Advertisement

What Is Minimally Invasive Surgery and How Do You Learn It?

  • Aaron G. Rosenberg
Chapter

Abstract

Innovation in surgery is not new and should not be unexpected. As an example, the history of total joint replacement has demonstrated continuous evolution, and the relatively high complication rates associated with early prostheses and techniques eventually led to the improvement of implants and refinement of the surgical procedures. Gradual adoption of these improvements and their eventual diffusion into the surgical community led to improved success and increased rates of implantation. Increased surgical experience was eventually accompanied by more rapid surgical performance and then by the development of standardized hospitalization protocols, which eventually led to more rapid rehabilitation and return to function. These benefits are well accepted and can be seen as helping contribute to the establishment of a more “consumer driven” and medical practice.

Most surgeons would agree that as experience guides the surgeon to more accurate incision placement, more precise dissection, and more skillful mobilization of structure, the need for wide exposure diminishes. Indeed, less invasiveness appears to be a hallmark of experience gained with a given procedure. From a historical perspective, this appears to be true of total hip replacement. The operation as initially described by Charnley required trochanteric osteotomy. The osteotomy served several purposes: generous exposure, access to the intramedullary canal for proper component placement and cement pressurization, and the ability of the surgeon to “tension” the abductors to improve stability. However, over time, it became apparent that trochanteric nonunion and retained trochanteric hardware could be proble­matic. In attempts to minimize these problems, some worked to develop improved techniques for trochanteric fixation. However, others went in a different direction, eventually demonstrating that the operation could be performed quite adequately without osteotomy. Many purists comp­lained that this was not the Charnley operation, and that the benefits of trochanteric osteotomy were lost. Yet the eventual acceptance of the nonosteotomy approaches by almost all surgeons performing primary total hip arthroplasty (THA) in the vast majority of circumstances would attest to the fact that osteotomy was not required to achieve the result that had come to be expected.

