Minimally invasive procedure
Encyclopedia
There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures (the latter of which may also be called open surgery).
is strictly defined as non-invasive when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example deep palpation and percussion is non-invasive but a rectal examination
is invasive. Similarly, examination of the ear-drum or inside the nose or a wound dressing change all fall outside the strict definition of non-invasive procedure. There are many non-invasive procedures, ranging from simple observation, to specialised forms of surgery, such as radiosurgery
.
For centuries, physicians have employed many simple non-invasive methods based on physical parameters in order to assess body function in health and disease (physical examination
and inspection
), such as pulse
-taking, the auscultation
of heart sounds
and lung sounds
(using the stethoscope
), temperature examination (using thermometer
s), respiratory examination
, peripheral vascular examination
, oral examination, abdominal examination
, external percussion
and palpation
, blood pressure
measurement (using the sphygmomanometer
), change in body volumes (using plethysmograph
), audiometry
, eye examination
and many others.
The discovery of the first modern non-invasive techniques based on physical methods, electrocardiography and X-ray
s, dates back to the end of the 19th century. Since then, non-invasive methods – which penetrate the body nonetheless, but by electromagnetic
or particle radiation
rather than a scalpel
– have continuously enlarged the scope of medical technology
. Non-invasive techniques commonly used for diagnosis
and therapy include the following:
A recent advance is the substitution of invasive medical tests, such as colonoscopy
by computer
-based 3D reconstructions, such as virtual colonoscopy
.
In some cases, non-invasive methods will not work for the intended purpose, so medical technology has developed minimally-invasive methods, such as hypodermic injection (using the syringe
), endoscopy
, percutaneous
surgery, laparoscopic surgery
, coronary catheterization
, angioplasty
, stereotactic surgery
and many others. The benefits for the patient are self-evident.
or otherwise) that is less invasive than open surgery used for the same purpose. A minimally invasive procedure typically involves use of laparoscopic
devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope
or similar device, and is carried out through the skin
or through a body cavity
or anatomical opening. This may result in shorter hospital stays, or allow outpatient treatment. However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trial
s. The term was coined by John EA Wickham in 1984, who wrote of it in British Medical Journal
in 1987 . A minimally invasive procedure is distinct from a non-invasive procedure, such as external imaging instead of exploratory surgery. When there is minimal damage of biological tissue
s at the point of entrance of instrument(s), the procedure is called minimally invasive.
s to remove masses or growths with minimal scar
ring and less recovery time. Most surgeon
s usually cut along 3/4 to the full length of the mass to access it or remove it. With the minimal incision technique the incision is usually about 1/10 the size of the underlying mass and the surgeon carefully dissects the mass out through this very small incision. A smaller incision forms a much smaller scar and results in less recovery time for the patient. This technique is useful for cyst
s or lipoma
s. Patients with such lesions on cosmetically or functionally important areas such as the face can gain great benefit from such techniques.
, air-pressure injection, subdermal implant
s, endoscopy
, percutaneous
surgery, laparoscopic surgery
, arthroscopic surgery, cryosurgery
, microsurgery
, keyhole surgery, endovascular surgery
(such as angioplasty
), coronary catheterization
, permanent spinal
and brain
electrodes, stereotactic surgery
, 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
, robotic surgery
and interventional radiology
.
should have less operative trauma
for the patient than an equivalent invasive procedure. It may be more or less expensive. 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 adhesions
. Some studies have compared heart surgery. However, minimally invasive surgery is not necessarily minor surgery
that only regional anesthesia is required. In fact, most of these procedures still requires general anesthesia to be administered beforehand.
All of these risks are present also in open, more invasive surgery.
There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation
. The use of heated and humidified CO2 may reduce this risk.
, have a higher incidence of strokes in some studies. The first successful minimally invasive aortic aneurysm
surgery was performed by Dr. Michael L. Marin
at Mount Sinai Hospital, New York
.
"Lapraroscopic surgery has been around for a long time. We've been using laparoscopy for appendectomies, for taking out gall bladders and for removing cysts on the ovaries. But it's been in very limited use for hysterectomies." Laparoscopic hysterectomy, with incisions measuring less than 10 mm, is used for less than 10% of the roughly 800,000 hysterectomies annually performed in the United States, according to the American Association of Gynecological Laparoscopists (AAGL).
