Practical Clinical and Patient Insights on MIBS

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Hi, I'm Larry DiDomenico. I'm in Youngstown, Ohio. I am a program director for East Liverpool City Hospital Residency Program. I'm also a fellowship director for NOMS ankle and foot care centers, and also relative to the minimally invasive surgery, I am the director of medical education for Voom Medical Devices. That's a minimally invasive bunion-focused company with a Bunionplasty 360 repair procedure.

How can surgeons in practice become more acquainted and proficient with MIBS surgery?

The literature suggests that 40 is that magic number of cases one needs to become proficient. And again, that's going to vary from surgeon to surgeon based on his or her experience, his or her techniques with this. Again, I think, well I could speak first hand with Voom. We do one-on-one training. There's chat rooms. There's continually weekly updates, education. There's a journal of minimally invasive bunion surgery that came out. The editor is an orthopedic surgeon out of Paris, France. There's a ton of education. It’s like anything else it's a whole.

The details are what's most important in the surgery and there's a whole team of surgeons who have a ton of experience they're gonna share and weigh in and help guide everybody through so there's one-on-one surgery. Typically we'll send somebody out first couple of surgeries until the surgeon is comfortable. And then the biggest thing is to follow up and learn the details of every maneuver that one is doing when they're doing this procedure. So I think that's like anything else that the devil's in the details and making sure that that individual follows through with the details as much as possible for that, you know. But again, for full disclosure, I'm early in my surgical career of this, not so much the knowledge, but the surgical career of doing these procedures. And that's been my experience thus far and watching others go through it and seeing those who have three, five years experience more than I do and listening to them and watching them, I think is the other part of that.

Answering common questions about MIBS

I think the biggest question is whether does a bone really heal? Because you're moving it so much. That's I think the biggest thing and then the second thing is, does a hold does a hold together because what we promote is actually it's counterintuitive and what you would think like the larger IM angle the easier it actually is. The larger IM angle the better the repair is. One screw is better and two screws, typically the AO way of thinking is two screws better. One, this all works sort of backwards in many ways and that's where the individuals who really want to look into this, they really have to study it and learn because there's a lot to learn from it. But once they learn it, it'll really stick with nicely and hold a lot of good water for them and be very predictable outcomes safely for them and their patients.

How have patients responded to MIBS?

You know, actually patients don't ask a ton, which is interesting. They love the fact that A, they're going to have a shoe on right away or B, they can walk on the same day and there's going to be small scars in particular more the female population than the male population. But in practice, I'm in private practice, it's real life. Either you're a single young adolescent or a teenager college student, but most of people I see are more adults. So they're either moms or taking care of their parents or something along those lines, and or they have a job. So all those type of scenarios, those people need to be weight-bearing, mobile, it's horrible to be laid up.

I'm personally a patient and, you know, being laid up a couple of times now, you realize what it is to be a patient and it's hard to be a patient. So anything we can do to help patients mobilize and more normal, if you will, I think is a game changer and I think patients really respect that. But most patients like that fact more than anything else.

I show them pictures before or after. Most patients don't really question that component of it as much. Some people are, you know, looking online and seeing other procedures and they may want to know the difference between procedure A and B and C and I explain it to them. And I always give it, let the patients make the options, I recommend what I think would be best for them or easiest for them and more globally sound for their bunion repair. And you know, this would be my first choice because it is, again, more patient friendly. And I think most patients like it, at least in my experience thus far, much more than other procedures.

Further clinical insights on MIBS

I think the biggest thing is any bunion does work. And again, typically, I was like, big, big bunions can't just opposite a bigger bunion is easier and better to some degree. It works for any bunion. And again, the bone heals. And it's, it's friendly in a sense that we're talking about two small incisions, one's a stab incision, essentially putting the screw in. Another one's maybe a half inch at the most I would say.

So cosmetically the soft tissue envelope is intact. You leave a natural anatomy there as much as possible and you're just really realigning the joint and you're realigning the osteostructures and creating a new functional axis for a straight toe and joint.