Conclusions: Current evidence suggests that mini-MVS maybe associated with decreased bleeding, blood product transfusion, atrial fibrillation, sternal wound infection, scar dissatisfaction, ventilation time, intensive care unit stay, hospital length of stay, and reduced time to return to normal activity, without detected adverse impact on long-term need for valvular reintervention and survival beyond 1 year. However, these potential benefits for mini-MVS may come with an increased risk of stroke, aortic dissection or aortic injury, phrenic nerve palsy, groin infections/complications, and increased cross-clamp, cardiopulmonary bypass, and procedure time. Available evidence is largely limited to retrospective comparisons of small cohorts comparing mini-MVS versus conv-MVS that provide only short-term outcomes. Given these limitations, randomized controlled trials with adequate power and duration of follow-up to measure clinically relevant outcomes are recommended to determine the balance of benefits and risks

. Radiation exposure higher for MIS procedures, but new innovations coming. Most minimally invasive spine surgical techniques use fluoroscopic guidance which increases surgeon and patient radiation exposure. At the 2013 NASS Annual Meeting symposium on current trends and controversies in minimally invasive spine surgery, Alexander R. Vaccaro, MD, PhD, cited radiation exposure as one of the top reasons he has not adopted minimally invasive techniques.

A 2013 study published in Spine found that spine surgeons performing percutaneous endoscopic lumbar discectomy procedures reach the limit of allowable radiation exposure without a lead apron after 219 lumbar spinal discectomies per year. Surgeons with the apron are able to perform 5,379 per year safely.

6. Goals of open spine surgery remain the gold standard. More spine surgeons are moving toward minimally invasive techniques, but the outcomes achieved with open spine surgery remain the gold standard. Residents and fellows continue to learn the open procedures first and then focus on less invasive techniques.

Types of minimally invasive surgery

Surgeons perform many minimally invasive surgeries, including:

• Adrenalectomy to remove one or both adrenal glands
• Anti-reflux surgery, sometimes called hiatal hernia repair, to relieve gastroesophageal reflux disease (GERD)
• Cancer surgery, for example, to destroy a tumor
• Chest (thoracic) surgery
• Cholecystectomy, to remove gallstones that cause pain
• Colectomy to remove parts of a diseased colon
• Colon and rectal surgery
• Ear, nose and throat surgery
• Endovascular surgery to treat or repair an aneurysm
• Gallbladder surgery (cholecystectomy) to remove gallstones that cause pain
• Gastroenterologic surgery, including for gastric bypass
• General surgery
• Gynecologic surgery
• Heart surgery
• Kidney surgery
• Living donor kidney transplant
• Neurosurgery
• Orthopedic surgery
• Splenectomy to remove the spleen
• Thoracic surgery, such as video-assisted thoracoscopic surgery (VATS) lobectomy
• Urologic surgery
• Dr. Jones points to a 2003 New England Journal of Medicine study that demonstrated the laparoscopic approach resulted in more rapid recovery, fewer recurrences (5 percent vs. 10 percent) and less chronic pain than open repairs, but took longer to perform.