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All about the non-invasive method

The introduction of the non-invasive method has revolutionized the surgical field, especially foot and ankle surgery.

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Percutaneous technique: possible operations

Since the 2000s and thanks to the percutaneous technique, foot operations have experienced unprecedented growth.

Minimally invasive surgery is different from traditional surgery, or “open surgery”. This type of surgery involves making a large incision in order to be able to access the internal structures to operate.

Conversely, the non-invasive medical technique allows intervention inside the body without having to make large openings.

Although the arrival of the non-invasive method has allowed us to revolutionize our approach to pathology and our way of operating, it cannot be used for all operations. Indeed, some surgical actions cannot be performed percutaneously. It is therefore sometimes necessary to resort to open-air surgery in order to complete the gestures made percutaneously.

Gestures that are achievable percutaneously

  • All gestures made on the tendons
  • Most gestures made on the joints
  • Hallux valgus surgery to realign the big toe
  • Correction of a slight deformation of the 1st metatarsal
  • Metatarsalgia surgery (pain under the forefoot)
  • Toe correction in claws

Deformations that can be corrected by a percutaneous technique

  • Hallux valgus (or onion)
  • Toes in claws
  • The bunionette (or quintus varus)
  • Pain of the metatarsal palette
  • Morton’s syndrome
  • Osteoarthritis of the big toe

Correction of forefoot deformities remains the primary use of percutaneous surgery. It is however possible to correct some deformities of the medio and the hind-foot such as:

  • Talalgia
  • Osteotomy of limestone, flat foot
  • The calcaneal exostosis
  • Haglund’s Syndrome
  • Osteoarthritis of the ankle, sub-talian osteoarthritis

History and definition of percutaneous technique

The appearance of the percutaneous technique in Europe and France follows many developments in the surgical field.

When did percutaneous surgery begin?

Percutaneous surgery first appeared in the United States in the 1940s. It gradually developed through the work and research of American podiatrists. They were not allowed to practise in hospitals, so they had to adapt the surgery in order to practice it in the office.

It was not until 1980 that this new percutaneous surgical technique was introduced in Europe. Over the years, percutaneous surgery has been increasingly used by surgeons around the world. Today, this method is one of the greatest revolutions of modern surgery.

The use of minimally invasive surgery extends to almost all areas of medicine: gynecology, urology, digestive surgery, cardiology, etc.

What is minimally invasive surgery?

The percutaneous method allows Dr. Julien Lopez to make micro-incisions at the level of the limb to be operated in order to perform the necessary surgical actions using different instruments. The terms “percutaneous surgery” and “minimally invasive surgery” are used to refer to the same thing.

Performing a percutaneous operation systematically requires the use of a non-invasive medical imaging technique. To do this, the surgeon uses a fluoroscopy to take x-rays during the operation to guide and control the surgical gesture. The visual inspection of the operation is carried out using radiographic control screens.

In addition to this technique, 2 instruments are particularly used during surgery:

  • The Beaver: It is a very fine scalpel used to perform all the gestures on the soft tissues of the foot (tendons, capsules…)
  • The strawberry: It makes it possible to perform osteotomies (bone gestures aimed at cutting the bone) or exostectomy (gestures aimed at abrading the bone)
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The advantages of the percutaneous method

Unlike traditional surgery, the percutaneous method has many advantages that greatly improve the patient’s comfort.

Open-pit surgery requires wider incisions at the level of the limb to be operated on. These incisions are not harmless and can lead to several inconveniences for the patient: profuse surgical bleeding, post-operative pain extended to the entire territory concerned by the operation, visible scars and often not very aesthetic, with increased risk of infection and a longer hospital stay.

The small incisions required for percutaneous surgery greatly decrease any inconvenience for the patient:

  • Incisions of only a few millimeters limit the size of the scars. The patient will benefit from aesthetic scars, fine and small.
  • The percutaneous technique also significantly reduces surgical trauma of the tissue and therefore the post-operative pain felt by the patient is reduced.
  • Micro incisions also help to limit the risk of infection and complications. The greater the incisions, the greater the chances of an infectious agent entering the body.
  • The patient may also benefit from leaving early from the clinic. Most percutaneous surgeries are performed on an outpatient basis, allowing the patient to go home on the same day.
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The informations on the page is provided for information only, it evokes general cases: your situation is specific.

Dr Julien Lopez, orthopedic foot surgeon in Nice welcomes you and advises you for your plantar aproneuritis.

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