What Exactly is Minimally Invasive Surgery (MIS)?

Minimally invasive surgery is any surgery that is able to achieve the same goals as more traditional surgeries, while causing less collateral damage. Almost all specialties have an MIS version of their traditional surgeries. Generally speaking, the MIS approach results in less pain, fewer complications, a shorter hospital stay and higher overall patient satisfaction. In general surgery, a laproscopic appendectomy would be an example.

The problem, however, is minimally invasive surgery is not a well-defined term, and some conversations regarding the method have blurred the lines of what is and what is not actually minimally invasive.

For Example:

Let’s suppose a person has herniated lumbar disc. Often, a lumbar micro-discectomy is recommended as the appropriate treatment. In this procedure, a 18 to 24mm incision is made on the patient’s lower back and a small tube or retractor is used along with a microscope, which provides light and magnification. This procedure is typically done on an outpatient basis because the incision is small and the recovery time is relatively quick.

One could say that this is a minimally invasive approach. However, it is also the standard operation for this condition and is the same procedure that almost every surgeon does. The same can be said for the most common cervical operation, an anterior cervical discectomy and fusion (ACDF). With this procedure the incision on the front of the neck is small and there is almost no muscle dissection. Is it accurate to say that these procedures are minimally invasive. But, this is the standard procedure that nearly every surgeon would perform and is not actually a less invasive surgical option than what is typically offered.

Now, let’s look at a more complicated lumbar fusion procedure. The standard operation here involves a large open incision in the back, dissection of the muscles off the spine, and placement of screws in the spine. Extremely invasive, right? There are far less invasive approaches to this procedure, however.

Posterior operations include a small incision in which a small tubular retractor is inserted and screws are placed using a tiny wires as guides. This procedure can also be done from the side which is called a lateral fusion. With these cases, the minimally invasive approach results in significantly less pain, reduced risk of complications, less time in the hospital and far greater patient satisfaction. The abilities of a surgeon to perform this type of procedure, using a minimally invasive approach, include additional training and a more focused skill set than the standard approach. It’s clear in this situation that the MIS approach is significantly different than the standard approach and is well deserving of the appropriate distinction.

Given that the term “minimally invasive” connotes a superior outcome, it is no surprise that many physicians want to market themselves as MIS surgeons. If a physician only performs the standard operation, are they truly worthy of the MIS distinction? On the other hand, when a physician does offer a MIS alternative to the standard operation, shouldn’t that be set apart?

If your surgeon tells you that a minimally invasive surgery is not your best option, get a second opinion before moving forward. There is almost always a better, less invasive option than traditional open surgery if you can find the appropriate surgeon.

When looking for a surgeon who does propose a MIS approach, you should find out what percentage of their operations are truly MIS, compared to standard procedures. A surgeon who truly understands and embraces the benefits of minimally invasive surgery will rarely, if ever, perform a traditional open surgery.