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 diagnosis
, visually identifying internal features and acting surgically on them.
or enters a body cavity
. Examples of invasive procedures include those that involve perforation, an incision, a catheterization, or other entry into the body. Surgery
is a typical medical invasive procedure. An open surgery means cutting skin and tissues so the surgeon has a direct access to the structures or organs involved. The structures and tissues involved can be seen and touched, and they are directly exposed to the air of the operating room. Examples of open surgery include the removal of organs, such as the gallbladder (though cholecsytectomy is now mostly done laproscopically) or kidney, and most types of cardiac surgery
and neurosurgery
. Open surgery involves large incisions, in which the tissues are exposed to the air.
Non-invasive procedure
A medical procedureMedical procedure
A medical procedure is a course of action intended to achieve a result in the care of persons with health problems.A medical procedure with the intention of determining, measuring or diagnosing a patient condition or parameter is also called a medical test...
is strictly defined as non-invasive when no break in the skin is created and there is no contact with the mucosa, or skin break, or internal body cavity beyond a natural or artificial body orifice. For example deep palpation and percussion is non-invasive but a rectal examination
Rectal examination
A rectal examination or rectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.-Procedure:...
is invasive. Similarly, examination of the ear-drum or inside the nose or a wound dressing change all fall outside the strict definition of non-invasive procedure. There are many non-invasive procedures, ranging from simple observation, to specialised forms of surgery, such as radiosurgery
Radiosurgery
Radiosurgery is a medical procedure that allows non-invasive treatment of benign and malignant tumors. It is also known as stereotactic radiotherapy, when used to target lesions in the brain, and stereotactic body radiotherapy when used to target lesions in the body...
.
For centuries, physicians have employed many simple non-invasive methods based on physical parameters in order to assess body function in health and disease (physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
and inspection
Inspection (medicine)
In medicine, inspection is the thorough and unhurried visualization of the client. This requires the use of the naked eye.During inspection, the examiner observes:External signs:...
), such as pulse
Pulse
In medicine, one's pulse represents the tactile arterial palpation of the heartbeat by trained fingertips. The pulse may be palpated in any place that allows an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the...
-taking, the auscultation
Auscultation
Auscultation is the term for listening to the internal sounds of the body, usually using a stethoscope...
of heart sounds
Heart sounds
Heart sounds, or heartbeats, are the noises generated by the beating heart and the resultant flow of blood through it...
and lung sounds
Breath sounds
Respiratory sounds refer to the specific sounds identified through auscultation of the respiratory system with a stethoscope....
(using the stethoscope
Stethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...
), temperature examination (using thermometer
Thermometer
Developed during the 16th and 17th centuries, a thermometer is a device that measures temperature or temperature gradient using a variety of different principles. A thermometer has two important elements: the temperature sensor Developed during the 16th and 17th centuries, a thermometer (from the...
s), respiratory examination
Respiratory examination
In medicine, the respiratory examination is performed as part of a physical examination, or when a patient presents with a respiratory problem or a history that suggests a pathology of the lungs...
, peripheral vascular examination
Peripheral vascular examination
In medicine, the peripheral vascular examination is a series of maneuvers to elicit signs of peripheral vascular pathology. It is performed as part of a physical examination, or when a patient presents with leg pain suggestive of a cardiovascular pathology....
, oral examination, abdominal examination
Abdominal examination
The abdominal exam, in medicine, is performed as part of a physical examination, or when a patient presents with abdominal pain or a history that suggests an abdominal pathology.The exam includes several parts:* Setting and preparation...
, external percussion
Percussion (medicine)
Percussion is a method of tapping on a surface to determine the underlying structure, and is used in clinical examinations to assess the condition of the thorax or abdomen. It is one of the four methods of clinical examination, together with inspection, palpation and auscultation...
and palpation
Palpation
Palpation is used as part of a physical examination in which an object is felt to determine its size, shape, firmness, or location...
, blood pressure
Blood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
measurement (using the sphygmomanometer
Sphygmomanometer
A sphygmomanometer or blood pressure meter is a device used to measure blood pressure, comprising an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just...
