Minimizing Risks in Minimally Invasive Surgery

Note: The following article was sponsored by Stryker. PROstep MIS is a Stryker product. Dr. Alastair Younger is a paid consultant of Stryker.
 
A subject often encountered, but rarely directly discussed, in our field of foot and ankle surgery is wound complications. Not long after I began practicing in 1998, I began arthroscopic surgeries because I knew, even as a young surgeon, that reducing the risk of wound complication was of the utmost importance.
 
At that time, I was conducting mainly open procedures in high-risk patients and arthroscoping allowed me to minimize those risks. Over time, however, it became clear that the best way to avoid wound complications is simply to avoid unnecessary wounds in the first place. Therefore, when minimally invasive surgical approaches became reliable and the tools necessary to conduct them available, I immediately changed to a minimally invasive approach over traditional open procedures.
 
So, when I was approached by Stryker to help develop their latest MIS surgical tools, I was quick to offer my expertise. Since then, my preference for MIS has only expanded.
 
While MIS has continued to evolve, there are still challenges to be addressed. Surgeons wanting to utilize the new technologies available need to learn how to perform the procedures.
 
In addition to my practice, I am also a Professor at the University of British Columbia, teaching rising doctors the ins and outs of foot and ankle surgery. In this role, I have seen first-hand that the basic open surgeries we routinely teach do not suffice if we want to ensure the next generation of surgeons can successfully treat a wide variety of patients, including those who may fall into higher-risk categories. While I make sure to provide my students with education on MIS, there is still a sharp learning curve involved for certain procedures.
 
One such MIS that still requires a steep learning curve for both students and experienced surgeons is minimally invasive chevron akin (MICA) surgery. MICA surgery still entails a good deal of “art” – surgeons are expected to rely on their own judgement and skill to ensure proper incisions, alignment, and implantation. Further, surgeons performing MICA will need to rely on additional support in the operating room (OR) to ensure fixation and accurate targeting.
 
That said, MICA surgeries should be considered the optimal approach for high-risk, qualifying patients. PROstep minimally invasive surgery gets patients back on their feet faster,^2,3 with less pain² and smaller incisions¹ compared to an open procedure. Some aspects in MICA surgery are harder to teach. After observing this both as a teacher and a practicing surgeon, I felt obligated to offer my experience to Stryker’s team and assist in the development of the most recent surgical tool for MICA – the PROstep MICA SOLO procedure guide.
 
PROstep MICA SOLO procedure guide is a pre- and intra-operative planning guide for minimally invasive PROstep bunion correction procedures that allows surgeons to visualize and target percutaneous burrs in patient anatomies. Among its benefits are a controlled and adjustable shift, automatic targeting of the screw regardless of shift, tri-planar stabilization, and hands-free maintenance of intra-operative correction. Designed for the solo surgeon, these benefits ensure that less support is needed in the OR and that the procedure is reproducible.
 
The all-in-one PROstep MICA SOLO procedure guide is the next step in the evolution of minimally invasive surgery and its features can benefit surgeons in numerous ways. Most importantly to me, however, is the fact that these guides can help my students feel more confident in performing a difficult procedure. When surgeons feel more confident, they can better treat patients. In the end, that’s what our profession is all about.
 
References:
¹ Lam P, Lee M, Xing J, Di Nallo M. Percutaneous Surgery for Mild to Moderate Hallux Valgus. Foot Ankle Clin N Am 2016; 21: 459-477 (data only with respect to chevron osteotomy procedure).
² Lee M, Walsh J, Smith MM, Ling J, Wines A, Lam P. Hallux Valgus Correction Comparing Percutaneous Chevron/Akin (PECA) and Open Scarf/Akin Osteotomies. Foot Ankle Intl 2017; 38(8): 838-846 (data only with respect to chevron osteotomy procedure).
³ Maffulli N, Longo UG, Oliva F, Denaro V, Coppola C. Bosch Osteotomy and Scarf Osteotomy for Hallux Valgus Correction. Orthop Clin North Am. 2009 Oct;40(4):515-24, ix-x. doi:10.1016/j.ocl.2009.06.003.

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Dr. Alastair Younger, M.B., CH.B., M.SC., CH.M., F.R.C.S.(C) is a tenure track professor at the University of British Columbia in recognition of his role as a researcher and teacher. He is the head of the Distal Extremities division at the University of British Columbia. He leads the foot and ankle research office at the University of British Columbia, and is the current President of the British Columbia Orthopaedic Association (BCOA). Dr. Younger has been in practice for 21 years at St. Paul’s hospital and initiated the foot and ankle program.
 
Attention: The views, opinions and product experiences discussed in this article, whether implicit or explicit, are those of Dr. Younger and do not necessarily reflect the views and opinions of Stryker. Proper surgical procedures and techniques are the responsibility of the medical professional and a surgeon must evaluate the appropriateness of the procedures based on his or her personal medical training and experience. Prior to use of any product the surgeon should refer to the package insert for complete warnings, precautions, indications. contraindications and adverse effects.