Scar-less Day Surgery for Ganglion Cyst
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Features of our Ganglion Surgery
Under high-definition echo guidance,Non-ablative ganglion surgeryThe procedure is performed using a surgical incision. Compared to the conventional method, which involves incisions, the scars are less noticeable and the surgery is less painful. Stitches are not required and water can be used on the same day. (Although minimally invasive, some pain and swelling may occur due to manipulation of the joint. It takes time for the tissue to repair and for a strong adhesion to occur.1~ (after a number N)2It will take about 3 months to complete the surgery, so take it easy as much as possible and do not do any strenuous or unnecessary labor or work after the surgery.1~ (after a number N)2Avoid for a period of months.)
What is a ganglion?
A ganglion is an accumulation of synovial fluid (lubricating oil for joints and tendons) secreted by synovial tissue in joints and tendon sheaths (sheaths around tendons) that has leaked out of the joint capsule or tendon sheath where it is supposed to be. Smaller fluid has no symptoms, but as it grows, it pushes against the surrounding area, causing pain and numbness. The disease is most common in women with soft joints and is often seen in the upper limbs. It is seen in people of all ages, from the young to the middle-aged and elderly.
Basically, it is not a tumor and is not malignant, so it can be left alone. The treatment of choice is punctal aspiration or radical surgery. However, the disease has a high recurrence rate and treatment may be prolonged.
Bridging the gap between injection therapy and surgery, "no-cut" surgery
A ganglion is a pool of water that leaks from a joint and is always connected to the joint. Therefore, even if only the accumulated water is drained out by injection, the water will still flow from the joint and in many casesrelapseThe first time I did it, I was not sure what to do.
The radical operation isIncision.Incisional surgery" or severing the connection with the joint,arthroscopeThe only way to do this was by "arthroscopic surgery," in which the pathway is destroyed with an arthroplasty. Most often, hospitalization is required, and a certain rate of recurrence occurs after either surgery, so there are still challenges to be overcome for complete radical cure.
Our clinic performs "no-cut" surgeries, which require as few incisions as possible and fill the gap between injections and surgeries.
Surgery for "non-surgical" ganglions is,Unique techniques developed at our clinicIt is the first clinic in Japan to introduce this technique. As a pioneer clinic in Japan that introduced this technique early on, we have evolved a delicate and precise method that is unmatched by other clinics, reducing the risk of ganglion recurrence and neurovascular damage, and improving safety and certainty.
Wound size and pain are about the same as injections
The "no-cut" ganglion surgery utilizes ultra-high definition echo to cut off the source of synovial fluid that causes recurrence of ganglions, making recurrence as good as or better than surgery. The pain (Note 1) is almost the same as with injections. Of course, the size of the wound is also almost the same as that of the injection. There is almost no scar left. (Note 1: Because the operation is performed inside the joint, inflammation around the joint may occur, in which case weak pain may occur.)
- Characteristics of "non-surgical" ganglion surgery
- day trip
- Less pain
- Leaves no scars
- Less bleeding.
- Low risk of infection
- You can take a bath from that day
- You can use your fingers from day one.
- No need for postoperative disinfection visits
- Safe because it is monitored by echo
- Easy reoperation in case of recurrence
Recommended for
(1) Those who cannot take time off work
(2) Those who are not comfortable with general anesthesia or anesthesia of the upper extremities
(iii) Those who are sensitive to pain
4) Water workers and housewives
(5) Those who do not want to leave scars
(6) Repeated recurrence of ganglion
(7) Musicians and musicians
Canon high-definition echo and 24 MHz high-frequency probe are used
In order to confirm the position and direction of the needle to be used, the clinic uses Canon high-definition echoes, which are known for their image resolution, instead of the standard echoes used in regular orthopedic surgery. The standard probe used in orthopedic practice18Mhz high-frequency probeIn addition to the24MHz ultra high frequency probecan be used.0.1With a resolution of mmBecause of,The images are more subtle than those of normal echoes, allowing for a safer and more reliable surgical procedure.The 24Mhz ultra-high definition probe has only been introduced at the university hospital level and is available nationwide.It is one of the few medical institutions using the same probe.
