Kai-Uwe Lewandrowski1, Friedrich Tieber2, Stefan Hellinger3, Paulo Sérgio Teixeira de Carvalho4, Max Rogério Freitas Ramos5, Zhang Xifeng6, André Luiz Calderaro7, Thiago Soares Dos Santos8, Jorge Felipe Ramírez León9, Marlon Sudário de Lima E Silva10, Girish Datar11, Jin-Sung Kim12, Hyeun Sung Kim13, Anthony Yeung14. 1. Center for Advanced Spine Care of Southern Arizona andSurgical Institute of Tucson, Tucson, Arizona, USA business@tucsonspine.com. 2. Friedrich Tieber, Augsburg, Germany. 3. Orthopaedic Surgeon, München, Germany. 4. Department of Neurosurgery, niversidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 5. Orthopedics and Traumatology, Federal University of the Rio de Janeiro State UNIRIO, Head of Orthopedic Clinics at Gaffrée Guinle University Hospital, Rio de Janeiro, Brazil. 6. Orthopaedic Surgeon, The Chinese PLA General Hospital, Beijing, China. 7. Centro Ortopedico Valqueire, Departamento de Full Endoscopia da Coluna Vertebral, Rio de Janeiro, Brazil. 8. Regina Hospital, Novo Hamburgo, Rio Grande Sur, Brazil. 9. Orthopedic & Minimally Invasive Spine Surgeon; Reina Sofía Clinic & Center of Minimally Invasive Spine Surgery - Bogotá Colombia. Chairman, Spine Surgery Program, Universidad Sanitas, Bogotá, USA. 10. Director of CLINCOL (Endoscopic Spine Clinic), Belo Horizonte, Minas Gerais, Brazil. 11. Orthopaedic Surgeon, Center For Endoscopic Spine Surgery, Sushruta Hospital for Orthopaedics & Traumatology, Maharashtra, India. 12. Department of Neurosurgery Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Korea. 13. Department of Neurosurgery, Nanoori Gangnam Hospital , Seoul , Republic of KoreaFaculty of the Korean Minimally Invasive Spine Surgery Society (KOMISS), Seoul, Republic of Korea. 14. University of New Mexico School of Medicine, Albuquerque, New MexicoDesert Institute for Spine Care, Phoenix, USA.
Abstract
BACKGROUND: Successful implementation of endoscopic spinal surgery programs hinges on reliable performance and case cost similar to traditional decompression surgeries of the lumbar spine. MATERIALS AND METHODS: To improve the statistical power of studying the durability of endoscopes with routine lumbar endoscopy, the authors performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, their preferred decompression instruments, and their experience with endoscopic equipment failure. RESULTS: A total of 485 surgeons responded, of whom 85 submitted a valid survey recording, rendering a completion rate of 27.1%. These 85 respondents reported a case volume of 12,650 lumbar endoscopies within the past year and, to date, had performed a total of 120,150 spinal endoscopies over their collective career years. The majority of respondents performed endoscopic surgery for herniated disc (65.9%) vs spinal stenosis (34.1%) in a hospital setting, preferentially employing the transforaminal (76.5%), interlaminar (51.8%), and unilateral biportal endoscopic (UBE; 15.3%) approach technique. The most commonly used endoscopic spine systems were Wolf/Riwo Spine (38.8%), Joimax (36.5%), Storz (24.7%), unspecified Chinese brand (22.4%), Maxmore (15.3%), Spinendos (12.9%), Elliquence (10.6%), unspecified Korean brand (7.1%), and asap Endosystems GmbH (2.4%). The most frequent failure mode of the endoscope reported by survey respondents was a blurry image (71.8%), followed by the loss of focus (21.2%), the loss of illumination of the surgical site (18.8%), and the failure of the irrigation/suction system integrated into the endoscope (4.7%). Most respondents thought they had problems with the lens (67.1%), the fiberglass light conductor (23.5%), the prism (16.5%), or the rod system (4.7%). Motorized high-speed power burrs and hand reamers and trephines were the reported favorite decompression tools that were presumably associated with the endoscope's failure. The majority of respondents (49.5%) performed up to 50 endoscopies before the endoscope had to be either exchanged or repaired. Another 15.3% of respondents reported their endoscope lasted between 101 and 200 cases and only 12.9% reported more than 300 cases. Besides abuse during surgery (25.9%), bad handling by staff was the most common suspected reason (45.9%), followed by the wrong sterilization technique (21.2%). Some 23.5% of respondents noted that the endoscope failed during their surgery. In that case, 66.3% asked for a replacement endoscope, and 36.1% completed the surgery with the broken endoscope. However, 10.8% stopped and another 6% of respondents woke the patient up and rescheduled the surgery to complete the decompression at another time. CONCLUSIONS: Spinal endoscopes used during routine lumbar decompression surgeries for herniated disc and spinal stenosis have an estimated life cycle between 50 and 100 surgeries. Abusive use by surgeons, mishandling by staff, and deviation for prescribed cleaning and sterilization protocols may substantially shorten the life cycle. Contingency protocols should be in place to readily replace a broken spinal endoscope during surgery. More comprehensive implementation of endoscopic spine surgery techniques will hinge on technology advancements to make these hightech surgical instruments more resistant to the stress of daily use and abuse of expanded clinical indications' for surgery. The regulatory burden on endoscope makers is likely to increase, calling for increased reimbursement for facilities to cover the added expense for capital equipment purchase, disposables, and the endoscopic spine surgery program's maintenance. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: End user surgeon survey study. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
