Biportal Endoscopy performed in Saishree Hospital
The next generation of Endoscopic spine surgery (Biportal Endoscopy) is here, expanding the indications of traditional Endoscopy and reducing the co-morbidities associated with open spine surgery.
Mr Ashok Bhor, an ordinance factory worker, was suffering from left lower limb pain since last two months; he was diagnosed on his MRI scan findings. The surgery was performed on August 10, 2017 and he was discharged on 14 August. He had a lumbo-sacral canal stenosis with right lower limb pain underwent Biportal endoscopic stenosis decompression surgery at Saishree hospital. Patient had immediate pain relief and was successfully discharged walking out of the hospital on 3rd post-operative day.”
Biportal Endoscopy involves use of 2 separate channels, Scopic port (4mm) and Working port (1.5mm) with continuous water flow. This causes less bleeding giving the surgeon clear & magnified surgical view, precise decompression, reducing the chances of intra-operative nerve damage and eliminating the chances of post-operative blood transfusion. Also chances of surgical site infection are significantly lesser than open surgery. There is significant reduction in pain at the operative site so patient can be mobilized earlier, as early as 2 to 3 hours after coming out of anesthesia. Patient is allowed to use commode chair on the following day reducing dependence. The total hospitalization period is typically 2 to 3 days and patient can walk home after that. Some physical restrictions need to be followed along with physiotherapy for 4 weeks post-op but the return to normal daily activities is much faster.
Pune’s Well Known spine surgeon Dr. Pradyumna Pai Raiturkar and Dr.Kean Deshphande performed this surgery
Dr. Pradyumna Pai Raiturkar said, “This is a revolutionary procedure in terms of technical advancement but is more acceptable than traditional endoscopy as the approach familiar anatomy and is cost effective as well.”
Dr. Ketan Deshpade added further, “This is the first ever case of Biportal Endoscopic Decompression performed in Maharashtra. As per the operating surgeons this technique has a very promising future and with the development of more advanced instruments will cover even more indications in spinal pathologies.”
Some Unique benefits of this technique to patient:
Cost-effectiveness: since majority of the instruments used in this procedure are same as traditional surgery, they are readily available with all spine surgeons.
Increased spectrum: Almost all pathologies in Lumbar spine can be treated using this method.
Advantages to the patient: Less pain post-operatively, early mobilization, less blood loss (avoiding blood transfusion), lesser hospitalization, and more cosmetic.
Future trends: UBE is well tested modality accepted in various international publications, but developments are still on to expand the scope of the procedure to include multilevel pathologies.
About UNILATERAL BIPORTAL ENDOSCOPY
Single portal (working channel) endoscopy is an established modality of minimally invasive spine surgery for lumbar and radiculopathy (slip disc) but unfortunately the spectrum of diseases treated under this technique are limited. Also this technique has a very steep learning curve and requires high end instruments. With a view to overcome these limitations UBE technique is developed.
The skin incision is significantly smaller than traditional surgery but the risk of neuronal injury is lesser cause. Magnification, better visualization, under water use of Cautery leading to heat dispersion.
The need for postoperative blood transfusion is not only dependent on intra-operative blood loss but also on handling of para-spinal muscle (operative trauma), post op drain, patients pre-op Hb, patient on anti-platelet medications etc. If these factors are taken into consideration the chances of needing a blood transfusion are lesser with endoscopy.
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