It’s a Small World

 
The modern operating room and Disneyland have something in common. While Disneyland’s theme park attraction, “It’s a Small World,” entertains millions, modern endosocpic surgical suites bring the “small world” to the patient with endoscopic and microscopic surgical technologies. The virtual voyage made possible by the development of endoscopic cameras, permit surgeons to make small incisions and see the anatomy once only the province of larger surgical approaches. The television era of surgery has invaded the operating room as surgeons learn new skills. Instead of staring directly at the anatomy though large surgical incisions, the small endoscopic cameras allow surgeons to see the anatomy displayed on television monitors and manipulate the structures while watching the image on the television screen.

 
Much like a video game, the surgical skills involve different eye-hand coordination than traditional head down surgical position. Are these skills new? No. With the advent of arthroscopy, knee, elbow, and shoulder surgery developed into outpatient procedures. Surgeons discovered that they could often “see” better in the small crevices by arthroscopic visualization than with the conventional large incision.

The arthroscopic revolution reached spine surgery when surgeons figured out how to “dock the camera,” freeing their hands to perform surgery without holding the endoscopic camera. The constant view of the anatomy could be magnified to provide the benefits of microsurgery, at the same time satisfying all the benefits of “open surgery.” For patients, having an operation with long standing traditional results but with less pain, less hospital time, and potentially quicker recovery, was appealing.

The goal of METRX microdiscectomy or METRX microendosocpic surgery is the decompression of the spinal nerve. The microscopic view involves pointing a microscope down the endoscopic tube and directly visualizing the magnified anatomy. The endosocpic view involves docking the endosocpic camera on the ring of the tube and visualizing the projected anatomy on the television. The surgical instruments are inserted through the tube which is fixed by a retractable arm to the side of the operating table. Herniated discs in the neck or back and bone spurs compressing spinal nerves may be accessible through these minimally invasive techniques.

The next time family or friends are thinking about spine surgery, remind them that it really is a small world.

Words © 2002 William Dillin, M.D.

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