The truth?

The truth is as follows: MIS has limited applications in foot and ankle surgery. Simple exostectomies, EPF, and joint arthroscopies are a few instances where this approach is viable and has documented literature.

MIS peaked in the mid 80s when 50%+ of the graduates were not receiving any postgraduate training. Many of those who touted these "innovated techniques" had little or no "open training" and were using the procedures as advertising tools. Walk in walk out surgery, come in and have your bunion fixed over lunch ads were seen in various cities.

If these techniques are better or even the same as open, please show me the literature to back this up. Many of the fathers of these procedure have found themselves more in the courtroom than the library. A report entitled the walking wounded surfaced in Chicago in the 80s where some of the devasting results of multiple osteotomies performed on the first visit were shown and the high number of malpractice cases these doctors generated.

Some of the advocates try to draw a parallel between this and laproscopic techniques used by general surgeons today. 2 big differences exist, first many/ most of these MIS surgeons( unlike the general surgeon) have litle or no open training, making their experience limited and their ability to handle complications difficult. Two, the general surgical procedures are the same whether open or closed with the same indications and have been proven scientifically. Many of the MIS gurus advocated transmetatarsal oseteotomies and other unproven techniques that are rarely indicated whether open or closed. Today, even the concept of outpatient surgery isn't an arguement since the majority of the procedures are now done as an outpatient whether through a stab incision or a 5 cm incision.

Finally this arguement that in certain areas this is done because of the lack of hospital privileges is also a sham. Sterility and general OR techniques should be the same be it for MIS or open surgery. An office OR can be setup for open as easily as closed procedures. It is either an OR or it isn't. Plastic surgeons for years have had office surgical suites equipted to do complex procedures. If the DPM does not have hospital privileges, I would question if they should be doing any surgery in today's world. Where will these doctors handle their severe postop infections, nonunions etc. We all know these can not be handle through MIS techniques. Is justified to pass these off to credentialed doctors when they occur?

Bottomline is as always put up or shut up. Show me where these techniques have been proven and show me how you received this training and answer the above questions. Why keep us in the dark?

My opinion................