Your response is pretty much that which I had predicted, alleging that my training in the procedure is lacking, and my description of this technique was flawed. But it's pretty laughable that the only thing you offer as proof of this is that I described the use of a tiny puncture incision at the beginning of the procedure and your say, "WRONG . . WRONG," the bur, or drill bit is driven . . oops . . "INTRODUCED" directly through the skin. Adding the word, "specialized" to the word "bur" is rhetoric intended to glorify an otherwise less than gentile procedure. Your attempt at slight-of-word is evidenced by your implication that a puncture wound with a blunt bur is superior to a puncture incision with a sharp scalpel . . I think NOT!
You then obfuscate the fact that an actual incision, such as is performed during traditional surgery, as opposed to the puncture incision, whether by scalpel or bur which is done in MIS, is intended for adequate and necessary visualization of the surgical site. Of course, the MIS devotee will hope that this small incision will somehow connect in patient's mind thoughts of truly state of the art minimally invasive techniques for such procedure as hernia repair and gall bladder removals. But you'll fail to mention when attempting to make that connection that through one of these incisions in these other surgeries is placed an endoscope with a tiny TV camera, so that actual visualization can be accomplished.
All surgery is to some degree traumatic, but the surgeon must balance the need for trauma against its benefits. And making an incision so that one can see what he is doing is a trade off that anyone would agree is appropriate.
As you have once again done here, you and other MIS enthusiasts constantly and repeatedly attempt to be lumped together your blind MIS foot procedures, with modern endoscopic and arthroscopic surgery as performed in other surgical specialties, and this is totally and blatantly disingenuous . . as is your constant fall-back rhetoric that the real reason that well-trained surgeons such of myself are not fully accepting of your techniques due to their being economically threatened by these practitioners. As I have previously stated, though I would prefer it not be, these procedures and many who perform them are more than a small source of income to me as I get to do a lot of resvisions on them.
Your constant assert that these MIS procedures in podiatry take more skill and training than traditional procedures is simply not valid. Skill in surgery is in handling tissues with both care and respect, and the procedures which you advocate demand neither.
The real problem with MIS is not that it CANNOT be done with a degree of skill, but that it CAN and IS done by many in the ABSENCE of skill. It's the "old see one . . . do one . . . teach one" philosophy. These procedures are, for the most part, done in the office, and out of the light of day and the scrutiny of others. That means that just about anyone with a license can do them and get away with it for an inordinate period of time. (courts move slowly) This is far less likely to occur when procedures are performed in a hospital where problems MIGHT be swept under the rug, but they cannot be hidden from those in the know, from peer review and quality assurance, which is the best assurance to the patient public. I know this as chief of my department and the time and care we take to assure quality work on my staff.
That is why my entire discussion with you was generated by your insistence that these MIS procedures are the ONLY valid format for foot surgery and that they should ONLY be done in the doctor's office.
Finally, bet when YOU get sick . . the last place you'll go is to GOOGLE to find a good doctor. Whys suggest that for others?
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