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Debate re minimal invasive surgery

Discussion in 'Foot Surgery' started by admin, Sep 29, 2004.

  1. Ian Reilly

    Ian Reilly Active Member

    Hi Fernando

    Big fan of the Pod Institute guys myself. I’ve been to Atlanta 3 times. So, like me, mainly open surgery but will use MIS techniques as and when. As apposed to guys just doing MIS who are unable to open the patient up if they run into trouble.

    For example, I did a MIS TA lengthening on a cadaver course recently, then opened it up to see how I’d done. What a mess - if I needed a TAL I know what I would sooner have…

    Ian
     
  2. Great you are one of my guys let´s keep the good work where are you practising at¿ i am in monterrey, mexico adios
    :)
     
  3. podrick

    podrick Active Member

    mis

    i think ian's point has been some what missed,by dr. vazquez.anyone graduating in a u.s. pod program within the last 15 years is as he quotes a "mcglamary kind of guy."over half of the chiefs of the surgery departments and their faculties are all pod institute graduates.
    as i mentioned once before,our residencies are fairly standardized in the states.the vast majority of the surgeons who have embraced mis techniques are not limiting themselves to these techniques,but rather as additional techniques.the journal of foot and ankle surgery featured an article on percutaneous achilles tendon lengthening in its january edition.orthopedic surgeons are now performing mis hip procedures using the c-arm as a guide.the journal of foot and ankle surgery will feature an article comparing the efficacy of nerve decompression (mis) procedures versus traditional morton's neuroma resections.
    i myself would rather do an mis exostectomy for a heloma molle or a subungal exostosis any day,rather than a fish mouth open procedure.
    i believe this is where the real debate lies.the efficacy of some of these mis procedures in foot surgery along with open conventional surgery.and yes we do ourselves a service to learn them.because in the states my friends,one group who is already mastering them and gaining ground are the plastic surgeons.they do mis foot surgery when possible and for bunionectomies they perform open,but very small incisions using absorbable k-wires(even for base wedges), inspired by mis surgery.i have seen some of their work and it is quite good. surgery is an art form that must evolve,we pods must lead.
     
  4. Dear Podrick what i am missing from ian´s coment?,you mean he is asking when mis¿ yes you are write but, let me tell you that there are several companies that i lecture for in non-invasive surgery for morton´s neuroma and plantar fasial release like the isogard for example i have the compleete lecture send me you e-mail and i will be more than happy to send it by e-mail they are designing tool for "us" or for their packets¿ the instruments cost about 1000.00 usd but the big money for them is in the special blades they cost whole lot. is the same for all profesions the industry of sales no the medical clinical research that we need they made tools to make money, we are the ones to select what ower patients needs and best. i will go with small incisions allways, mis few well selected ones, ther is no reason for other incision but the one that is for a prosedure, i graduated from a dpm american school got podiatry residency and also got and m.d. degree i am the podiatric chairman at san lucas hospital in monterrey mexico and have an office in Hidalgo texas, u.s.a. don´t let your self impress with other medical profesions podiatry is fantastic let´s keep the good work. regards :)
     
    Last edited: Jun 28, 2005
  5. podrick

    podrick Active Member

    mis

    dr.vasquez,
    i appreciate your training and status in the profession.the point that i was making is that podiatry in today's market is not a primary type of medicine the way orthopedic surgery is.we are an elective specialty. what we offer the public is something more than what the othopedist or the therapist is offering them.the reason being that many professions in medicine treat the foot as well.
    thus we must be leaders in this endeavor.if conventional surgeons such as ourselves are already learning and applying new techniques that have been proven to be effective.we owe it to our patients to learn them.
    i am going to confess something that i feel i shouldn't but when i was in residency some of the bes surgery taught to me,was by orthopedic surgeons who were foot and ankle fellows.and they felt that although mcglamary,marcinko etc had made major contributions to foot surgery they also tenden to "over do it at times",excessive fixation and dissections etc.
    and as for doing the research on procedures.please remember if you studied here that,they create procedures and go and perform it on 40 guinea pigs,do a 4 month follow up and get published.it is hardly what i would call a scientific method.
    i appreciate your respond.incidentally,i too am hispanic and practice in miami.
    abrazos y suerte
     
  6. SIS is the future

    Dear Coleagues:
    MIS is been taking for most practitiones that don´t have a podiatric recidensy or hospital privileges but as i coment before my dear friend and profesor Blair Bycura a MIS founder instruct me at nycpm about when mis and with the time i developed SIS (small incision surgery) it is a combination of open and mis but with out a Shannon 44. regards :)
     
  7. admin

    admin Administrator Staff Member

    I think the debate/discussion in this thread and the other one can be summarized as:

    MIS as a surgical option/technique practised by those surgically qualified and have other surgical options available (bearing in mind that the surgical qualifications outside North America are very different)