), change in body volumes (using plethysmograph
Plethysmograph
A plethysmograph is an instrument for measuring changes in volume within an organ or whole body .-Lungs:...
), audiometry
Audiometry
Audiometry is the testing of hearing ability, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or...
, eye examination
Eye examination
An eye examination is a battery of tests performed by an ophthalmologist, optometrist, or orthoptist assessing vision and ability to focus on and discern objects, as well as other tests and examinations pertaining to the eyes....
and many others.
The discovery of the first modern non-invasive techniques based on physical methods, electrocardiography and X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s, dates back to the end of the 19th century. Since then, non-invasive methods – which penetrate the body nonetheless, but by electromagnetic
Electromagnetic radiation
Electromagnetic radiation is a form of energy that exhibits wave-like behavior as it travels through space...
or particle radiation
Particle radiation
Particle radiation is the radiation of energy by means of fast-moving subatomic particles. Particle radiation is referred to as a particle beam if the particles are all moving in the same direction, similar to a light beam....
rather than a scalpel
Scalpel
A scalpel, or lancet, is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, and various arts and crafts . Scalpels may be single-use disposable or re-usable. Re-usable scalpels can have attached, resharpenable blades or, more commonly, non-attached, replaceable...
– have continuously enlarged the scope of medical technology
Medical technology
Medical Technology encompasses a wide range of healthcare products and is used to diagnose, monitor or treat diseases or medical conditions affecting humans. Such technologies are intended to improve the quality of healthcare delivered through earlier diagnosis, less invasive treatment options and...
. Non-invasive techniques commonly used for diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
and therapy include the following:
Diagnostic images
- Bioluminescence imagingBioluminescence imagingBioluminescence imaging is a technology developed over the past decade that allows for the noninvasive study of ongoing biological processes in small laboratory animals. Recently, bioluminescence tomography has become possible and several systems have become commercially...
- DermatoscopyDermatoscopyDermatoscopy is the examination of skin lesions with a dermatoscope...
- Diffuse optical tomography
- Gamma cameraGamma cameraA gamma camera, also called a scintillation camera or Anger camera, is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy...
and other scintillographical methods, such as Positron Emission TomographyPositron emission tomographyPositron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
(PET) and Single-Photon Emission Tomography (SPECT), using radioactive tracers in the body - Computed TomographyComputed tomographyX-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
- Gene expression imaging
- InfraredInfraredInfrared light is electromagnetic radiation with a wavelength longer than that of visible light, measured from the nominal edge of visible red light at 0.74 micrometres , and extending conventionally to 300 µm...
imaging of the body - Magnetic resonance elastographyMagnetic resonance elastographyMagnetic resonance elastography is a medical imaging technique that images propagating mechanical waves using MRI. It non-invasively measures the stiffness of biological tissues. Pathological tissues are often harder than the surrounding normal tissue...
- Magnetic resonance imagingMagnetic resonance imagingMagnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
, using external magneticMagnetismMagnetism is a property of materials that respond at an atomic or subatomic level to an applied magnetic field. Ferromagnetism is the strongest and most familiar type of magnetism. It is responsible for the behavior of permanent magnets, which produce their own persistent magnetic fields, as well...
fields - Magnetic resonance spectroscopy
- Optical coherence tomographyOptical coherence tomographyOptical coherence tomography is an optical signal acquisition and processing method. It captures micrometer-resolution, three-dimensional images from within optical scattering media . Optical coherence tomography is an interferometric technique, typically employing near-infrared light...
- PosturographyPosturographyPosturography is a general term that covers all the techniques used to quantify postural control in upright stance in either static or dynamic conditions...
- RadiographyRadiographyRadiography is the use of X-rays to view a non-uniformly composed material such as the human body. By using the physical properties of the ray an image can be developed which displays areas of different density and composition....
, fluoroscopyFluoroscopyFluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...
and computed tomographyComputed tomographyX-ray computed tomography or Computer tomography , is a medical imaging method employing tomography created by computer processing...
