FPMNR244
Free Paper (MIS/Navigation/Robotics)
Novel Technique of Assisted Uniportal Interlaminar Percutaneous Endoscopic Lumbar Discectomy to Increase Versatility for Discectomy: Technical Notes
Yudha Mathan Sakti, Tedjo Rukmoyo, Zikrina Lanodiyu, Deas Makalingga Emiri, Kadek Egadia Calisto
Department of Orthopaedics and Traumatology, Dr Sardjito General Hospital, Yogyakarta, Indonesia
Discectomy was initially performed using a microsurgical interlaminar approach, which later evolved into the widely accepted percutaneous endoscopic lumbar discectomy. However, it requires a single operator to perform both visualization and discectomy. The limitations persist in treating contained disc herniations, where aggressive disc removal and annulotomy are often necessary and requires a stable visualization. Steep learning curve is the challenge in educational setting for young surgeons. To address these challenges, we proposed a novel approach to increase technique’s versatility by introducing assisted uniportal for interlaminar PELD. The technique begins with the insertion of a spinal needle using interlaminar approach under fluoroscopic guidance to target the affected disc space. A working cannula is then positioned to create a stable endoscopic access to the intervertebral disc. Primary operator focused on discectomy, while the working channel was stabilized by a secondary operator. The secondary operator performed annular docking by medialization of the dural sac for better visualization of the herniated disc. Discectomy was then performed by the primary operator. This particular technique is indicated in contained disc herniations, where annulus remained intact. Patients were evaluated for postoperative VAS, ODI, and complication rates. Surgeon, fellow and residents were evaluated using semi quantitative questionnaire. We observed similar improvements in VAS and ODI scores in our patients compared to those undergoing traditional PELD. Minor complications were reported, predominantly paresthesia. Semi-quantitative measurements showed a more effective learning process of this technique with the help of the assistants. The technique offered several advantages, such as enhancing visualization for contained herniated discs, improving safety while increasing operator focus, and addressing the learning curve. Making it a more user-friendly approach for surgeons in any level of expertise. With the assisted technique for educational purposes, young surgeons can focus to learn discectomy and reduce the learning curve. For technical notes on this assisted model, this technique creates an easier medialization of the dural sleeve and annular docking process. Assisted uniportal interlaminar PELD is a safe and valuable option to enhance versatility for discectomy and reduce the learning curve. For educational purposes, this technique gives a better room for knowledge transfer.