Keywords

Minimally Invasive Surgery Continue Medical Education Surgical Training Surgical Performance Psychomotor Skill 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Peltier LF. The history of hip surgery. In: Callaghan JJ, Rosenberg AG, Rubash HE (Eds.). The Adult Hip. Lippincott, Phialdelphia, 1998, pp. 4–19Google Scholar
  2. 2.
    Dixon MC, Scott RD, Schai PA, Stamos V. A simple capsulorrhaphy in a posterior approach for total hip arthroplasty. J Arthroplasty 2004 19(3):373–6CrossRefPubMedGoogle Scholar
  3. 3.
    Rogers EM. The Diffusion of Innovation. Free Press, New York, 5 edition, 2002Google Scholar
  4. 4.
    Fenton DS, Czervionke LF (Eds.). Image-Guided Spine Intervention. W B Saunders, New York, 2002Google Scholar
  5. 5.
    Castaneda-Zuniga WR, Tadavarthy SM, Qia Z. Interventional Radio­logy. Lippincott, Williams & Wilkins, Philadelphia, 3 edition, 1997Google Scholar
  6. 6.
    Tuffs A. Kurt Semm Obituary. Br Med J 2003 (327);397Google Scholar
  7. 7.
    Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P. Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 2003;46(10):1371–8CrossRefPubMedGoogle Scholar
  8. 8.
    Gallagher AG, Smith CD, Bowers SP, Seymour NE, Pearson A, McNatt S, Hananel D, Satava RM. Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures. J Am Coll Surg 2003;197(3):479–88CrossRefPubMedGoogle Scholar
  9. 9.
    McCormick PH, Tanner WA, Keane FB, Tierney S. Minimally invasive techniques in common surgical procedures: implications for training. Ir J Med Sci 2003 172(1):27–9CrossRefPubMedGoogle Scholar
  10. 10.
    Berger RA, Duwelius PJ. The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am 2004 35(2):163–72CrossRefPubMedGoogle Scholar
  11. 11.
    Hartzband, MA. Posterolateral minimal incision for total hip replacement: technique and early results. Orthop Clin North Am 2004;35(2):119–29CrossRefGoogle Scholar
  12. 12.
    Howell, JR, Masri, BA, Duncan, CP. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. Orthop Clin North Am 2004;35 (2): 153–62CrossRefPubMedGoogle Scholar
  13. 13.
    Wright JM, Crockett HC, Delgado S, Lyman S, Madsen M, Sculco TP Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 2004 19(5):538–45CrossRefPubMedGoogle Scholar
  14. 14.
    Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am 2004 86A(7):1353–8PubMedGoogle Scholar
  15. 15.
    Callaghan JJ, Crowninshield RD, Greenwald AS, Lieberman JR, Rosenberg AG, Lewallen DG. Symposium: introducing technology into orthopaedic practice. How should it be done? J Bone Joint Surg Am 2005 87(5):1146–58CrossRefPubMedGoogle Scholar
  16. 16.
    Ericsson KA Charness N Feltovich PJ, Hoffman RR. The Cambridge Handbook of Expertise and Expert Performance. Cambridge University Press, Cambridge, 2006Google Scholar
  17. 17.
    Wilhelm DM, Ogan K, Roehrborn CG, Cadeddu JA, Pearle MS. Assessment of basic endoscopic performance using a virtual reality simulator. J Urol 2003 170(2 Pt 1):692Google Scholar
  18. 18.
    Gallagher AG, Smith CD, Bowers SP, Seymour NE, Pearson A, McNatt S, Hananel D, Satava RM. Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures. J Am Coll Surg 2003 197(3):479–88CrossRefPubMedGoogle Scholar
  19. 19.
    McCormick PH, Tanner WA, Keane FB, Tierney S. Minimally invasive techniques in common surgical procedures: implications for training. Ir J Med Sci 2003 172(1):27–9CrossRefPubMedGoogle Scholar
  20. 20.
    Amirault RJ, Branson R. Educators and expertise: a brief history of theories and models. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR (Eds.). The Cambridge Handbook of Expertise and Expert Performance. Cambridge University Press, Cambridge, 2006, pp. 72–4Google Scholar
  21. 21.
    Zhou W, Lin PH, Bush RL, Lumsden AB. Endovascular training of vascular surgeons: have we made progress? Semin Vasc Surg 2006 19(2):122–6CrossRefPubMedGoogle Scholar
  22. 22.
    Colt HG, Crawford SW, Galbraith O. Virtual reality bronchoscopy simulation. Chest 2001 120:1333–39CrossRefPubMedGoogle Scholar
  23. 23.
    Rosser JC, Jr, Rosser LE, Savalgi RS. Skill acquisition and assessment for laparoscopic surgery. Arch Surg 1998 133(6):657–61CrossRefPubMedGoogle Scholar
  24. 24.
    Rogers DA. Ethical and educational considerations in minimally invasive surgery training for practicing surgeons. Semin Laparosc Surg 2002 9(4):206–11CrossRefPubMedGoogle Scholar
  25. 25.
    Wanzel KR, HmastraSJ, AnastakisDJ, Matsumoto ED, Cusimano MD. Effect of visuo-spatial ability on learning of spatially-complex surgical skills. Lancet 2002 38:617–27Google Scholar
  26. 26.
    Naik VN, Matsumoto ED, Houston PL, Hamstra SJ, Yeung RY-M, Mallon JS, Martire TM Fibreoptic oral tracheal intubation skills: do manipulation skills learned on a simple model transfer into the operating room Anesthesiology 2001 95:343–48CrossRefPubMedGoogle Scholar
  27. 27.
    Figert PL, Park AE, Witzke DB, Schwartz RW. Transfer of training in acquiring laparoscopic skills. J Am Coll Surg 2001 193(5):533–7CrossRefPubMedGoogle Scholar
  28. 28.
    Norman G, Eva K, Brooks L, Hamstra S. Expertise in medicine and surgery. In: Ericsson KA, Charness N, Feltovich PJ, Hoffman RR (Eds.). The Cambridge Handbook of Expe-rtise and Expert Performance. Cambridge University Press, Cambridge, 2006Google Scholar
  29. 29.
    Bond WF, Deitrick LM, Eberhardt M, Barr GC, Kane BG, Worrilow CC, Arnold DC, Croskerry P. Cognitive versus technical debriefing after simulation training. Acad Emerg Med 2006 13(3):276–83CrossRefPubMedGoogle Scholar
  30. 30.
    Moorthy K, Munz Y, Adams S, Pandey V, Darzi A. A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Ann Surg 2005 242(5):631–9CrossRefPubMedGoogle Scholar
  31. 31.

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Aaron G. Rosenberg
    • 1
  1. 1.Department of Orthopaedic SurgeryRush Medical CollegeChicagoUSA

Personalised recommendations