, using X-rayX-rayX-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
s - Ultrasonography and echocardiographyEchocardiographyAn echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart . Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart...
using ultrasoundUltrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
waves for imaging
A recent advance is the substitution of invasive medical tests, such as colonoscopy
Colonoscopy
Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. It may provide a visual diagnosis and grants the opportunity for biopsy or removal of suspected...
by computer
Computer
A computer is a programmable machine designed to sequentially and automatically carry out a sequence of arithmetic or logical operations. The particular sequence of operations can be changed readily, allowing the computer to solve more than one kind of problem...
-based 3D reconstructions, such as virtual colonoscopy
Virtual colonoscopy
Virtual colonoscopy is a medical imaging procedure which uses x-rays and computers to produce two- and three-dimensional images of the colon from the lowest part, the rectum, all the way to the lower end of the small intestine and display them on a screen...
.
Diagnostic signals
- Electrocardiography (EKG)
- ElectroencephalographyElectroencephalographyElectroencephalography is the recording of electrical activity along the scalp. EEG measures voltage fluctuations resulting from ionic current flows within the neurons of the brain...
(EEG) - ElectromyographyElectromyographyElectromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...
(EMG) - PhotoplethysmographPhotoplethysmographA photoplethysmogram is an optically obtained plethysmogram, a volumetric measurement of an organ. A PPG is often obtained by using a pulse oximeter which illuminates the skin and measures changes in light absorption...
(PPG) - Electrical impedance tomographyElectrical impedance tomographyElectrical impedance tomography is a medical imaging technique in which an image of the conductivity or permittivity of part of the body is inferred from surface electrical measurements. Typically, conducting electrodes are attached to the skin of the subject and small alternating currents are...
(EIT) - ElectroneuronographyElectroneuronographyElectroneuronography is a neurological non-invasive test that was first described by Esslen and Fisch in 1979 and is used to examine the integrity and conductivity of a peripheral nerve...
(ENoG) - ElectroretinographyElectroretinographyElectroretinography measures the electrical responses of various cell types in the retina, including the photoreceptors , inner retinal cells , and the ganglion cells. Electrodes are usually placed on the cornea and the skin near the eye, although it is possible to record the ERG from skin electrodes...
(ERG) - ElectronystagmographyElectronystagmographyElectronystagmography is a diagnostic test to record involuntary movements of the eye caused by a condition known as nystagmus. It can also be used to diagnose the cause of vertigo, dizziness or balance dysfunction by testing the vestibular system....
(ENG) - MagnetoencephalographyMagnetoencephalographyMagnetoencephalography is a technique for mapping brain activity by recording magnetic fields produced by electrical currents occurring naturally in the brain, using arrays of SQUIDs...
(MEG) - Evoked potentials, such as the visual evoked potentials (VEP) and the brain evoked response audiometry (BERA) tests
- Body impedanciometry
- Impedance phlebographyImpedance phlebographyImpedance phlebography, or impedance plethysmography , is a non-invasive medical test that measures small changes in electrical resistance of the chest, calf or other regions of the body. These measurements reflect blood volume changes, and can indirectly indicate the presence or absence of venous...
- Nuclear magnetic resonanceNuclear magnetic resonanceNuclear magnetic resonance is a physical phenomenon in which magnetic nuclei in a magnetic field absorb and re-emit electromagnetic radiation...
spectroscopy - PercutaneousPercutaneousIn surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
light spectroscopySpectroscopySpectroscopy is the study of the interaction between matter and radiated energy. Historically, spectroscopy originated through the study of visible light dispersed according to its wavelength, e.g., by a prism. Later the concept was expanded greatly to comprise any interaction with radiative...
(such as in pulse oximetryPulse oximetryPulse oximetry is a non-invasive method allowing the monitoring of the oxygenation of a patient's hemoglobin.A sensor is placed on a thin part of the patient's body, usually a fingertip or earlobe, or in the case of an infant, across a foot....
and capnographyCapnographyCapnography is the monitoring of the concentration or partial pressure of carbon dioxide in the respiratory gases. Its main development has been as a monitoring tool for use during anaesthesia and intensive care. It is usually presented as a graph of expiratory plotted against time, or, less...
