Advancement of technology and surgical skills act in synergy to lead to exploration of new solutions in spine surgery. One of the key areas of spine innovation is endoscopic spine surgery and its application to a broader spectrum of conditions with the aim of reducing perioperative morbidities, soft tissue and bony conservation and yet achieving long term target outcomes of gold standard traditional open spine surgery. Twenty first century marks the new century of opportunities and challenges, in the face of threat of Coronavirus pandemic and difficult circumstances in hospital bed management and limitation in medical resources, minimally invasiveness is evolving from individual patients’ benefits to public interest.
The year of 2020 as a dawn of a new century presented new challenges in the world of medicine. The emergence of Coronavirus-19 (COVID-19) had led to new perspective in the treatment of patients. Many countries went into various versions of locked down or limitation of social interactions restrictions order in different period of the year 2020, health care institutions and hospitals are overwhelmed with patients requiring medical attention for Coronavirus. Many chronic and degenerative surgical conditions treatment are placed on the lower priority in the hospital administration point of view. Elective spine surgeries are postponed or cancelled for sustained period of time. Day surgeries are preferred to surgeries requiring hospital stay unless it is an emergency. Inpatient beds are prioritized for treatment of patients who are in respiratory distress, reserve beds are also kept empty to preserve space in preparation for a spike in Coronavirus situation. As the countries are preparing themselves for the new normal, spine surgery has to keep up in innovation, technical development and protocol generation for the new era of preservation of hospital resources. Endoscopic Spine Surgery has undergone several generations of development and has replaced many of the open surgeries as a treatment for patient with degenerative spinal conditions in some of the surgeons’ practice [
The key feature for day surgery is minimizing postoperative pain, soft tissue preservation and small wound size for easy wound care. Lee et al showed there is decreased soft tissue and muscle injury in endoscopic as compared to microscopic surgery with low creatinine kinase as marker of soft tissue injury postoperatively [
In a typical case of uniportal and biportal and endoscopic surgery, the need for assistant surgeon is optional rather than essential. As there is only one incision in uniportal endoscopic surgery, there is no role in assistant surgeon in the operation as it is performed by a single surgeon only. In biportal surgery, although there are 2 incisions and some surgeons have a preference for a surgical assistant to assist in osteotomy and holding of retractor, the need for assistant is optional rather than essential. As there are working portal retractor designed for the purpose of keeping working portal opened. There are few trays of instruments required for either uniportal and biportal surgery, hence there is less demand on nursing staff as well. A typical of endoscopic spine surgery is performed with one operating surgeon, one scrubbed nurse, one radiographer, one circulating nurse and an anesthetist. Other operating personnel re optional. The advantage of decreasing the need for assistant surgeon and nursing support in endoscopic surgery: (1) decrease manpower cost as part of operational cost for hospital administration, (2) decrease cross infection risk among patient - healthcare workers and healthcare workers - healthcare workers during COVID-19 pandemic, (3) decrease wound infection risk and (4) privacy for patients.
Reduce Resources On Respiratory Support Equipment and Reduce Usage Of Intensive Care Unit And High Dependency
Many of the endoscopic procedures can be performed with local anesthesia and sedation [
Reduce Hospital Inpatient Requirement: Demands For Day Surgery Procedures.
Recently some of the hospitals in the world has developed protocols in order to streamline the work processes in order to achieve high percentage of day surgeries their spine surgery practice. Wu et al highlighted that as a response for COVID-19 pandemic, their team set up a “Lumbar Endoscopic Awake Discectomy Surgery (LEADS)” protocol which consisted of 3 components: using moderate sedation and local anaesthesia to perform transforaminal endoscopic lumbar discectomy, same-day discharge for all patients who had undergone transforaminal endoscopic lumbar discectomy, and telemedicine communication at first week for follow-up with in-person visits 6 weeks after surgery. With the use of zoom and other tools for teleconsult/telemedicine, patients who had undergone endoscopic spine surgery can minimize visits to hospital. As the wound in his series are closed with tissue glues and no removal of stitches are required, many of the patients do not require physical consult and hence minimize risk of cross transmission of diseases and virus in hospital [
Invasive Technology Several endoscopic surgeons have gradually broaden the indications for endoscopic spine surgeries and hence replacing a large portion of their open surgical load with endoscopic spine surgery [
As part of medical fraternity, spine surgeons do our part in the fight against COVID-19, endoscopic spine surgery has inherent potential to be surgery of choice not only for patients’ benefits but for public interests to decrease risk of spread of COVID-19, conservation of respiratory equipment and maintaining elective surgery service for patients who needed spine surgery during this era of pandemic and for the future.
Dr. HS Kim is an editorial board member of the journal but was not involved in the peer reviewer selection, evaluation, or decision process of this article. There are no other potential conflicts of interest relevant to this article to declare.
Editorial Team for journal of minimally invasive spine surgery and technique endoscopic spine surgery edition: A new paradigm in spine surgery.