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Defining Arthroscopic, Laparoscopic, Endoscopic

Thirty years ago, many of the modern minimally invasive surgery techniques had yet to become common place in the operating room. When I was an intern in General Surgery in 1986, we were still doing gallbladder removals by cutting large open incisions beneath the rib cage on the right side – a very painful approach, to say the least. Now, the use of small TV cameras has become commonplace and used to treat many medical and surgical disorders revolutionizing the world of medicine.

Everyone probably has heard of arthroscopic surgery. “Arthro” is a prefix meaning joint and comes from the Greek word arthron. Joints such as the knee or shoulder can be treated arthroscopically. This is a minimally invasive approach that uses a special TV camera inserted through small “portals,” or incisions, to look around tight spaces like joints, and perform work to repair cartilage, ligaments, tendons, etc. Progressively since the 1980s, arthroscopic surgery has become the standard of care for many joint problems as techniques and equipment continue to improve.

Laparoscopic comes from two Greek words. The first is lapara, which means “the soft parts of the body between the rib margins and hips,” or, more simply, the “flank or loin.” The other Greek root is skopein, which means “to see or view or examine.” Laparoscopic surgery still uses a TV camera to see inside your body, but instead of joints, surgeons go in through small portals in your abdomen to look around and treat problems such as gallbladder disorders, hernias, infected appendixes and uterine problems. Many weight reduction surgeries are considered laparoscopic.

So then, what is endoscopic surgery? All these procedures can be lumped into the category of endoscopic surgery, which comes from the Greek word endon and means “within” and uses small cameras to “look within a body area.” All are considered minimally invasive procedures. Patients benefit from faster recovery times, and much less pain and discomfort.

The lower back (or lumbar spine) is an area of the body that endoscopes can be used to explore and treat spinal disorders. A herniated disc is one such disorder, which occurs when the soft jelly part of the disc comes out and presses on nerves. Spinal stenosis is another and develops when arthritis presses on nerves in back. Both disorders cause pain that radiates down the leg with associated numbness, tingling and weakness.

This use of TV cameras to treat common spinal disorders has been around for more than 40 years, but has been slow to advance, and until now, has not been offered in Northern Arizona. Unlike common orthopaedic and general surgery, endoscopic procedures, endoscopic spine surgery has had slower advancements in technology, equipment, training and associated expertise. The advanced surgical skills required depend on great surgical dexterity and skillfulness; as the very nature of working around nerves in tight places (a very delicate place to be) is critical for good outcomes.

Today, endoscopic spinal surgery is occurring more frequently. The February 2016 Journal of Neurosurgery was entirely dedicated to endoscopic spine surgery, discussing its history, application to spinal disease, outcomes and complication rates, which data suggests are low, compared to open procedures. Studies also show a generally faster recovery time and return to function.

A typical endoscopic spine surgery is done in an outpatient surgery setting and usually under local anesthesia. The approach is through the small opening on the side of the spine where the nerves exit and uses a small 1/3-inch skin incision. This is where the camera or scope is inserted. A surgeon can also approach from the back of the spine and in between the lamina (the boney part of the spine that covers the main nerve canal). Either approach is considered minimally invasive.

Endoscopic spine surgery is an exciting treatment for people with lumbar spine disorders together with nerve compressions, whose conditions have not responded to non-operative care.

Traditional spine surgical techniques are still required for most patients, but for those who have specific, well-defined problems of nerve compression, this “new,” less invasive approach can make a difference. FBN

By Michael Glover, M.D., MBA

Dr. Glover is a fellowship trained, board certified orthopaedic spinal surgeon with the Spine and Pain Center at Northern Arizona Orthopaedics. He recently became trained in the application of Transforaminal Endoscopic Spinal Surgery Systems (TESSYS) helping patients recover much faster from spine surgery. To learn more, visit NorthAZortho.com or call 928-774-7757.

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