In addition, depending on the body part, high-definition echoes may be used as an adjunct tomicroarthroscopefor the first time in the past.Thinner than the 2mm or larger diameter arthroscope usually used, with a diameter of 1.9mmThe micro-arthroscope allows for minimally invasive, accurate, and safe treatment.
Standard resolution echo commonly used in orthopedics
break up an ant's nest
The best way to prevent the recurrence of ganglions is to cut off the source. If we think of the supply passage as an "ant's nest hole," the "no-cut" ganglion surgery is performed in the same way as "breaking the entrance to an ant's nest. That is, the entrance is broken with a needle and covered with blood to prevent recurrence. In addition, the pathway and pouch are also disrupted so that the pouch does not swell when fluid leaks out.
Because the entrance, pathway, and bag are broken in three stages, the recurrence rate is kept to a minimum.
Surgery is performed under local anesthesia. Therefore, it is a one-day procedure, and in all cases, patients are able to move their fingers and take a bath on the same day.
The "non-surgical" ganglion procedure
- Inject local anesthesia.
- While looking at the echo (or microarthroscope), break the source, pathway, and pouch of the ganglion.
- Aspirate the inner solution in the bag.
- Compression hemostasis is applied and the procedure is completed.
Day trip and can be wet from day one.
The procedure involves crushing the ganglion's opening (the joint capsule with its ligaments) and daring to form a blood scab to close the hole by covering it with a lid. The pathway and fluid collection bag are also broken. It also breaks the pathway and fluid collection bag. Therefore,Inflammation around joints.There are times whenPain persists for some timeThere may be Tissue repair (time for the ligaments and surrounding synovium at the site of origin to regenerate) and,It takes one to two months for strong adhesions to occur.Therefore, take it as easy as possible,Avoid strenuous or unnecessary labor and work for 1-2 months after surgery.Please make sure to do so. (Avoid manual handling, heavy lifting, wringing towels, etc.)
To prevent recurrence to the greatest extent possible,Wear a brace for 1-2 months after surgeryWe recommend that you do the following
(For ganglions in the lower extremities, the recurrence rate is higher because of the tendency to leak joint fluid due to the load applied.)
Postoperative Precautions
The procedure involves crushing the ganglion's opening (the joint capsule with its ligaments) and daring to form a blood scab to close the hole by covering it with a lid. It also destroys the pathway and the bag in which fluid accumulates. Therefore,May cause inflammation around joints, and pain persists for some timeThere may be Tissue repair (time for the ligaments and surrounding synovium at the site of origin to regenerate) and,Before a strong adhesion occurs.1~ (after a number N)2It'll take months.Therefore, take it as easy as possible,Heavy or unnecessary labor or work is postoperative.1~ (after a number N)2Avoid for a monthPlease do so. (Avoid touching, carrying heavy objects, wringing towels, etc.)
To prevent recurrence to the greatest extent possible, postoperative1~ (after a number N)2 weeksis wearing a brace (Figure)We recommend that you do the following
(For ganglions in the lower extremities, the recurrence rate is higher because of the tendency to leak joint fluid due to the load applied.)
If you just aspirate with a needle, the recurrence rate is40~ (after a number N)70It is said to be about 1.5%. Even if this surgery is performed, the approximateRecurrence in about 5%.(Except in the case of the lower extremity, because of the load applied, and in the case of the toes,About 40% relapse)It will cause aIn that case, this treatment can be done again because it is as invasive as the injection treatment. If the disease inevitably recurs, another method may be tried. Please consult your doctor at the time of consultation for more details.
If it recurs, don't worry.
