Page 31 - Read Online

Ohara et al. Percutaneous endoscopic lumbar laminectomy

[Figure 3]. However, the fact that only limited kinds second port might be able to use for only the large
of instrumentation can be used during PELL tends to instrumentation like Kerison punch that is used for
make operations more difficult. Drilling of the lateral the conventional surgery. Despite the requirement for
recess can be carried out relatively easily. Although the technical proficiency described above, adaptations
corresponding top part of the lamina should be drilled like this may offer one possible direction for the
before insertion of the endoscope, the ligament must development of this method.
be dissected from the surrounding bone. Complete
detachment of the ligament on the opposite side is In conclusion, PELL is a method of treatment that
particularly difficult. If the detachment is difficult, the minimizes soft-tissue damage caused by invasion
bone area attaching to the ligament should be drilled associated with the surgical approach. However,
to remove the ligament together with the surrounding because of its technical difficulty, PELL has not yet
bone. been become a popular procedure. Nevertheless, this
technique offers a range of advantages if the operator
The technical difficulty of PELL using a single-port acquires a sufficient level of technical proficiency to
endoscope has already been described, as have the complete the procedure in approximately the same
facts that additional time is required for the procedure and time required for microscopic lumbar laminotomy.
the end result might be incomplete decompression. [19] Further developments in the procedure will be required
Other studies have also emphasized that the learning to encourage more widespread use, such as using a
curve for PELL is more gradual than those for MEL larger endoscope to enable the use of a wider range of
or PED. This technique should not be started without instrumentation, or use of a second port.
first achieving a certain level of proficiency in PED IL.
Unless adequate technical skills have been acquired, Authors’ contributions
the procedure can hardly be described as minimally Study conception and design, performing the surgical
invasive. technique: Y. Ohara
Critical revision: S. Shimizu, J. Mizuno
Some studies have described a method involving use
of a second port to increase the number of instruments Financial support and sponsorship
that can be used and remove the restrictions on None.
field of view and usable instrumentation. [19,20,22] In
arthroscopy, surgery is performed using the triangle Conflicts of interest
technique. Different reports have detailed the There are no conflicts of interest.
application of this technique to the spinal field and use
different terms; irrigation endoscopic decompressive Patient consent
laminotomy (IEDL), [19] percutaneous biportal Obtained.
endoscopic decompression (PBED), [20] and two-portal
percutaneous endoscopic decompression. [22] In all Ethics approval
these techniques, the arthroscope is inserted via the The ethics committee of ShinYurigaoka General
first port and the instrumentation is inserted via the Hospital approved this retrospective study.
second port, with the operation being performed under
irrigation. All authors concluded that these methods REFERENCES
resolve the restrictions on the size of instrument
that can be inserted via the second port, enabling 1. Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A. Comparison of
the use of drills, Kerison punches, and curettes percutaneous endoscopic lumber discectomy versus open lumbar
employed in conventional laminectomy. In addition, microdiscectomy for lumbar disc herniation: a metaanalysis. Int J
no special equipment is required, as the surgery can Surg 2016;31:86-92.
be performed using an arthroscope and normal spinal 2. Kleinpeter G, Markowitsch MM, Bock F. Percutaneous endoscopic
lumbar discectomy: minimally invasive but perhaps only minimally
surgery instrumentation. However, these second- usefil? Surg Neurol 1995;43:534-9.
portal technique may also need special training. [22] 3. Sairyo K, Egawa H, Matsuura T, Takahashi M, Higashino K, Sakai
Eum et al. [20] reported that this technique is similar to T, Suzue N, Hamada D, Goto T, Takata Y, Nishisho T, Goda Y, Sato
a knee arthroscopic surgery or thoracoscopic surgery. R, Tsutsui T, Tonogai I, Kondo K, Tezuka F, Mineta K, Sugiura K,
All of these techniques used arthroscope but now we Takeuchi M, Dezawa A. State of the art: transforaminal approach for
can use the single port endoscope that can allow using percutaneous endoscopic lumbar discectomy under local anesthesia. J
Med Invest 2014;61:217-25.
the instrumentation through the endoscope. Then the 4. Sairyo K, Matsuura T, Higashino K, Sakai T, Takata Y, Goda Y, Suzue
modification might be able to apply the second port N, Hamada D, Goto T, Nishisho T, Sato R, Tsutsui T, Tonogai I, Mineta
method. Basically single port method is applied. And K. Surgery related complications in percutaneous endoscopic lumbar
Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017 79