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Dezawa Education of endoscopic spine surgery

risk, contributing to the sound spread and progress of surgery (ligating method, etc.).
endoscopic spinal surgery in Japan; and so on. [3]
Of those listed above, 2 through 8 should be studied
ACTIONS RELATED TO THE SKILL and fully mastered by attending the endoscopic
QUALIFICATION SYSTEM spinal surgery education/training courses provided or
authorized by the JOA.
Guidelines on endoscopic spinal surgery
1. Before endoscopic spinal surgery, preparatory 7. Requirement of surgeons performing anterior
steps need to be taken in accordance with the rules approach endoscopic spinal surgery: having
prevailing at the facility concerned. experienced the anterior approach spinal surgery in at
least 20 cases.
2. Thoracoscopic surgery should be performed under
the supervision of a surgeon qualified by JOA to 8. Requirement of surgeons performing posterior/
perform endoscopic spinal surgery, who has acquired posterolateral approach endoscopic spinal surgery:
sufficient skills in open chest surgery and can cope having experienced the posterior/posterolateral
with any complications arising during or after surgery approach spinal surgery in at least 30 cases.
appropriately (hereinafter called “skill-qualified
surgeon”). 9. Informed consent, based on a decision made by the
patient after sufficient explanation, must be obtained
3. Laparoscopic or posterior laparoscopic surgery before endoscopic spinal surgery.
should be performed under the supervision of a skill-
qualified surgeon who has acquired sufficient skills 10. In the event of a near-miss or an actual accident
in open abdominal surgery and the retroperitoneal during endoscopic spinal surgery, primary emphasis
approach and can cope with any complications arising needs to be placed on securing of the patient’s safety
during or after surgery appropriately. [5] and appropriate actions must be taken promptly in
accordance with all relevant hospital rules. At the same
4. If thoracotomy or laparotomy is required during time, an endoscopic spinal surgery near-miss/accident
endoscopic surgery, the surgery should be immediately report needs to be submitted to the “Endoscopic
switched to open chest or open abdominal surgery. Spinal Surgery Skill Qualification Committee” (c/o JOA
It must be ensured that cooperation from a thoracic Secretariat). [6]
surgeon or an abdominal surgeon is always available,
in the event of being needed. [6] Educational system and maintenance of
qualified skills
5. Preoperative and postoperative patient management Training methods can be roughly divided into training
is conducted under a system in which the surgeon with the use of animals (pigs, sheep), participation
plays a central role. in training courses, supervision by endoscopic
surgeons, implementation of existing open chest/
6. Requirements before endoscopic spinal surgery. abdominal surgery under endoscopic guidance, and
so on. Japanese Society for the Study of Endoscopic
(1) Learning open chest/abdominal surgery procedure
and perioperative management and how to deal with
complications;
(2) Understanding the anatomical structure and relative
position of each organ during endoscopy;
(3) Mastering the approaches with a thoracoscope,
laparoscope and posterior/posterolateral spinal
endoscope;
(4) Mastering the sense of depth under two-dimensional
video monitor images;
(5) Mastering the sense of organ touch by remote
control;
(6) Mastering coordination between visual sense and
finger motions under magnified images;
(7) Mastering how to use special tools/devices; Figure 1: Animal surgery allows the surgeon to practice important
(8) Mastering the special skills required for endoscopic skills needed during actual surgery
54 Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017