Minimally Invasive Surgery

What is minimally invasive surgery?

Minimally invasive surgery (MIS) is an approach to surgery that minimizes cutting through your skin and tissues. Surgeons use MIS techniques and technology to cause as little trauma as possible during your procedure. Smaller cuts reduce your potential for pain, complications and recovery time. Healthcare providers perform many common procedures today using minimally invasive surgery techniques.

What are the different types of minimally invasive surgery?

Keyhole surgery

Most minimally invasive surgery procedures involve the use of small, “keyhole” incisions to serve as ports for special instruments during your surgery. Depending on the location, these incisions are usually a half-inch long or less. One port provides access for an endoscope, a narrow tube with a lighted camera at the end that projects images to a screen. Surgeons operate through the other ports with long, narrow instruments.

There are different types of endoscopes for different body parts, and sometimes they go by specific names. For example, a laparoscope goes into your abdominal cavity, a thoracoscope goes into your chest cavity and an arthroscope goes into your joints. Surgery using these scopes may be called laparoscopic surgery, thoracoscopic surgery or arthroscopic surgery. These are a few types of minimally invasive surgery.

Robotic surgery

An advanced form of minimally invasive surgery uses robotic arms to operate through the small incisions. This is called robotic surgery. A specially trained surgeon operates the robot arms from a console within the operating room. Robotics allow for greater precision and control in smaller areas. Most robotic surgery procedures use several ports, but sometimes single-port surgery is possible.

Endovascular surgery

Endovascular surgery involves threading a tiny catheter through a blood vessel and operating through it. It takes only one tiny incision to access the blood vessel. Often, endovascular surgeons can puncture the skin with a needle rather than cutting it. This minimizes bleeding. Surgeons thread the catheter over a guidewire, then remove the wire and pass surgical instruments through the catheter to operate.

Endoscopic surgery

Finally, some endoscopes can go through an existing opening in your body, like your nose or mouth. Surgeons can operate through these endoscopes using long, narrow tools, without cutting through your skin at all. This is called “natural orifice” endoscopic surgery. “Endoluminal” procedures happen within the walls of your organ, while “transluminal” procedures cut through one of the walls of your organ.

What are some examples of minimally invasive surgery procedures?

Common examples of minimally invasive surgery procedures include:

• Minimally invasive urological surgery: Kidney removal (nephrectomy), prostate removal (prostatectomy) or pelvic organ prolapse repair (sacrocolpopexy).
• Minimally invasive spine surgery: Spinal fusion, tumor removal and to treat spinal stenosis.
• Minimally invasive heart surgery: Atrial septal defect repair and mitral valve repair.
• Arthroscopy: Shoulder arthroscopy to treat rotator cuff tears, ankle arthroscopy to treat ankle pain or hip arthroscopy to repair minor hip damage.
• Video-assisted thoracic surgery (VATS): Thoracoscopy-guided procedures to treat cancer in your chest cavity, or to repair pectus excavatum (Nuss procedure).
• Laparoscopic surgery: Gallbladder removal (cholecystectomy), appendix removal (appendectomy) adrenal removal (adrenalectomy) and hernia repair.
• Endovascular surgery: Angioplasty, atherectomy, embolization and stenting.
• Functional endoscopic sinus surgery: Endoscopic sinus surgery for serious sinus conditions.
• Endoluminal surgery in your gastrointestinal tract: Tumor removal (endoscopic submucosal dissection or transanal endoscopic microsurgery) and sphincter myotomy.
• Epilepsy surgeries: Stereoelectroencephalography (SEEG) and deep brain stimulation (DBS).
• Bariatric surgeries: Gastric sleeve surgery and gastric bypass surgery for weight loss.

Who is a candidate for minimally invasive surgery?

In many aspects, minimally invasive surgery is safer than traditional open surgery. In fact, some people who aren’t candidates for traditional open surgery may be candidates for minimally invasive procedures. However, minimally invasive techniques can take longer than open surgery, and they require some preparation in advance. This may not work in an emergency, or when your condition isn’t yet clear.