BACKGROUND: Successful implementation of endoscopic spinal surgery programs hinges on reliable performance and case cost similar to traditional decompression surgeries of the lumbar spine. MATERIALS AND METHODS: To improve the statistical power of studying the durability of endoscopes with routine lumbar endoscopy, the authors performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, their preferred decompression instruments, and their experience with endoscopic equipment failure. RESULTS: A total of 485 surgeons responded, of whom 85 submitted a valid survey recording, rendering a completion rate of 27.1%. These 85 respondents reported a case volume of 12,650 lumbar endoscopies within the past year and, to date, had performed a total of 120,150 spinal endoscopies over their collective career years. The majority of respondents performed endoscopic surgery for herniated disc (65.9%) vs spinal stenosis (34.1%) in a hospital setting, preferentially employing the transforaminal (76.5%), interlaminar (51.8%), and unilateral biportal endoscopic (UBE; 15.3%) approach technique. The most commonly used endoscopic spine systems were Wolf/Riwo Spine (38.8%), Joimax (36.5%), Storz (24.7%), unspecified Chinese brand (22.4%), Maxmore (15.3%), Spinendos (12.9%), Elliquence (10.6%), unspecified Korean brand (7.1%), and asap Endosystems GmbH (2.4%). The most frequent failure mode of the endoscope reported by survey respondents was a blurry image (71.8%), followed by the loss of focus (21.2%), the loss of illumination of the surgical site (18.8%), and the failure of the irrigation/suction system integrated into the endoscope (4.7%). Most respondents thought they had problems with the lens (67.1%), the fiberglass light conductor (23.5%), the prism (16.5%), or the rod system (4.7%). Motorized high-speed power burrs and hand reamers and trephines were the reported favorite decompression tools that were presumably associated with the endoscope's failure. The majority of respondents (49.5%) performed up to 50 endoscopies before the endoscope had to be either exchanged or repaired. Another 15.3% of respondents reported their endoscope lasted between 101 and 200 cases and only 12.9% reported more than 300 cases. Besides abuse during surgery (25.9%), bad handling by staff was the most common suspected reason (45.9%), followed by the wrong sterilization technique (21.2%). Some 23.5% of respondents noted that the endoscope failed during their surgery. In that case, 66.3% asked for a replacement endoscope, and 36.1% completed the surgery with the broken endoscope. However, 10.8% stopped and another 6% of respondents woke the patient up and rescheduled the surgery to complete the decompression at another time. CONCLUSIONS: Spinal endoscopes used during routine lumbar decompression surgeries for herniated disc and spinal stenosis have an estimated life cycle between 50 and 100 surgeries. Abusive use by surgeons, mishandling by staff, and deviation for prescribed cleaning and sterilization protocols may substantially shorten the life cycle. Contingency protocols should be in place to readily replace a broken spinal endoscope during surgery. More comprehensive implementation of endoscopic spine surgery techniques will hinge on technology advancements to make these hightech surgical instruments more resistant to the stress of daily use and abuse of expanded clinical indications' for surgery. The regulatory burden on endoscope makers is likely to increase, calling for increased reimbursement for facilities to cover the added expense for capital equipment purchase, disposables, and the endoscopic spine surgery program's maintenance. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: End user surgeon survey study. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
Authors: Kai-Uwe Lewandrowski; José-Antonio Soriano-Sánchez; Xifeng Zhang; Jorge Felipe Ramírez León; Sergio Soriano Solis; José Gabriel Rugeles Ortíz; Carolina Ramírez Martínez; Gabriel Oswaldo Alonso Cuéllar; Kaixuan Liu; Qiang Fu; Marlon Sudário de Lima E Silva; Paulo Sérgio Teixeira de Carvalho; Stefan Hellinger; Álvaro Dowling; Nicholas Prada; Gun Choi; Girish Datar; Anthony Yeung Journal: J Spine Surg Date: 2020-01
Authors: Kai-Uwe Lewandrowski; Paulo Sérgio Teixeira de Carvalho; André Luiz Calderaro; Thiago Soares Dos Santos; Marlon Sudário de Lima E Silva; Paulo de Carvalho; Anthony Yeung Journal: J Spine Surg Date: 2020-01