Minimally Invasive Hand Surgery
P re f a c e
Catherine Curtin, MD
Minimally invasive surgery is an area of intense interest for both patients and surgeons. Other surgical disciplines have been revolutionized by smaller incisions and exposures. For example, vascular surgery has embraced endovascular techniques, which had previously been performed mainly by interventional radiologists. Now vascular surgical residencies include endovascular rotations. Minimal techniques have had a more moderate impact on the field of hand surgery. Hand surgery generally does not require explorations of deep dark holes and thus smaller exposures are common practice. Yet there are still opportunities to reduce soft tissue exposures in hand surgery. Also it is likely that we can reduce overall surgical costs to the patient and the health care system using a minimally invasive surgical approach. This issue provides an overview of the areas where minimally invasive techniques can be incorporated into the practice of hand surgery. Before reading this issue, a hand surgeon may ask: “why bother with minimally invasive approaches in hand surgery? Our current practice provides safe and effective care.” There are several reasons for the hand surgeon to be familiar with these techniques. One primary reason is patient demand. If a surgery can be done as safely and effectively with a smaller incision, then patients will seek out this care. In the emerging health care system, patient preference and satisfaction will take on increasing importance to the practicing hand surgeon. For elective procedures, patients are increasingly using the Internet when choosing a physician and they will seek out the surgeon who can offer a smaller “scar.”1,2 In addition, patient satisfaction
is becoming tied to reimbursement. In 2012 Medicare began linking financial incentives to patient satisfaction measures, and smaller surgical exposures are almost always associated with greater patient acceptance. A second reason supporting the adoption of minimally invasive surgery is the potential impact on costs. Some minimally invasive techniques use less manpower and equipment than alternative methods. Dr Lalonde has shown that his surgery on wide-awake patients can be performed safely with lower use of health care resources. His patients have hand surgery with local anesthetic and often simple field sterility.3 Cost comparisons have not been widely undertaken on different techniques. Dr Chung performed a study on Dupuytren’s treatment and found that percutaneous needle aponeurotomy was more cost effective than collagenase or fasciectomy.4 Minimally invasive techniques may become more prominent as insurance companies demand the most cost-effective treatments. Minimally invasive procedures not only are procedures with smaller incisions but also have the potential to significantly lower overall costs. Patient preference and pursuit of the most economic care should not compel us to perform unsafe operations. This issue will detail minimally invasive hand surgery techniques: how they are done and their outcomes. Some of these procedures have been around for decades, such as endoscopic carpal tunnel; others are new approaches to old problems (Dr Lalonde’s wide-awake fracture treatment), and some are treatments that have not been widely adopted (percutaneous trigger release). We hope that this presentation of minimally invasive options
Hand Clin 30 (2014) ix–x http://dx.doi.org/10.1016/j.hcl.2013.09.007 0749-0712/14/$ – see front matter Published by Elsevier Inc.
hand.theclinics.com
Editor
x
Preface and their outcomes will help surgeons choose what techniques might safely fit into their practice. Catherine Curtin, MD Department of Plastic Surgery Palo Alto Veterans Hospital 3801 Miranda Avenue Palo Alto, CA 94304, USA E-mail address: [email protected]
REFERENCES 1. Emmert M, Meier F, Pisch F, et al. Physician choice making and characteristics associated with using
physician-rating websites: cross-sectional study. J Med Internet Res 2013;15(8):e187. 2. Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int 2013;34(6):773–80. 3. Leblanc MR, Lalonde DH, Thoma A, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (NY) 2011;6(1):60–3. 4. Chen NC, Shauver MJ, Chung KC. Costeffectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. J Hand Surg Am 2011;36(11): 1826–34.
P re f a c e
Catherine Curtin, MD
Minimally invasive surgery is an area of intense interest for both patients and surgeons. Other surgical disciplines have been revolutionized by smaller incisions and exposures. For example, vascular surgery has embraced endovascular techniques, which had previously been performed mainly by interventional radiologists. Now vascular surgical residencies include endovascular rotations. Minimal techniques have had a more moderate impact on the field of hand surgery. Hand surgery generally does not require explorations of deep dark holes and thus smaller exposures are common practice. Yet there are still opportunities to reduce soft tissue exposures in hand surgery. Also it is likely that we can reduce overall surgical costs to the patient and the health care system using a minimally invasive surgical approach. This issue provides an overview of the areas where minimally invasive techniques can be incorporated into the practice of hand surgery. Before reading this issue, a hand surgeon may ask: “why bother with minimally invasive approaches in hand surgery? Our current practice provides safe and effective care.” There are several reasons for the hand surgeon to be familiar with these techniques. One primary reason is patient demand. If a surgery can be done as safely and effectively with a smaller incision, then patients will seek out this care. In the emerging health care system, patient preference and satisfaction will take on increasing importance to the practicing hand surgeon. For elective procedures, patients are increasingly using the Internet when choosing a physician and they will seek out the surgeon who can offer a smaller “scar.”1,2 In addition, patient satisfaction
is becoming tied to reimbursement. In 2012 Medicare began linking financial incentives to patient satisfaction measures, and smaller surgical exposures are almost always associated with greater patient acceptance. A second reason supporting the adoption of minimally invasive surgery is the potential impact on costs. Some minimally invasive techniques use less manpower and equipment than alternative methods. Dr Lalonde has shown that his surgery on wide-awake patients can be performed safely with lower use of health care resources. His patients have hand surgery with local anesthetic and often simple field sterility.3 Cost comparisons have not been widely undertaken on different techniques. Dr Chung performed a study on Dupuytren’s treatment and found that percutaneous needle aponeurotomy was more cost effective than collagenase or fasciectomy.4 Minimally invasive techniques may become more prominent as insurance companies demand the most cost-effective treatments. Minimally invasive procedures not only are procedures with smaller incisions but also have the potential to significantly lower overall costs. Patient preference and pursuit of the most economic care should not compel us to perform unsafe operations. This issue will detail minimally invasive hand surgery techniques: how they are done and their outcomes. Some of these procedures have been around for decades, such as endoscopic carpal tunnel; others are new approaches to old problems (Dr Lalonde’s wide-awake fracture treatment), and some are treatments that have not been widely adopted (percutaneous trigger release). We hope that this presentation of minimally invasive options
Hand Clin 30 (2014) ix–x http://dx.doi.org/10.1016/j.hcl.2013.09.007 0749-0712/14/$ – see front matter Published by Elsevier Inc.
hand.theclinics.com
Editor
x
Preface and their outcomes will help surgeons choose what techniques might safely fit into their practice. Catherine Curtin, MD Department of Plastic Surgery Palo Alto Veterans Hospital 3801 Miranda Avenue Palo Alto, CA 94304, USA E-mail address: [email protected]
REFERENCES 1. Emmert M, Meier F, Pisch F, et al. Physician choice making and characteristics associated with using
physician-rating websites: cross-sectional study. J Med Internet Res 2013;15(8):e187. 2. Kline AJ, Anderson RB, Davis WH, et al. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int 2013;34(6):773–80. 3. Leblanc MR, Lalonde DH, Thoma A, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand (NY) 2011;6(1):60–3. 4. Chen NC, Shauver MJ, Chung KC. Costeffectiveness of open partial fasciectomy, needle aponeurotomy, and collagenase injection for dupuytren contracture. J Hand Surg Am 2011;36(11): 1826–34.
