Dr. Lim Recognized as a 2018 Best Doctor by Northern Virginia Magazine
Dr. Lim has been named a 2018 Best Doctor by Northern Virginia Magazine.Read more
Endoscopic Spine Surgery
Endoscopic spine surgery is a minimally invasive procedure that uses micro incisions and specialized tools to address spinal conditions with greater accuracy, more safety and better results.
In simple terms, endoscopic spine surgery is a minimally invasive spinal procedure that uses micro incisions as well as specialized visualization and surgical tools to treat a wide variety of spinal conditions.
This cutting-edge technique is used at the affected portion of the spine with minimal muscle and tissue disruption. A small camera, known as an endoscope, allows the surgeon to view what they’re doing without opening up large portions of the back.
Endoscopic spine surgery is a minimally invasive spine surgery meaning that there is less disruption to the muscles, nerves and soft tissues that surround the spine. Additionally, it boasts greater surgical accuracy which lends itself to a safer operation and speeds up recovery dramatically.
The average incision size for a minimally invasive surgery is around 1 inch. In contrast, open spine surgery generally requires a 6-inch incision--a dramatic difference.
However, one of the primary benefits of minimally invasive spine surgery is also one of its largest drawbacks. In these procedures, surgeons are required to work through a very small opening and have almost no ability to see where they’re working with their naked eyes. In the past, they’ve used fluoroscopes as well as large, bulky microscopes to visualize the spine. While these solutions are suitable for a trained surgeon, they don’t always provide great views of the spine and can, depending on the location of the affected area, force the physician to work in an awkward position.
Enter the endoscope.
An endoscope is a thin, flexible tube with a light and a camera attached to the end. It’s an instrument pretty commonly used in the healthcare industry to give physicians a high-resolution look at internal organs and structures.
The first endoscope was invented in the early 1800s by a man named Philipp Bozzini. However, it wasn’t until the mid-1900s, when fiber optics were first being pioneered, that endoscopes really started to become a practical and powerful tool in the operating room.
Originally, endoscopes were designed for exploring areas of high risk such as the throat, lungs, stomach and intestines. While they’re still used in this way today, they’ve also found a critical place in minimally invasive surgical procedures.
In the field of orthopedics, surgeons have been using endoscopes to treat damage in the knees and shoulders without exposing the entire joint. However, implementation in the field of neurosurgery has been rather slow because working around critical structures of the spine requires an unparalleled degree of accuracy.
Recent advances in visual technology and the creation of specialized tools are now allowing highly-trained neurosurgeons to safely integrate the benefits of endoscopy into the field of minimally invasive spine surgery.
Endoscopic spine surgery is groundbreaking because it requires a much smaller incision while still giving neurosurgeons the ability to see everything clearly. This increases accuracy and speeds up recovery.
In an endoscopic spine surgery, a surgeon will make a small keyhole incision in the back, often about 7mm, and place a specialized endoscope down to the affected area of the spine.
This endoscope is an instrument specially created for spine surgery, giving enough room for a high definition camera and light source as well as a working channel for the neurosurgeon's instruments and an irrigation channel.
This gives the surgeon everything they need to perform their operation safely and effectively without having to open up a large section of the back.
Unlike open spine surgery, which requires surgeons to scale or cut through muscles and soft tissue when accessing the spine, neurosurgeons simply need to push the soft tissues aside when traveling down to the affected portion of the spine. This gentle approach is safer and causes far less post-operative pain.
Once the endoscope has reached the affected portion of the spine, the neurosurgeon is able to run specialized tools down through the tube and shave, clip or extract the damaged portions of the disc or spine that are pressing up against the nerves.
In terms of visualization, the endoscope is second to none. With the high definition camera and a powerful light source, physicians are able to see exactly where they’re working and what’s occurring in the back at all times.
The endoscopic camera is connected to a monitor that sits in front of the operating surgeon which he watches while performing the procedure. This is, undoubtedly, one of the most technical parts of the operation because the neurosurgeon must work with their hands while watching a screen.
Being able to do this with the level of precision required for spine surgery takes years of specialized training.
Below is a real-life example of what a neurosurgeon sees while performing an endoscopic spine surgery.
Endoscopic spine surgery can be used a treat a wide number of spinal conditions using minimally invasive, precise techniques. In many cases patients are able to walk up and leave the hospital the same day.
Within the last several years, incredible advances have been made allowing highly trained neurosurgeons to combine the minimally invasive benefits of endoscopic spine surgery with the accuracy and cutting-edge precision provided by robotic technology.
As we’ve mentioned before, diseased or damaged discs in the spine aren’t always in convenient locations for surgeons. Often, they’ll have to enter the back at an awkward angle in order to avoid hitting nerves or damaging too much soft tissue during the operation. Additionally, they’re often tethered to their high-powered microscope which, while adjustable, is simply not capable of moving everywhere with the surgeon.
This is where robotics combined with endoscopy makes a dramatic impact.