People with certain heart and lung conditions may not be ideal candidates for laparoscopic surgery in particular. This is because laparoscopic surgery involves pumping gases into your abdominal cavity to separate your abdominal wall from your organs. In some people, these gases may increase the risk of heart and lung complications during surgery. Your surgeon will assess your risk on an individual basis.

What happens in minimally invasive surgery?

Different types of surgical procedures involve different steps. However, there are some general differences between traditional open surgery and minimally invasive surgery procedures.

• Anesthesia: While open surgery almost always requires general anesthesia, some minimally invasive procedures don’t. You may only need local anesthesia at the incision site, with or without sedation to help you relax. If you’re having endoscopic surgery, you may not need anesthesia at all. A numbing agent in your throat can help the endoscope pass through without triggering your choking reflex.
• Incisions: The hallmark of minimally invasive surgery is small incisions, if any. These small incisions for endoscopes and surgical instruments are typically a half-inch long or less. An incision might be slightly larger if your surgeon needs to remove an organ through it — or smaller, if it’s in your brain or vascular system. Smaller incisions make for an easier recovery, with less pain and less risk of complications.
• Operating and recovery time: In general, operations take longer when surgeons use minimally invasive methods because there are many more steps, tools and helpers involved. This is especially true for robotic surgery. On the other hand, the recovery time tends to be much faster. You can often go home the same day as your procedure, and your smaller incision wounds heal in weeks rather than months.

What tools or equipment are used in minimally invasive surgery?

Minimally invasive surgery requires specialized tools and equipment, which require specialized training to use. In addition to the surgeon, it takes a well-trained surgical team to help manage it all. The surgical team helps monitor the machines and make adjustments to the equipment during surgery. They stay by the operating table to help place instruments when the surgeon operates from the robotic console.

Some of the equipment they use includes:

• Endoscopes. Endoscopes are long, narrow tubes with a lighted video camera at the end. They come in different sizes for looking inside different body cavities. They can be rigid or flexible.
• Imaging equipment. Monitors project video from the endoscope during surgery. Surgeons often use other imaging technology to locate the surgical site, such as ultrasound or fluoroscopy.
• Endovascular catheters. These tiny catheters travel through blood vessels. Surgeons use guidewires and X-ray imaging to guide them to the surgical site, and then operate through them.
• Trocars. Trocars are tubes that the surgical team places within your keyhole incisions (ports). They place the other surgical instruments, including endoscopes, through the trocars.
• Insufflators. Insufflators deliver low-pressure carbon dioxide gas through a tube into your body cavity. Surgeons use insufflators when they need to inflate your cavity for visibility and access.
• Balloons. When surgeons don’t want or need to inflate your entire body cavity, they might use an inflatable balloon to make space to operate just where they need it. They place the balloon at the end of a trocar, endoscope or catheter and inflate it by pumping gas through the tube.
• Surgical instruments. Minimally invasive surgical instruments are long and narrow to operate within narrow spaces. Surgeons manipulate them through trocars, endoscopes or catheters.
• Da Vinci Surgical System. The da Vinci Surgical System is the robotic system that surgeons use in robotic surgery. It includes an operating console, a separate video screen and an equipment cart that holds the surgical instruments and camera. The console operates four robotic arms.

What are the benefits of minimally invasive surgery?

Potential benefits include:

• Reduced trauma.
• Reduced blood loss.
• Reduced risk of surgical complications.
• Reduced risk of infection.
• Reduced scarring.
• Reduced hospital stay.
• Reduced recovery time.
• Reduced pain and need for medication.
• May not require general anesthesia.
• May make surgery possible for some people where it wasn’t otherwise.

What are the disadvantages of minimally invasive surgery?

Potential disadvantages include:

• Requires special training and equipment.
• May not be available locally.
• May be more expensive.
• Operations may take longer.
• May not work in an emergency setting.
• Gas insufflation poses cardiopulmonary risks for some people.

A note from Cleveland Clinic

Advances in surgical technology and techniques are allowing surgeons to complete more operations using minimally invasive methods. By accessing your organs through smaller portals, surgeons can minimize your surgical trauma, thereby reducing your pain, complications and recovery time. If you need an operation, ask your healthcare provider if you’re a candidate for minimally invasive surgery.