) - ActigraphyActigraphyActigraphy is a non-invasive method of monitoring human rest/activity cycles. A small actigraph unit, also called an actimetry sensor, is worn by a patient to measure gross motor activity. Motor activity often under test is that of the wrist, measured by an actigraph in a wrist-watch-like package....
- Breath testBreath testA breath test is a type of test performed on air generated from the act of exhalation.Types include:*Breathalyzer - By far the most common usage of this term relates to the legal breath test to determine if a person is driving under the influence of alcohol.*Hydrogen breath test - it is becoming...
s, such as the urea breath testUrea breath testThe urea breath test is a rapid diagnostic procedure used to identify infections by Helicobacter pylori, a spiral bacterium implicated in gastritis, gastric ulcer, and peptic ulcer disease. It is based upon the ability of H. pylori to convert urea to ammonia and carbon dioxide... - Intelligent biomedical clothing
- Non-invasive biomedical sensors
- Endoluminal capsule monitoringEndoluminal capsule monitoringEndoluminal capsule monitoring is a non-invasive medical diagnostic procedure which uses a miniaturized wireless radio transmitter embedded into an ingestible water-tight capsule...
Therapy
- Radiation therapyRadiation therapyRadiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
and radiosurgeryRadiosurgeryRadiosurgery is a medical procedure that allows non-invasive treatment of benign and malignant tumors. It is also known as stereotactic radiotherapy, when used to target lesions in the brain, and stereotactic body radiotherapy when used to target lesions in the body...
, procedures that use external atomic particles (protons, neutrons, photons, alpha particles, etc.) or teletherapy x-rays to destroy pathological tissue within the body (brachytherapyBrachytherapyBrachytherapy , also known as internal radiotherapy, sealed source radiotherapy, curietherapy or endocurietherapy, is a form of radiotherapy where a radiation source is placed inside or next to the area requiring treatment...
can be non-invasive, minimally invasive, or invasive) - LithotripsyLithotripsyLithotripsy refers to the physical destruction of gallstones or kidney stones. The term is derived from the Greek words meaning "breaking stones" .Forms include:* Extracorporeal shock wave lithotripsy...
, a procedure that uses ultrasoundUltrasoundUltrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
shock waves to break urinary calculus - DefibrillationDefibrillationDefibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, a procedure to block heart fibrillationFibrillationFibrillation is the rapid, irregular, and unsynchronized contraction of muscle fibers. An important occurrence is with regards to the heart.-Cardiology:There are two major classes of cardiac fibrillation: atrial fibrillation and ventricular fibrillation....
and start normal rhythm - Mechanical ventilationMechanical ventilationIn medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a physician, respiratory therapist or other suitable person compressing a bag or set of bellows...
, such as the iron lungIron lungA negative pressure ventilator is a form of medical ventilator that enables a person to breathe when normal muscle control has been lost or the work of breathing exceeds the person's ability....
. - Transdermal patchTransdermal patchA transdermal patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream. Often, this promotes healing to an injured area of the body. An advantage of a transdermal drug delivery route over other types of...
es, used to deliver drugs applied to the skinSkin-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
. - BiofeedbackBiofeedbackBiofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...
- CPAPCPAPCPAP may stand for:* Continuous positive airway pressure, a particular type of ventilation therapy* The Center for Public Administration and Policy, an academic department at Virginia Tech...
(Continuous Positive Airway Pressure) used to treat sleep apneaSleep apneaSleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low... - VPAP
- BIPAP
- Neurally Adjusted Ventilatory AssistNeurally Adjusted Ventilatory AssistNAVA - Neurally Adjusted Ventilatory Assist - is a mode of mechanical ventilation. NAVA delivers assist in proportion to and in synchrony with the patient's respiratory efforts, as reflected by the Edi signal...
- Biphasic Cuirass VentilationBiphasic Cuirass VentilationBiphasic cuirass ventilation is a method of ventilation which requires the patient to wear an upper body shell or cuirass, so named after the body armor worn by medieval soldiers. The ventilation is biphasic because the cuirass is attached to a pump which actively controls both the inspiratory and...
(BCV, e.g. Hayek RTX) - Photodynamic therapyPhotodynamic therapyPhotodynamic therapy is used clinically to treat a wide range of medical conditions, including malignant cancers, and is recognised as a treatment strategy which is both minimally invasive and minimally toxic...
