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Is minimal incision surgery (MIS) making a comeback?

Discussion in 'Foot Surgery' started by Craig Payne, Jul 9, 2012.

  1. Craig Payne

    Craig Payne Moderator


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    There was a dark chapter in the history of the profession (more so in the US in the 80's) when MIS (minimally invasive/incision surgery) was blindly and widely adopted and lead to some pretty disastrous outcomes. In the UK, it was seen as a shortcut to doing surgery without completing the appropriate surgical qualification. In continental Europe, they appeared oblivious to the problems in the USA and have been doing it successfully for years. However, many want to put that chapter behind us and confine it to the history books as a footnote. However, it was still being practiced on the fringe in many countries.

    Going back, we have had some threads on the topic:
    Debate re minimal invasive surgery
    Minimal Invasive Surgery cadaver training
    Percutaneous minimally invasive surgery for HV
    The College of Minimal Invasive Foot & Ankle Surgery
    Lesser toe surgery

    In those threads you see the issues I mentioned above coming through.

    Having said that, I have been noticing more conference presentations, more research being published and more discussion of MIS ..

    ....is it making a comeback into the mainstream?
  2. Paul Bowles

    Paul Bowles Well-Known Member

    I have had a fair few of my patients choose to have procedures via minimal incision surgery. I know of two Pod Surgeons in Australia actively doing it. The results I have seen thus far have been very very encouraging to say the least. Successful outcomes, patients are happy with the outcome post operatively and ones I have seen over a year out now are very happy they had it done. Im not advocating or endorsing it in any way shape or form - however with the data showing some good outcomes I think MIS has its place in the surgical system.
  3. Rob Kidd

    Rob Kidd Well-Known Member

    I am very well read in some areas, and totally ignorant in others. Please would someone care to give me a 1-2 sentence definition and description of what we mean by minimal incision surgery? Are talking about things like tenotomies? Rob
  4. Rob:

    Minimal incision surgery (MIS), specific to podiatry, is the use of small skin incisions to do surgery, basically, by feel, not by seeing the structure that is being operated on. Typically, in podiatry, MIS refers to using a Shannon #44 rotary side-cutting burr (see photo) to perform osteotomies and other osseous procedures through skin incisions about 3 mm in length (i.e. a minimal incision).

    When I was a surgical resident in 1983-1984, I was trained on MIS by a very good MIS surgeon. However, I preferred open surgery since MIS was becoming frowned upon by the most well-known and politically powerful surgeons in the US due to the widespread overuse of this type of surgery by podiatrists who were not residency trained in surgery, and the complications they supposedly created.

    When in lectured in Rome, Italy a few years ago, I was surprised to see lectures on MIS again even though the surgeons in the US made a big stink about it during the 1980s. I find it somewhat odd, but funny, to see MIS making a comeback since I remember the time during the 1980s when anyone who did this surgery was considered as a lesser surgeon than those that did open surgery.
  5. Rob Kidd

    Rob Kidd Well-Known Member

    Thank you for that lucid reply. It rather reminds me of when I was a Pod student in the early 70's. My Dad was a GP, but did surgical internships; I asked him what the advances in surgery would be over the next few years. The answer - less, little or no surgery. His thought was that the less surgery that was being done, was for the best from a quality assurance point of view; removing the need for surgery was hs surgical aim...............
  6. reckles

    reckles Member

    There are many still performing these types of procedures in the US, and I have no doubt that with the benefit of improved instrumentation and techniques that this approach proves successful for many people. However, now, as was the case in the 80's, the best results come from the best trained hands- surgeons who receive traditional comprehensive residency based experiences may well adopt minimally invasive strategies with positive outcomes. It will always be true that it isn't whether the procedure is done open or closed, it's the planning and execution that matters. in the 80's, many of those "trained" in MIS were very poorly prepared to undertake surgery of any kind.
  7. Paul Bowles

    Paul Bowles Well-Known Member

    Very true response - its all in the hands of the right person! Ive seen plenty of botch jobs with open procedures as well.
  8. Gibby

    Gibby Active Member

    I have heard negative things about MIS- and the practitioners I've known to perform MIS were older docs without residency training. I have seen some bad outcomes with MIS bunionectomy procedures... it still doesn't make sense to me HOW a surgeon could possibly perform such a surgery without actually seeing everything. Is the metatarsal head, capsule, and associated soft tissue structure just mashed up into a paste of some sort? I suppose I need to do some research. Anyone with info/experience regarding this?
  9. Rodrigo Diaz

    Rodrigo Diaz Member

    Hi everybody,

    I´m a Podiatry student in Málaga, Spain, sorry for my English in advance.

    Here Podiatrist have been performing MIS since 80's when US doctors like Isham went here to explain us those new procedures. Later (from 2008 aprox to now) orthopedic surgeons began to use these technics and called them percutaneos surgery or lasser surgery (what is totally fake). Actually, if you go to the Social Security (where most of the people go because you don't have to pay money) your surgeon will be an orthopedic one and he probably perform MIS.

    As podiatrist, in our private clinics, we are seing a lot of iatrogenesis where you can find bad realigments, paresthesia, etc. In my opinion, all of this is because of a not well trained surgeon (in these case orthopedic surgeons ) who does not carry about biomechanic and just try to realigne and put straight the bones on th XRay.

    Here, I think most of Podiatrics do open surgery, but there is an increasing numbers of people who are performing MIS and you can see a lot of courses and lectures about MIS. In my school, my surgery teacher thinks MIS is not a good procedure because you damage a lot of soft tissue, there are other teachers that say its the future...

    When osteotomy is performed by MIS, is not screwed or blocled, what normally is an argument to say theres a big risk of failure.

    Do you know if there are MIS procedures with internal atachments like screws or k-wires ?

    Can you talk me a lil more about what happened in UK in the 80's please?
  10. W J Liggins

    W J Liggins Well-Known Member

    Ola Rodrigo

    Your English is excellent, much better than my Spanish!

    The vast majority of formally trained podiatric surgeons in the UK took warning from what had happened in the USA and did not carry out MIS foot surgery. A few podiatrists who had not been through the formal programme learned about MIS from the States and carried it out. However, subsequently, the statutory body, The HCPC informed one of the better known MIS practitioners that his training was not acceptable and that the system which he had put in place should stop.

    My own view is that there probably is a place for some limited MIS but that those practitioners using the technique should have training in 'open' surgery to deal with iatrogenic and other potential problems.

    All the best

  11. Rodrigo Diaz

    Rodrigo Diaz Member

    Thanks W J Liggins for the answer. I think you need open surgery experience to perform MIS too.

    Is MIS normally performed in USA?

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