Notas / Notes - Active Congress.......

MIÉRCOLES / WEDNESDAY
54
There are no data that indicate one small incision is better
than another. Comparative studies of posterior mini-incisions
to two-incision operations do not show superiority for pain
and show conflicting data for functional differences. 8,27 The
anterior “no muscle cut” incisions likewise have shown no
superiority. Berger has not been able to achieve same-day
surgery discharge with the anterior incision as he achieves
with the two-incision operations (personal communication).
Duwelius and coworkers 8 also had earlier discharge with the
two-incision patients. A cadaver study suggests the anterior
and posterior small incisions have similar muscle damage
because of retraction force with the anterior incision. 32 Clinical
results are not better in anterior incisions than published for
posterior incisions, 12,23,26 and no randomized studies have
been reported with anterior incisions. It would seem that
surgeons who operate posteriorly should remain posterior,
and those who do so anteriorly should continue to do so.
This will eliminate the risk of additional stress for the surgeon,
and complications, which would be present in changing the
operative approach in addition to the incision length.
Surgeons must accept the change in patient attitude, which
has been the quintessential feature of the MIS experience.
Today’s electronic age exponentially expands the patient’s
community network through which they seek and gain knowledge
for their health care. 11,12,19 Patients form expectations
and develop optimism and decisiveness to overcome their
disability if they gain information that gives them hope of
regaining quickly their control of their social world. 14,18 Optimism
and education will encourage the underserved patients to
overcome their fears and elect to undergo the operations.
10,11,14,19 The surgeon must learn the expectations of
each patient and strive to fulfill their goals. 13,14,20,21 If goals
are unrealistic, the surgeon must take the time to direct the
patient to acceptable achievable goals. Each surgeon must
weigh the risk-to-benefit ratio of MIS THR for each patient
based on surgical skill and experience, the culture of his/her
community, and the mental health of the patient.
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