkologie |volume=27 |issue=3 |pages=304–9 |doi=10.1159/000077983 |pmid=15249722 |s2cid=20644834}}
* {{Cite journal |last=Cherry SR |date=February 2004 |title=In vivo molecular and genomic imaging: new challenges for imaging physics |journal=Physics in Medicine and Biology |volume=49 |issue=3 |pages=R13–48 |doi=10.1088/0031-9155/49/3/R01 |pmid=15012005 |s2cid=250810092}}
* {{Cite journal |vauthors=Lymberis A, Olsson S |year=2003 |title=Intelligent biomedical clothing for personal health and disease management: state of the art and future vision |journal=Telemedicine Journal and e-Health |volume=9 |issue=4 |pages=379–86 |doi=10.1089/153056203772744716 |pmid=14980096}}
* {{Cite journal |vauthors=Söling A, Rainov NG |date=October 2003 |title=Bioluminescence imaging in vivo - application to cancer research |journal=Expert Opinion on Biological Therapy |volume=3 |issue=7 |pages=1163–72 |doi=10.1517/14712598.3.7.1163 |pmid=14519079 |s2cid=28865110}}
* {{Cite journal |vauthors=Rohrscheib M, Robinson R, Eaton RP |date=September 2003 |title=Non-invasive glucose sensors and improved informatics--the future of diabetes management |journal=Diabetes, Obesity & Metabolism |volume=5 |issue=5 |pages=280–4 |doi=10.1046/j.1463-1326.2003.00275.x |pmid=12940864 |s2cid=7192060}}
* {{Cite journal |vauthors=Jacobs AH, Winkeler A, Dittmar C, Hilker R, Heiss WD |year=2002 |title=Prospects of molecular imaging in neurology |journal=Journal of Cellular Biochemistry. Supplement |volume=39 |pages=98–109 |doi=10.1002/jcb.10414 |pmid=12552609 |s2cid=8618818}}
* {{Cite journal |vauthors=Malhi GS, Valenzuela M, Wen W, Sachdev P |date=February 2002 |title=Magnetic resonance spectroscopy and its applications in psychiatry |journal=The Australian and New Zealand Journal of Psychiatry |volume=36 |issue=1 |pages=31–43 |doi=10.1046/j.1440-1614.2002.00992.x |pmid=11929436 |s2cid=15981685}}
* {{Cite journal |vauthors=Jacobs A, Heiss WD |date=April 2002 |title=Towards non-invasive imaging of HSV-1 vector-mediated gene expression by positron emission tomography |journal=Veterinary Microbiology |volume=86 |issue=1–2 |pages=27–36 |doi=10.1016/S0378-1135(01)00488-6 |pmid=11888687}}
* {{Cite journal |vauthors=Leman JA, Morton CA |date=January 2002 |title=Photodynamic therapy: applications in dermatology |journal=Expert Opinion on Biological Therapy |volume=2 |issue=1 |pages=45–53 |doi=10.1517/14712598.2.1.45 |pmid=11772339 |s2cid=40893453}}
* {{Cite journal |last=Richter JE |date=November 1997 |title=Ambulatory esophageal pH monitoring |journal=The American Journal of Medicine |volume=103 |issue=5A |pages=130S–134S |doi=10.1016/S0002-9343(97)00338-0 |pmid=9422638}}
}}

==External links==
* [https://www.nlm.nih.gov/medlineplus/ency/article/007012.htm Minimally invasive heart surgery]. Medical Encyclopedia, MedlinePlus.
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[[Category:Medical terminology]]
[[Category:Minimally invasive surgery| ]]