Less Invasive Procedures
By Alejandro Badia, MD, FACS
I am inclined to perform a new operation or variation of a procedure when I feel the existing option does not lead to ideal results, or more often, when the newer option is more efficient and often cost-effective, and more imporantly, when the patient will recover faster and with less discomfort. For the latter to occur, this often means leaning towards less invasive procedures.
Recently, I performed my 2nd shoulder arthroscopic SCR (superior capsular reconstruction) in a patient with massive rotator cuff deficiency, but minimal to no cuff arthropathy changes. Previously, I would simply debride the shoulder, intent some type of margin convergance, and hope for pain relief. If pain was severe enough, I often went to reverse shoulder arthroplasty, always outpatient of course (another topic). I moved to the SCR because it is minimally invasive, burns NO bridges, and my first patient did remarkably well. Granted it is not “evidence based medicine” but I make my clinical decisions based upon my knowledge of pathology, kinematics and understanding the options, not simply because a clinical series suggested this. Heresy I know, but I feel we must use our common sense and clinical acumen to provide our patients with the best option one can provide, not the literature.