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Basically, the definition of minimally invasive surgery or minimal
access surgery as it is often referred to,
is that we are trying to minimize the amount of trauma
to achieve the end desired goal inside the body
that’s been seen in things like gallbladder surgery which use to be open
surgery and is now strictly laparoscopic.
When it comes to spine, it has been developed in a more gradual fashion
because we don’t have the same use of laparoscopes. So there are basically
techniques that have been developed which allow us to get in
through small incisions, minimizing the soft tissue trauma,
and allows us to get to the spine and do the reconstructive work. So in many cases,
the more exciting stuff that’s happened
is not how it refers to just the use of an operating microscope, which is how we’ve
defined microsurgery over the years,
but being able to
make small incisions and then work through basically those small openings to
do fairly advanced reconstructive work. So spinal fusion,
which has moved into the field of minimally invasive surgery,
is technically not minimally invasive
invasive in the sense on the inside we are still achieving
that big goal of reconstructing the spine which is
actually relatively invasive,
but we are doing it through small incisions making this minimal access
and therefore less soft tissue trauma and easier recoveries for the patients.
Each patient that walks into my office is evaluated as an individual.
To say that there is a uniform, you know, approach to any particular problem
is somewhat na?ve
and the reality is that we take on a case by case basis,
look at the particular surgical,
and we’ll say surgical situation, that may be presenting itself,
and in that situation
we may have several options, and I will offer them to these patients and basically
say, here’s what’s the old standard,
the one that is basically still a standard of care.
Here are some of the newer options and here’s what our experience has been with
these new options,
and here’s the advantages to some of those newer options. In some cases,
the anatomical approach, there may be a reason why we can’t offer a minimally
invasive procedure. There are
techniques which you may have already
heard about, one that approach is from the side of the spine, some are calling
XLIF procedure.
Well, that procedure can’t be done at L5-S1, the lowest of the lumbar segments.
So someone with strictly lumbar 5 to sacral pathology
is not something we can offer the XLIF to at least at this point in time,
but that being said, there are other techniques that are minimally invasive
for that and so it is basically based on the pathology
and then what our
goal is in the surgery, which sometimes is reconstructive
and sometimes is just decompressing the nerves
and we will look at each individual patient and say what, what fits the bill here.
What’s going to be the least
sort of destructive procedure
to achieve the desired goal and to get the patient off the table fastest
and recovering fastest.
So for me, one of the, you know, companies that’s basically going to stand out in
this in the last few years
has been the NuVasive Corporation
who helped bring this XLIF or extreme lateral lumbar fusion into play and what
basically that has done for my practice is allowed me to help patients even
upwards in their mid 80s who may have
advanced degenerative scoliosis.
And years ago we would have avoided operating on those patients knowing that 0:03:22.369,0:03:25.699 we may not have really been able to help their overall situation.
Now, we are able to help some of those patients without as much destructive
work as standard 0:03:31.209, 0:03:36.329 standard scoliosis or deformity work in the past would afford the patient.
Now, you know that’s one group of patients,
then there is basically patients who are
very active that are looking for the quickest recovery possible
and there are techniques with smaller and smaller incisions and so
basically they can either leave
in a 24-hour period
and they’re not spending the same kind of time they used to in the hospital recovery
and I think that allows them to just
heal faster, both mentally and physically. 0:04:00.069,0:04:02.189 Originally, I was approached by Dr. Smith
who is a colleague,
recently he’s actually also taken care of my mother personally and did surgery on her,
but my trust and faith in Dr. Smith was that
here is a very talented gentleman, as far as his surgical
techniques are concerned.
I have learned from him,
even being across the country,
and something that he was interested in here in developing was
a chance to work with colleagues of similar expertise,
getting us together,
share ideas.
Being done in another country
just makes it that much more interesting in that fashion, but being able to help
people around the world,
affording basically others the opportunity that the people in the States
have, as well as one intriguing factor.
I have had that opportunity in doing it for charitable work in Africa.
With that being said, this opens up a whole new community around the world
that basically we,
you know, have an option for the minimally invasive approaches.
So it was partly the colleagues, partly the ability to share these techniques
with others around the world outside of the States. Not having seen the 0:05:04.830,0:05:08.559 numbers myself, but being aware of some of the cost of healthcare in this
country, just as I have seen
what a hospitalization can cost, what a surgical center situation can cost,
the fees here,
don’t seem real in some ways,
and it seems to make sense that the ability to deliver this kind of care is going to be
available elsewhere
at potentially a lesser, lesser cost.
The fact that can be streamlined in a process like this where there is actually
a business model to help develop and get patients
from around the world, including this country, to say, well
this is one option for you. You can choose to go elsewhere and potentially have this for
a lower price. Now, whether or not patients here in this country
will jump at that chance, some may, some who
have basically legal issues involving their cases who may not be dealing with the
bills themselves
may choose to do that to expedite their care
because they know that they may be able to deal with this process and that the
legalities,
meaning any personal injury cases and so forth, be dealt with afterwards.
The reality is these people
many cases get dragged through a very slow meandering process in the States
where it may take them years sometimes to achieve the care that
they need relatively early on
and that does not help their case. So if we can approach those patients and
basically make them aware
that this is an option for them,
I think there will be a fair number in this country
that will seek out that option as well.
My experience, I have had basically 18 years in practice, 7 years
in training prior to that.
When it comes down to new technologies,
there are kind of looked at from a business perspective
as those who innovate and those who are early adopters. I have been an early adopter.
I am not necessarily the creator of devices, but
very comfortable with recognizing new technology for what potential advantages
it has. I was involved with 0:06:56.519,0:07:00.349 the early adoption of techniques even a dozen years out in
my institutions locally.
So I think I bring that excitement and that desire
and the willingness to challenge myself
with the newer devices and I think being surrounded with the other
types of physicians who I think are similarly minded
will, it raises the bar and allows each of us to challenge each other and push each other and to raise the care for patients. 0:07:20.789,0:07:23.070 The one thing that
is currently
lacking in what qualifies as advanced technology may be the robotics end
which up to this point, while there have been some robots available for spine
work,
they really do not accelerate the case in any fashion. So in reality, they have slowed the
process down for us.
Whether or not that is a decade away with, you know, 0:07:45.610,0:07:46.399 Computers
faster and faster and our ability 0:07:48.410,0:07:54.369 to find ways for these robots to actually facilitate rather than just to slow us down
that’s potentially a source of it.
Otherwise, as I said before, I may not be the innovator, so I may not
be the creator of these new technologies, but I hopefully
hopefully recognize the good stuff as it comes along, but I see robotics as potentially
creating something new for us or giving us an extra pair of hands that may
facilitate our surgery. I anticipate it is going to change my practice a little bit and my day-to-day 0:08:15.400,0:08:17.550 life. I’m looking forward to
the opportunity to
see consults come in from far away, see how the information is being delivered
to me so I can analyze it the way I typically do in this office,
and so I’m kind of
excited about
how fast and furiously that information is going to come in because I am sure there is a lot of needy people
around
the world and I see that as one challenge to my day-to-day and I expect that over the course of
the next year or two I will be spending a
fair amount of time heading
out to Cyprus. So I’m looking forward to that.