- Therapeutic ultrasoundTherapeutic ultrasoundTherapeutic ultrasound refers generally to any type of procedure that uses ultrasound for therapeutic benefit. This includes HIFU, lithotripsy, targeted ultrasounddrug delivery, trans-dermal ultrasound drug delivery, ultrasound hemostasis, and ultrasound assisted thrombolysis.-Physical...
- Extracorporeal thermal ablation
- Extracorporeal magnetic innervation
- Photo-infrared pulsed bio-modulation
- Transcranial magnetic stimulationTranscranial magnetic stimulationTranscranial magnetic stimulation is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain...
In some cases, non-invasive methods will not work for the intended purpose, so medical technology has developed minimally-invasive methods, such as hypodermic injection (using the syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
), endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
, percutaneous
Percutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
surgery, laparoscopic surgery
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
, coronary catheterization
Coronary catheterization
A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional purposes....
, angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
, stereotactic surgery
Stereotactic surgery
Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation,...
and many others. The benefits for the patient are self-evident.
Minimally invasive procedure
A minimally invasive procedure is any procedure (surgicalSurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
or otherwise) that is less invasive than open surgery used for the same purpose. A minimally invasive procedure typically involves use of laparoscopic
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
or similar device, and is carried out through the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
or through a body cavity
Body cavity
By the broadest definition, a body cavity is any fluid-filled space in a multicellular organism. However, the term usually refers to the space located between an animal’s outer covering and the outer lining of the gut cavity, where internal organs develop...
or anatomical opening. This may result in shorter hospital stays, or allow outpatient treatment. However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trial
Randomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
s. The term was coined by John EA Wickham in 1984, who wrote of it in British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
in 1987 . A minimally invasive procedure is distinct from a non-invasive procedure, such as external imaging instead of exploratory surgery. When there is minimal damage of biological tissue
Biological tissue
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
s at the point of entrance of instrument(s), the procedure is called minimally invasive.
Minimal incision technique
The minimal incision technique is a specialized surgical technique practiced by some physicianPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s to remove masses or growths with minimal scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
ring and less recovery time. Most surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
s usually cut along 3/4 to the full length of the mass to access it or remove it. With the minimal incision technique the incision is usually about 1/10 the size of the underlying mass and the surgeon carefully dissects the mass out through this very small incision. A smaller incision forms a much smaller scar and results in less recovery time for the patient. This technique is useful for cyst
Cyst
A cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...
s or lipoma
Lipoma
A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor. Lipomas are soft to the touch, usually movable, and are generally painless. Many lipomas are small but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults...
s. Patients with such lesions on cosmetically or functionally important areas such as the face can gain great benefit from such techniques.
Specific procedures
Many medical procedures are called minimally invasive, such as hypodermic injectionSyringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...
, air-pressure injection, subdermal implant
Subdermal implant
A subdermal implant refers to a kind of body jewelry that is placed underneath the skin, therefore allowing the body to heal over the implant and creating a raised design. These kinds of implants fall under the broad category of body modification. Many people who have these implants use them in...
s, endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
, percutaneous
Percutaneous
In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed .The percutaneous approach is commonly used in vascular procedures...
surgery, laparoscopic surgery
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
, arthroscopic surgery, cryosurgery
Cryosurgery
Cryosurgery is the application of extreme cold to destroy abnormal or diseased tissue. The term comes from the Greek words cryo and surgery meaning "hand work" or "handiwork"....
, microsurgery
Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
, keyhole surgery, endovascular surgery
Endovascular surgery
Endovascular surgery is a form of minimally invasive surgery that was designed to access many regions of the body via major blood vessels.Endovascular techniques were originally designed for diagnostic purposes. Basic techniques involve the introduction of a catheter percutaneously into a large...
(such as angioplasty
Angioplasty
Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size...
), coronary catheterization
Coronary catheterization
A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter. It is performed for both diagnostic and interventional purposes....