    MIS as a philosophy and concern with the zealots (bearing in mind the harm that has been done in the past)
     
  8. Querido Amigo:
    You are perfectlly correct, but the problem a see is that lots of the companies and the public see us like the dentist, optometrist etc no like m.d.´s because the ortopod is first m.d. as you know and then ortopod the plastic surgeon etc.etc. when podiatry becomes a m.d. specialty i mean when the podiatrist program icludes m.d. degree before podiatry training, every thing will channge personally i train m.d. in mexico to become podiatrist ther is no podiatry carrer any where in the hispanic countries because podologos are not podiatrist lo tienes claro eso no¿ in mexico they do not even have highschool, te invito a dar una platica en monterrey, regards :)
     
  9. You are perfectlly correct, regards
     
  10. Ian Reilly

    Ian Reilly Active Member

    ... but misses the key point that practitioners who ONLY do MIS can not offer a full service to their patients.

    Ian
     
  11. Dermotfox

    Dermotfox Active Member

    MIS Conference

    There is a few places left if you wish to attend the MIS conference later this year. If you are interested please visit

    www.cmifas.co.uk or e-mail info@CMIFAS.co.uk


    and contact Amin.

    All you need to know about MIS will be explained and Prof Isham (AAFAS) from America will answer all your questions.

    Be quick
     
  12. admin

    admin Administrator Staff Member

    Didn't he just loose his licence to practice because of all the malpractice suits?
     
  13. W J Liggins

    W J Liggins Well-Known Member

    Mis

    Is it not reasonable that appropriate questions on matters podiatric should be answered on this site? Is that not one of the purposes of this site?
    To encourage paid attendance at a conference to answer simple questions which should properly be answered here is surely ethically inappropriate and grossly discourteous to colleagues? Further, to feature a practitioner who no longer has a license to practice is an insult to those who are familiar with the full range of podiatric surgery and dangerous to those who are not.

    W J Liggins
     
  14. Dieter Fellner

    Dieter Fellner Well-Known Member

    mis

    amen!
     
  15. jack golding

    jack golding Active Member

    JACK GOLDING

    Leaving aside the adequacy of training of MIS surgeons no-one seems to have answered my question. 'Where is MIS surgery carried out? If, as I suspect, in the chair of a routine practice, I would suggest that those carrying out surgery in this way have a serious talk with an infection control nurse before they have a major disaster. In 2007 podiatry and podiatric surgery will be subject to inspection by Care Standards. There will be serious consequences for those who believe that surgery, MIS or otherwise, can be carried out other than in an operating theatre. Care Standards have wide and sweeping powers and let no-body think that podiatry will be let of lightly.
     
  16. podrick

    podrick Active Member

    jack,
    with all due respect,where have you been during the last 15 years? i graduated from the barry university program in florida,where i also completed a psr24.in our clinics it was routine to see our attendings,doing office neurectomies and exostectomies,not to mention biopsies and arthroplasties.this is nothing new in our specialty,nor in any medical field for that matter.i just had a percutaneous vasectomy done in my urologist's office.
    i understand that the office must be certified to be up to code.and i am sure most will and those that aren't will be fined.however,the interest in percutaneous procedures by thos of us who conventional surgeons is very real and academically very sound.the orthopods are now perfecting a very effective mis hip replacement procedure,less trauma and earlier ambulation.it is where medicine is heading.
    the idea that practitioners that practice mis procedures are doing these procedures in practitioner's chairs without sterile technique is ignorant and quite frankly irresponsible.
     
  17. jack golding

    jack golding Active Member

    Jack Golding

    podrick remember I practise in Great Britain and with or without sterile techniques it is not acceptable to perform surgery other than in dedicated operating theatre.To do so would not only negate any malpractice insurance but would almost cetainly be indefensible in British law.Care standards are with us like it or not and I know they would not accept office based surgery and quoting what is acceptable in the USA will
    not make it otherwise.
     
  18. podrick

    podrick Active Member

    jack,

    forgive my ignorance i didn't realize where you were coming from.you must have plenty of plastic surgeons who practice either office or ambulatory out patient,in a fee for service mode in britain.

    what i am talking about is pretty much the same thing.furthermore,you must understand that i am still a conventional surgeon,over 85% of all my surgeries are outpatient hospital based.however,when an exostectomy or even a percutaneous neuroma decompression procedure comes up.i do perform them in a small procedures room i have in my office.i am aclf certified and i do have a defibrilator in the office.

    it is a matter of choice for what is best for the patient's outcome and comfort.it isn't because this all i can do.i would say to you that in the states,this is more common.the old time "mis buzzers" as they were once called are a dwindling minority.the new debate today,is on mis proper place in modern conventional surgery.

    take care
     
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