1. The Concept of Minimally Invasive
In the written history of medicine, the original concept of minimally invasive can be traced back to the great philosopher and medical scientist Hippocrates, who recognized and told us more than 2,000 years ago that “medical interventions must first be as non-invasive as possible, otherwise the therapeutic effect can be worse than the natural course of the disease”.
In the 20th century, with the invention of anesthesia, asepsis, antibiotics and the understanding of human physiology, surgery reached a new level of development, but it was then recognized that surgery is a double-edged sword, which has a negative impact on the body when removing lesions. In the late 20th century, the development of microelectronics, optics, modern science and technology made minimally invasive surgery more popular.
Nowadays, minimally invasive techniques such as endoscopy, laparoscopy, key roll, laser technology, etc. have been widely used. Regardless of the method used, the meaning of minimally invasive surgery in a broad sense should be to reduce the local and systemic injurious effects brought about by surgery. Guo Chaobin, Department of Otolaryngology, Qingdao Municipal Hospital
2. Several views on minimally invasive
Minimally invasive surgery is a relative concept for traditional surgery. The basic development trend of medical treatment is to be as minimally invasive as possible to achieve the best therapeutic effect with the least medical source damage. For minimally invasive surgery, it is not enough to operate gently. It is important to emphasize that a procedure cannot be considered minimally invasive if a small, non-medically invasive approach is used inappropriately for a particular lesion, but because it does not achieve the desired result.
Any large surgical approach that can effectively remove a lesion but does not take into account minimizing the damage to all layers of tissue during the procedure cannot be called minimally invasive either.
According to Qiu Fazu, any treatment measure that can reduce the surgical damage to the tissues and facilitate the recovery of body functions should be minimally invasive surgery. While curing the disease can still retain the appearance of a complete, beautiful body, restore the physiological functions of the human body, which obviously meets the highest interests of patients, but also to meet the pursuit of the surgeon’s combination of science and art.
3. Our means to achieve minimally invasive purposes
The development of modern diagnostic imaging technology, surgery and surgery-related technology can help us achieve this goal. the development and popularization of these advanced diagnostic methods such as CT, MR and super-selective angiography, the continuous improvement of microsurgery technology and endoscopic surgery technology, and the application of image navigation technology or computer-aided surgery provide technical support for minimally invasive surgery.
4.Application of minimally invasive technology in rhinology
The nose is located in the human head, with complex anatomical structure and adjacent relationship with the surrounding, and is mostly located in the craniofacial bones, with deep location and relatively difficult surgical access, with the development of various medical related technologies, minimally invasive techniques are widely used in rhinology. Among them, the application of nasal endoscopy technology is an epoch-making change in rhinology, which also makes rhinosurgery in the forefront of minimally invasive surgery, and laser, microwave and radiofrequency technologies are also important components of minimally invasive rhinology technology.
Functional endoscopic sinus surgery (FESS)” mentioned by Kennedy refers to the surgical operation performed under the nasal endoscope with the goal of unblocking the sinus-oral-nasal tract complex, which is a milestone in the development of nasal endoscopic surgery, but gradually replaced by minimally invasive nasal endoscopic surgery. The connotation of modern nasal endoscopic surgery should be: under the direct view of nasal endoscope, with the premise of preserving the structure and function of the nasal cavity and sinuses as much as possible, to remove the lesion, improve and reconstruct the function of nasal cavity and sinus ventilation and drainage as the purpose of nasal surgery techniques. The specific contents include the following four aspects.
① nasal endoscopic surgery under television surveillance;
② Removal of nasal cavity and sinus lesions;
③ Correct mucosal harvesting and structural reconstruction;
④Postoperative follow-up and comprehensive treatment.
The above connotations are in line with the concept of minimally invasive surgery, and it is worth emphasizing that using nasal endoscopy for surgery does not mean minimally invasive surgery. The concept of minimally invasive surgery should be carried out in every procedure of nasal endoscopy including examination, anesthesia, surgery, stuffing, removal of stuffing, drug exchange, rinsing, etc. In addition to the lesions affecting the ventilation and drainage of the nasal cavity and sinuses should be completely removed, inflammatory lesions should be preserved as much as possible and their recovery should be promoted through comprehensive treatment; the removal of lesions and opening of the sinuses should be done with sharp instruments such as sinus knives, mucosal forceps and cutting drills as much as possible to avoid tearing so as not to The opening of the sinus opening should be moderate, not the bigger the better.
In addition, the minimally invasive concept of nasal endoscopic surgery does not mean that auxiliary incisions or auxiliary accesses cannot be added. In some complex lesions of the nasal cavity and sinuses, such as nasal sinus tumors, the addition of external nasal incisions and other auxiliary accesses to ensure complete removal of the lesion is also in line with the minimally invasive concept. The application of some new equipment or tools such as electric suction cutter, laser, microwave and radiofrequency is also an important component of minimally invasive nasal endoscopic techniques and should be widely used.
I often encounter patients who reported that they had undergone minimally invasive nasal endoscopic surgery in local hospitals, but after the surgery, they had dry nasal cavity, hyperventilation, headache, and still runny nose, and the examination revealed a “mess”, so to speak, with absent middle turbinate, extensive scarring of middle nasal tract, and oversized maxillary sinus opening.
This indicates that although it is a nasal endoscopic surgery, no attention is paid to the protection of important nasal structures and mucous membranes during the operation, thus damaging the physiological function of the nasal cavity and causing irreversible consequences. Therefore, nasal endoscopic surgery should be chosen carefully, firstly, adequate perioperative treatment should be performed before surgery; secondly, doctors trained in nasal endoscopic surgery in regular hospitals should be chosen to do it; thirdly, follow-up, follow-up and treatment should be insisted on.