, permanent spinal
Vertebral column
In human anatomy, the vertebral column is a column usually consisting of 24 articulating vertebrae, and 9 fused vertebrae in the sacrum and the coccyx. It is situated in the dorsal aspect of the torso, separated by intervertebral discs...
and brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
electrodes, stereotactic surgery
Stereotactic surgery
Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation,...
, The Nuss Procedure
Nuss procedure
The Nuss procedure is a minimally-invasive procedure, invented by Dr. Donald Nuss for treating pectus excavatum. He developed it at Children's Hospital of The King's Daughters, in Norfolk, Virginia...
, radioactivity-based medical imaging methods, such as gamma camera
Gamma camera
A gamma camera, also called a scintillation camera or Anger camera, is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy...
, Positron emission tomography
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
and SPECT (single photon emission tomography). Related procedures are image-guided surgery
Image-guided surgery
Image-guided surgery is the general term used for any surgical procedure where the surgeon employs tracked surgical instruments in conjunction with preoperative or intraoperative images in order to indirectly guide the procedure. Most image-guided surgical procedures are minimally invasive...
, robotic surgery
Robotic surgery
Robotic surgery, computer-assisted surgery, and robotically-assisted surgery are terms for technological developments that use robotic systems to aid in surgical procedures....
and interventional radiology
Interventional radiology
Interventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
.
Benefits
Minimally invasive surgerySurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
should have less operative trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
for the patient than an equivalent invasive procedure. It may be more or less expensive. Operative time is longer, but hospitalization time is shorter. It causes less pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
and scar
Scar
Scars are areas of fibrous tissue that replace normal skin after injury. A scar results from the biological process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in...
ring, speeds recovery, and reduces the incidence of post-surgical complications, such as adhesions
Adhesion (medicine)
Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connect tissues not normally connected.-Pathophysiology:...
. Some studies have compared heart surgery. However, minimally invasive surgery is not necessarily minor surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
that only regional anesthesia is required. In fact, most of these procedures still requires general anesthesia to be administered beforehand.
Risks
Minimally invasive procedures are not completely safe, and some have complications ranging from infection to death. Risks and complications include the following:- Anesthesia or medication reactions
- Bleeding
- Infection
- Internal organ injury
- Blood vessel injury
- Vein or lung blood clotting
- Breathing problems
- Death
All of these risks are present also in open, more invasive surgery.
There may be an increased risk of hypothermia and peritoneal trauma due to increased exposure to cold, dry gases during insufflation
Insufflation (medicine)
Insufflation is the practice of inhaling a substance. Insufflation has limited medical use, but is a common route of administration with many respiratory drugs used to treat conditions in the lungs and paranasal sinus .The technique is common for many recreational drugs and is also used for some...
. The use of heated and humidified CO2 may reduce this risk.
Prevalence
Due to these advantages, surgeons are attempting to perform more procedures as minimally invasive procedures. Some procedures, such as gall bladder removal, can be done very effectively as minimally invasive surgery. Other procedures, such as endarterectomyEndarterectomy
Endarterectomy is a surgical procedure to remove the atheromatous plaque material, or blockage, in the lining of an artery constricted by the buildup of soft/hardening deposits. It is carried out by separating the plaque from the arterial wall....
, have a higher incidence of strokes in some studies. The first successful minimally invasive aortic aneurysm
Aortic aneurysm
An aortic aneurysm is a general term for any swelling of the aorta to greater than 1.5 times normal, usually representing an underlying weakness in the wall of the aorta at that location...
surgery was performed by Dr. Michael L. Marin
Michael L. Marin
Michael L. Marin is an American vascular surgeon, the first in the United States to perform minimally invasive aortic aneurysm surgery together with Drs. Frank Veith, Juan C. Parodi and Claudio J. Schonholz...
at Mount Sinai Hospital, New York
Mount Sinai Hospital, New York
Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. In 2011-2012, Mount Sinai Hospital was ranked as one of America's best hospitals by U.S...
.
"Lapraroscopic surgery has been around for a long time. We've been using laparoscopy for appendectomies, for taking out gall bladders and for removing cysts on the ovaries. But it's been in very limited use for hysterectomies." Laparoscopic hysterectomy, with incisions measuring less than 10 mm, is used for less than 10% of the roughly 800,000 hysterectomies annually performed in the United States, according to the American Association of Gynecological Laparoscopists (AAGL).