Before putting anyone on the operating table, neurosurgeons are able to create what is a called a pre-operative plan using 3D scans and x-rays of the patient’s spine. This allows them to put together a roadmap of exactly how they want to handle the operation. They’re able to see exactly where the affected portions of the spine are, how they should enter, what should be removed, what implants or screws need to be added, etc. They are then able to program all this information into the Mazor X robotics system and, during the operation, the robot will move based on the commands the surgeons put into its system.
The result is an accuracy rate of over 98%.
It’s important to note that the robot is not operating on the spine at any point. Rather, it’s a guidance system that helps ensure that surgeons are working precisely where they should at all times.
Now, couple the accuracy and safety benefits of robotic spine surgery with the minimally invasive and visualization benefits of endoscopic spine surgery and you have one of the most groundbreaking, safest methods of back surgery on the planet.
The combination of endoscopic spine surgery and robotics is a truly groundbreaking advancement. Mechanical guidance helps surgeons attain unparalleled accuracy and endoscopy allows them to visualize their workspace clearly.
Robotic-guided endoscopic spine surgery is a minimally invasive procedure which means that patients can reap the benefits of a smaller incision, less tissue damage and a smaller amount of blood loss. This, in turn, helps them recover more quickly from their procedure and get back to regular, active life.
As a powerful subset of minimally invasive spine surgery, one of the main benefits of endoscopic spine surgery is the fact that it requires a very small incision, usually less than one inch.
A common misconception about incisions is that they’re just used to break the skin and open up the interior of the body, kind of like cutting your finger with a knife. This isn’t actually the case. To a surgeon, an incision is the act of cutting through the skin and through the underlying tissue (including muscle) in order to access the affected portion of the body.
Large incisions, which are common in open spine surgery, are problematic because they force surgeons to cut through and pull back more muscle and soft tissue than is actually necessary. It’s typically done so that surgeons can see the spine with their naked eyes and operate carefully around the nerve roots that exit from the spinal column. However modern technology has made this methodology obsolete and completely unnecessary.
Affecting more anatomy than is absolutely required can make recovery more painful and extend it dramatically.
Physicians who specialize in endoscopic spine surgery use what is known as a keyhole, or laparoscopic incision. This means that they create an opening just large enough to allow their surgical instruments to fit into the body; nothing more.
By opening up less of the back, patients are better protected from excessive blood loss, infection, misplaced surgical instruments while still giving surgeons the visualization they need to perform the surgery safely and accurately.
As mentioned previously, robotic guidance allows surgeons to attain accuracy during surgery that is simply unattainable by the human hand. This, coupled with the fact that they are able to clearly see everything that’s happening where they’re operating and are able to work in a position that’s comfortable to them means that they are able to focus solely on the surgery at hand.
Studies have found that surgeons who use robotic guidance are accurate to a degree of 1.5 millimeters. For scale, that’s slightly smaller than the width of a quarter.
This accuracy is absolutely essential when working in the area of the body because surgeons are often operating around some of the most complex and critical components in the body including nerves and major arteries. There is simply no room for error or lack of accuracy when dealing with such vital systems.
Because surgeons are able to work through such a small incision in the back, they don’t need to give patients as much general anesthesia and, because they’ve already pre-mapped out their operation they don’t need to take as many intra-operative scans.
This is an incredible benefit for patients because, despite the fact that complications arising from anesthesia or intraoperative radiation are very rare, it simply removes another risk factor from the operation.
For many patients, post-operative recovery can be one of the most difficult parts of their surgery. The truth is that every surgery, regardless of its level of invasiveness, has an impact on the body and will require some time to heal.
However, minimally invasive techniques can help shorten the amount of a time a patient has to stay in the hospital and speed up their recovery time dramatically.
In the past, patients were expected to spend at least 2-3 days recovering in the hospital after their surgery. Now, thanks to better technology and minimally invasive techniques, patients can walk out of the hospital, often pain-free, the day of their surgery.
Additionally, it used to take patients an estimated 3-4 months of rest and recovery to fully heal from their spine surgery. This often meant that they weren’t able to exercise strenuously, couldn’t work a job that required manual labor and were on pain-relieving medication for months after their operation.
With minimally invasive techniques, however, patients can expect to make a full recovery in an average of 6 weeks or less with rehabilitation.
Robotic-Guided Endoscopic Spine Surgery provides patients with all the benefits of minimally invasive procedures while simultaneously being one of the most accurate and safest procedures in healthcare.
If you are suffering from a debilitating or painful spinal condition that has not been corrected through conservative treatments like physical therapy or medication or your spine specialist has recommended that you undergo spine surgery to address your back pain, you might be a candidate for endoscopic spine surgery. Our neurosurgeons can use the combination of endoscopy and robotic-guidance to treat a wide variety of spinal issues including degenerative disc disease, herniated discs, scoliosis and spondylolisthesis. If you’re interested in learning more about robotic spine surgery, please get in touch with our office.
Dr. Lim has been named a 2018 Best Doctor by Northern Virginia Magazine.Read more