Since the beginning of surgery, surgeons have sought to minimize trauma to patients, not only in terms of tissue and organs, but also in terms of physiology and psychology. At the end of the 20th century, the concept of “minimally invasive surgery” (MIS) emerged in the surgical community.
After nearly 20 years of clinical practice, the concept of MIS has been generally accepted by surgeons and is considered to be the main theme of surgical development in the 21st century. Minimally invasive surgery is a profound revolution in surgical techniques (surgery) based on traditional surgery (or classical surgery), and should naturally be the future of surgical development.
Minimally invasive surgery (MIS) is considered to be a profound revolution in surgical techniques developed on the basis of traditional (classical) surgery and is the main theme of surgery in the 2l century. Huang [2] pointed out from a theoretical height that “MIS refers to the achievement and maintenance of an optimal state of internal environmental stability (local and systemic) under any surgical traumatic stress condition”. However, there is no mature and unanimously agreed definition of MIS so far. Most people agree that any surgery (treatment) that can reduce the trauma to the tissues and organs, physiology and psychology of the patient’s body can be included in MIS (treatment).
Although the official name of minimally invasive surgery is in the late last century, but the emergence of minimally invasive surgery prototype has been very long. As early as the 16th century, surgical methods of hemostasis changed from thermal coagulation with a soldering iron to ligation of blood vessels, and the use of cool oil instead of the traditional boiling oil in the treatment of gunshot wounds (ambrosiapare, 1510-1590). All of these improvements were informed by the concept of minimally invasive surgery. Although the concept of MIS was introduced by Wickham as early as 1983, it was not until 1987, when Philippe Mouret performed the first laparoscopic cholecystectomy, that MIS was formally recognized and developed rapidly. History and experience have proven that science, technology, and engineering are inextricably linked. The advent and development of minimally invasive surgery confirms this.
Minimally invasive surgery is mainly about skill, but without the scientific concept. It is impossible to emerge without the support of new techniques, materials and instruments. The emergence of minimally invasive surgery should be based on the rapid development of high technology in the late last century, which is mainly information technology, especially the emergence of modern digital diagnostic instruments (CT, MR, DSA, B ultrasound and three-dimensional imaging, etc.) based on the development of computers, advanced endoscopic, lumpectomy and minimally invasive surgical instruments of all kinds, as well as from the molecular level, especially the in-depth research on genes, molecular signaling, etc., to promote The development of various minimally invasive therapies such as targeted therapy has been promoted. Without these, minimally invasive surgery or procedures would be a source of no water.
Like other systems of surgery, minimally invasive surgery in the oral, maxillofacial and cervical areas has been carried out gradually since the 1980s from scratch. The earliest start was temporomandibular arthroscopy based on systemic endoscopy (Onishi, 1975), followed by minimally invasive endoscopic thyroid surgery (Gagner, 1995) and endoscopic (or assisted) salivary gland surgery (Katz, 1991).
At present, minimally invasive oral maxillofacial and cervical surgery is gradually being performed in various subspecialties, such as oral and maxillofacial nerve disorders, maxillofacial trauma, orthognathic surgery, and minimally invasive surgery for oral and maxillofacial a head and neck tumors, etc. The content of MIS in a broad sense should include endoscopic surgery, interventional therapy, directional guidance surgery, navigation surgery, telesurgery (robotic surgery), etc.; secondly, laser therapy, cryotherapy, biological targeting therapy and improvement of surgical style (including preservation surgery, surgical access incision improvement) can also be considered as MIS or minimally invasive treatment.
At present, the main MIS carried out in the field of oral and maxillofacial surgery are as follows.
1, endoscopic surgery or endoscopic-assisted surgery endoscopic surgery (endoscopic surgery) refers to the entire surgery is performed under the endoscope; and endoscopic-assisted surgery (adjuvant endoscopic surgery) is only in some surgical steps using endoscopic surgery.
2, temporomandibular joint disease endoscopic surgery indications include osteoarthrosis, intracapsular fibrous adhesions, habitual joint dislocation, septic arthritis, synovial chondromatosis, and adjunctive joint reconstruction surgery.
3.Salivary gland diseases are mainly used for ductal calculus, non-lithotripsy obstructive salivary gland disease can also be applied, and occasionally used for adjuvant submandibular gland removal and parotid gland lobectomy.
4.Maxillofacial neurological diseases are mainly used for imaging-oriented positioning of radiofrequency temperature-controlled thermocoagulation, which can enable accurate positioning of the needle tip; it can also be used to assist intracranial and external decompression surgery for triple neuralgia and facial muscle twitching.
5.Maxillofacial trauma can be used for various types of maxillofacial fracture repositioning and internal fixation. The minimally invasive effect of applying endoscopic positioning to perform deep foreign body removal is even more worthy of affirmation.
6, oral and maxillofacial – head and neck tumors to selectively used for benign tumors and adjuvant parotid benign tumor resection has been reported more.
7, oral and maxillofacial deformities or defects are mainly used in cosmetic surgery. Such as facial contouring and dermatoglyphic tautness. In experimental studies, it has been confirmed that it can also be used in orthognathic surgery.
8.Interventional therapy is mainly used for transarterial cannulation or biological targeting of malignant tumors. It has excellent effect on vascular malformation, especially central arteriovenous malformation of the jaw, and can avoid the disadvantage of surgical bone cutting.
9. Surgical improvements include selective cervical lymphatic dissection for malignant tumors (electiveneck dissection), open window decompression for large jaw cysts, distraction osteogenesis, minimally invasive tooth extraction, minimally invasive implant surgery (such as maxillary sinus lift), and so on, all of which reflect the guiding ideology and spirit of MIS.
Surgery has been developed for centuries and has accumulated a lot of clinical practice experience. In the process of development, some procedures have been naturally eliminated, while others have become more mature and have been preserved as recognized and effective traditional (or classical) procedures. Any new procedure or treatment always has to be clinically tested and its value and usefulness has to be finally evaluated in practice. What are the indications for minimally invasive surgery?
What are the indications for minimally invasive surgery? Which minimally invasive surgery is suitable for which disease or which condition, all need to be summarized and explored in practice before a clear conclusion can be reached. Until then, some traditional surgeries still occupy the main position and have clear indications; at least for a period of time, it is not possible to talk about minimally invasive surgery instead of traditional surgery. For this reason, the relationship between traditional surgery and minimally invasive surgery must be viewed in two different ways and dialectically.
The concept of traditional surgery and minimally invasive surgery also needs to be dialectically unified and not viewed in opposition to each other. For example, traditional surgery emphasizes the exposure of the surgical field, resulting in longer and more incisions and larger trauma, but the purpose is to reduce the trauma surface rather than intentionally creating trauma. Smaller incisions and fewer incisions can cause poor exposure of the surgical field, and forced traction can cause greater tissue trauma, which is counterproductive to the purpose of minimally invasive surgery. Likewise, if the total time consumption of minimally invasive surgery greatly exceeds that of conventional surgery, ask which procedure is more traumatic?
In addition to the aforementioned oral, maxillofacial and neck surgery, which requires continued efforts in clinical practice to explore and determine the indications for surgery, it is more important to conduct clinical studies scientifically, systematically and prospectively to further clarify the advantages and disadvantages of minimally invasive surgery. In conclusion, minimally invasive surgery is an important direction for the development of surgery in the 21st century, and there is a long way to go, not only for all surgical subspecialties, but also for oral, maxillofacial and cervical surgery.