Minimal acess surgery

Dr. Sabin Viswanath, Specialists Hospital, Ernakulam

Othopaedics has evolved in leaps and bounds in the past one decade In this era of key hole

surgeries orthopaedics has its share of minimal access surgeries as well. Minimal access surgery is a philosophy of doing the routine surgeries through a small incision. Even though the benefits of less morbidity , early mobilization , and going home early are there , one should be aware of the possibility of maximal damage in the hands of an untrained surgeon. It has spread its roots in trauma, arthroscopy and spine. In trauma we are able to do fracture fixations with minimal incisions with the aid of C arm image intensifier. Even arthroscopic assisted fracture fixation is possible in certain fractures. Shoulder arthroscopy has evolved so much that we are able to do acromioplasties , bankarts repair, and rotator cuff repairs arthroscopically.

 Shoulder dislocations are best tackled in its early phase itself and we are able to achieve a near normal range of motion with this technique. Using knee arthroscopy we are able to tackle meniscectomies, meniscal repairs anterior and posterior ligament reconstruction & osteochondral defects. Hip , ankle & wrist arthroscopies have also evolved though their indications are limited. 90% of back pains can be treated conservatively and only 10% is treated surgically. The C arm image intensifier again aids us to give perineural blocks and facetal blocks .and even do vertebroplasties and kyphoplasties. We are able to do endoscopically sequestrated or extruded disc removal and lamina decompressions. In conclusion minimal access orthopaedics has a great future but it has to be used judiciously with caution.