If you just aspirate with a needle, the recurrence rate is40~ (after a number N)70It is said to be about 1.5%. Even if this surgery is performed, the approximateRecurrence in about 5%.(Except in the case of the lower extremity, because of the load applied, and in the case of the toes,About 40% relapse)It will cause aIn that case, this treatment can be done again because it is as invasive as the injection treatment. If the disease inevitably recurs, another method may be tried. Please consult your doctor at the time of consultation for more details.
Complications and Disadvantages of Surgery
Because any surgery or procedure is invasive to the body, there is a risk of complications. Specifically, there are the following risks: (1) allergies due to drugs; (2) complications due to swelling, bleeding, or hematoma; (3) infection; (4) nerve or blood vessel damage; (5) pain or resulting movement disorders; (6) thrombosis or embolism; (7) skin scars, keloids, or wound pain; (8) joint contracture or joint instability (when joints are manipulated); (9) other complications (CRPS) and other unforeseen complications (e.g., problems not only in the affected area but in other parts of the body as well). Since the future can be unpredictable, we will take the best possible measures (administration of drugs, additional surgical procedures, additional treatment, resuscitation, emergency medical care, etc.) depending on the situation. In case of emergency, we may perform the surgery without your consent, but we ask that you understand this before accepting the surgery.
Difference from ganglion surgery, which involves an incision
Incisional ganglion surgery can be divided into two methods: one is to remove the ganglion from outside the joint through a regular incision, and the other is to destroy only the leakage opening from within the joint using an arthroscope. Both require incisions, which can lead to infection, swelling and swelling, bleeding and hematoma, increased anesthetic fluid volume, resulting drug allergy, neurovascular damage, and pain,CRPSThe risk of complications is generally increased, such as In addition, arthroscopy often requires general anesthesia and hospitalization. The surgery is long, and the tourniquet is applied for a long time, which causes intraoperative pain. Stitches and disinfection visits are necessary because of the incision. Of course, scars will remain. Since the joints are touched, joint contracture due to adhesion is likely to occur, so a less invasive surgery is desirable.
Unfortunately, both incisional and nonincisional surgery sometimes recur. Therefore, we believe that surgery that is as minimally invasive as possible is easier to deal with reoperation in the event of recurrence.
Disadvantages of incisional ganglion surgery
(Comparison with non-surgical ganglion surgery)
risk | important point |
|---|---|
Hemorrhage/hematoma point | Many require hospitalization. |
infection | Increased operating time |
Swelling, edema | Tourniquet arm hurts during surgery. |
Anesthesia solution volume | Requires a visit to the hospital every 2 days for disinfection. |
drug allergy | need to have stitches removed |
neurovascular injury | be left with scars |
pain | 10-14 days, no water work allowed |
CRPS | When it recurs, it recurs, even with incisional methods. |
range of motion limitation | Large incisions are made around the joints, which can cause joint contractures (poor movement) and a feeling of tightness. |
About the cost of treatment
Surgery for ganglions without incision is covered by insurance (depending on the site, it may not be covered by insurance).
Treatment costs vary depending on the area, so please inquire at the time of consultation.
Finally.
Surgery for "non-surgical" ganglions is,Unique techniques developed at our clinicIt is the first clinic in Japan to introduce this technique. As a pioneer clinic in Japan that introduced this technique early on, we have evolved a delicate and precise method that is unmatched by other clinics, reducing the risk of ganglion recurrence and neurovascular damage, and improving safety and certainty.
Since this is a new technique, we explain the advantages and disadvantages of the surgery to the patient and let them choose for themselves. We will then do our best to provide the treatment that you have chosen.
At our clinic, we believe that a trusting relationship with our patients is of the utmost importance. Without mutual trust, we cannot provide treatment. Please feel free to contact us if you have any questions.
Responsibility: Dr. Yuki Toya, Orthopedic Surgeon, Hand Surgery Specialist/Supervisor
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