Equipment
Special medical equipmentMedical equipment
Medical equipment is designed to aid in the diagnosis, monitoring or treatment of medical conditions.-Types:There are several basic types:* Diagnostic equipment includes medical imaging machines, used to aid in diagnosis...
may be used, such as fiber optic cables, miniature video camera
Video camera
A video camera is a camera used for electronic motion picture acquisition, initially developed by the television industry but now common in other applications as well. The earliest video cameras were those of John Logie Baird, based on the electromechanical Nipkow disk and used by the BBC in...
s and special surgical instruments
Surgical instruments
A surgical instrument is a specially designed tool or device for performing specific actions of carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools...
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
Video monitor
A video monitor also called a broadcast monitor, broadcast reference monitor or just reference monitor, is a display device similar to a television set, used to monitor the output of a video-generating device, such as playout from a video server, IRD, video camera, VCR, or DVD player. It may or...
and the surgeon has the possibility of making a diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
, visually identifying internal features and acting surgically on them.
Open surgery
An invasive procedure is one which penetrates or breaks the skinSkin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
or enters a body cavity
Body cavity
By the broadest definition, a body cavity is any fluid-filled space in a multicellular organism. However, the term usually refers to the space located between an animal’s outer covering and the outer lining of the gut cavity, where internal organs develop...
. Examples of invasive procedures include those that involve perforation, an incision, a catheterization, or other entry into the body. Surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
is a typical medical invasive procedure. An open surgery means cutting skin and tissues so the surgeon has a direct access to the structures or organs involved. The structures and tissues involved can be seen and touched, and they are directly exposed to the air of the operating room. Examples of open surgery include the removal of organs, such as the gallbladder (though cholecsytectomy is now mostly done laproscopically) or kidney, and most types of cardiac surgery
Cardiac surgery
Cardiovascular surgery is surgery on the heart or great vessels performed by cardiac surgeons. Frequently, it is done to treat complications of ischemic heart disease , correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart...
and neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
. Open surgery involves large incisions, in which the tissues are exposed to the air.
See also
- AnesthesiaAnesthesiaAnesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
- ASA physical status classification system or pre-operative physical fitness
- EndoscopyEndoscopyEndoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
- Interventional RadiologyInterventional radiologyInterventional radiology is a specialty of radiology, in which image-guided procedures are used to diagnose and treat a multitude of diseases across all body systems...
- Laparoscopic surgeryLaparoscopic surgeryLaparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
- MedicineMedicineMedicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
- Natural Orifice Transluminal Endoscopic Surgery
- SurgerySurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
- TraumatologyTraumatologyTraumatology is the study of wounds and injuries caused by accidents or violence to a person, and the surgical therapy and repair of the damage. Traumatology is a branch of medicine. It is often considered a subset of surgery and in countries without the specialty of trauma surgery it is most...
- Medical imagingMedical imagingMedical imaging is the technique and process used to create images of the human body for clinical purposes or medical science...
- Biomedical engineeringBiomedical engineeringBiomedical Engineering is the application of engineering principles and design concepts to medicine and biology. This field seeks to close the gap between engineering and medicine: It combines the design and problem solving skills of engineering with medical and biological sciences to improve...
- Molecular ImagingMolecular imagingMolecular imaging originated from the field of radiopharmacology due to the need to better understand the fundamental molecular pathways inside organisms in a noninvasive manner.- Overview :...
- Surgical Incisions
Minimally invasive procedure
- Wickham JEA. The new surgery. Br Med J 1987;29:1581–1582.
- Minimally invasive heart surgery. Medical Encyclopedia, MedlinePlus.
- Minimally invasive aortic valve surgery. CTSNet article.
- Minimally invasive surgery yields benefits. The American Academy of Orthopedic Surgeons. Febr. 2003.
- Minimally invasive cancer treatments highlighted. Science Daily. Nov. 2005.
- Minimal Parathyroid Surgery. The minimally invasive technique utilizing intraoperative nuclear mapping, slso called Minimally Invasive Radioguided Parathyroidectomy, or "MIRP". EndocrineWeb. June 20, 2005.