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Mizuno Japanese training system for PELD

facilitating the removal of subligamentous, extruded, together with their curriculum vitae, recommendation
and sequestered disc fragments. Foraminoplasty can letter by any of previously certified members to the
enlarge the foramen to decompress the spinal canal PELD office in Shin-Yurigaoka General Hospital
and lateral recess stenosis. (office.peld@lesnm.ac). An investigation committee
which consists of previously certified 5 members
PELD allows for targeted fragmentectomy of the herniated has a role of the judgment of the application form
disc by performing the “inside-out” technique. Unlike the and the operative video record. The review process
knee or hip joints, the spinal canal has no fluid cavity. by the committee is closed to the general public but
Continuous irrigation of the endoscope is necessary. applications are strictly assessed. If applicant does not
Basic techniques of PELD includes transforaminal pass the examination, points for improvement will be
approach and interlaminar approach. The route to the conveyed to the applicant.
spinal canal or spinal nerves is different in these two
approaches, and the spinal surgeons must select the The learning curve for endoscopic spine surgery is very
best approach in each case. Once the cannula is placed steep, however it can be grasped by every endoscopic
inside the spinal canal, the “inside-out” technique is surgeon with proper training. As with novel surgical
performed to remove the herniated disc. procedures, the complication rate may be relatively
higher during the learning curve. Proper inclusion and
In 2009, the first hands-on training course of exclusion criteria for PELD is the first step for a successful
spinal endoscopic procedure was organized operation. Correlation of the preoperative image and
at the 16th Annual Meeting of Japanese patients’ subjective pain must be well understood by the
Society for Neuroendoscopy (JSNE) in Toyama surgeon who performs PELD. For the safer endoscopic
(http://www.med.u-toyama.ac.jp/nsurgery/jsne2009/). operation, the importance of the intraoperative
Spinal endoscopic training was officially accepted as neurophysiological monitoring, anesthesia or surgical
one of the neuro-endoscopic training courses by JSNE tools and techniques should be discussed for the future
the following year. In 2014, the first hands-on training advances of endoscopic spine procedures.
course was organized at the 34th Annual Meeting
of Japanese Congress of Neurological Surgeons Finally, several academic meetings related to the
(https://www.jcns-online.jp/en/) in Osaka. In 2016, minimally invasive spinal operations including PELD or
Neuro-Spinal Society of Japan (NSSJ) approved to MED are listed below:
start the official training system of PELD and PELL.
Japanese Society Orthopedic Surgery had started the Less-Invasive and Endoscopic Spinal Neurosurgery
official training system prior to our training system, (LESNM)
and there are 131 board-certified MED, surgeons Japanese Society of Minimally Invasive Spinal Surgery
and 23 board-certified PELD surgeons on November, (JASMISS)
2016. NSSJ initially approved 5 board-certified PELD Pacific and Asian Society of Minimally Intervention
surgeons, Dr. Junichi Mizuno, Dr. Yasuhiko Nishimura, Spinal Surgery (PASMISS)
Dr. Yukoh Ohara, Dr. Yoshihiro Kitahama and Dr. International Society of Minimally Intervention in Spinal
Hisaaki Uchikado to initiate the training system. All of Surgery (ISMISS)
these 5 surgeons have experienced various techniques World Congress of Minimally Invasive Spine Surgery
of PELD and PELL through huge volumes of knowledge and Techniques (WCMISST)
and surgical techniques. Interested individuals who
want to apply the certification system must be an DECLARATIONS
official member of NSSJ and an official member of
Japanese Society of Neurological Surgery. Ten clinical Authors’ contributions
experience of either PELD or PELL as a major operator J. Mizuno contributed solely to this paper.
in the past are required. The lectures and hands-on
training courses (both anatomical model and cadaver) Financial support and sponsorship
are also mandatory to attend. This certification system None.
restricts laser disc decompression or percutaneous
endoscopic cervical discectomy. Additional, the Conflicts of interest
member can only apply to this certification system
after the number of attendance has reached the There are no conflicts of interest.
specified number of times. The applicants must send
the operative summary of previous experiences of Patient consent
PELD and operative video record which is not edited Not applicable.
104 Mini-invasive Surgery ¦ Volume 1 ¦ September 30