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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.

Alejandro Badia, MD, FACS
Hand and Upper Limb Surgeon
Badia Hand to Shoulder Center BHSC
Co-Founder / Chief Medical Officer – OrthoNOW®
Author of Healthcare From The Trenches  

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