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Yang Training system of PELD in China

After two decades of developing the surgical approach during that period. In addition, some physicians have
and visible technique, Yeung introduced his “inside- expressed a desire to to invite experts to their local
[1]
out” technique (YESS) with a rigid rod-lens, water hospitals in order to have hands on demonstrations.
flow-integrated, and multichannel spinal cannula that
combined a camera, light and the working channel Chinese teachers have invented a couple of methods
together. He introduced this technique into China in to boost the learning . They guide the trainees to
[4]
1997. More doctors in China began to learn the YESS combine X-ray, magnetic resonance imaging and
technique, and they began to practice this technique computed tomography images to 3D models to help
more routinely. They became mentors for other the trainees build 3D images. The learning curve is
surgeons in China who wanted to learn the technique. 60 operations for the surgeon to be skilled to perform
[5]
In 1999, Hoogland et al. started a new technique of PELD . In a transforaminal approach, the L4/5
[2]
a lateral transforaminal approach to the spinal canal technique was easier to master than L5/S1 .
[6]
(THESSYS). The THESSYS technique was introduced
to China in 2007 . After mastering the PELD technique, In order to standardize the application of minimal
[3]
surgeons began to spread this technique, and a formal invasive spinal surgery in China, a Spinal Endoscopic
training system was soon developed. Diagnosis and Treatment Management Standards
(edition 2013) was established by National Health and
[7]
Before the PELD training program, minimally invasive Family Planning Commission in 2013 . It established
spinal surgery workshops involving MED technique detailed requirements for medical institutions,
appeared in China as early as 2004. In 2007, PELD doctors and ancillary staff. It also set the standard for
technique was introduced in seminars. In 2010, endoscopic diagnosis and treatment. Most importantly,
PELD cadaver workshop advertisements appeared the detailed requirements of medical education and
in meeting notices. Currently, more than 20 seminars training bases for spinal endoscopic activities were
were held in China annually. As other surgical technique clearly defined. The education bases must be:
trainings, the training of PELD for Chinese doctors was 1. Class 3A ranked hospitals;
in two stages. The first consisted of training abroad in 2. No less than 10 years experience in spinal diseases
which pioneers were educated abroad and returned treatment, with grade 4 (highest) surgical ability to
to their home country to start practice. The second perform spinal endoscopic activities; no less than
was training at home in which overseas returnees 1,500 spinal cases were surgically treated in the
introduced PELD technique and held workshops past 3 years, and 50 cases of endoscopic operations
to spread the techniques. For a surgeon without a annually;
background in endoscopic surgery, seminar, cadaver 3. No less than 2 doctors have grade 4 spinal endoscopic
workshop and hands on practice are the stepwise way surgery ability, and at least 1 is a consultant doctor;
to learn the technique. The important areas that help 4. The institution fulfills the entire requirement including
the surgeon to understand the PELD technique include staffs, techniques, instruments and facilities;
a clear understanding of the anatomical structure and 5. The institution has held national spinal endoscopy
image pictures, accurate judgment of different tissue meeting or finished national continuing medical
under endoscopy, and correct 3D positional imprints. education program.
Therefore, training and learning are heavily focused on
these three aspects. After establishment, it served as a solid protocol, but
updates are absolutely required, especially as more
For a typical training class, teaching modules and more doctors obtained the ability to perform good
generally include an introduction of PELD technique, PELD.
working cannula placement, endoscopic performance,
and pitfalls that might be encountered. After lectures, In China, physicians not working in spinal surgery units
cadaver workshop let each attendee practice the have performed the PELD technique in treating lumbar
working cannula insertion and practice operations disc herniation. It is difficult to determine the training
under endoscopy. An operation demonstration qualifications of the doctors who perform PELD in pain
with instant explanation would come before or clinics. An Internet search of renowned physicians in the
after workshop. Then, before practicing operations Pain department with their showed that some doctors
on patients, an intensive watching and hands-on switched from the Orthopedic Department and some
operations needs to be finished. Many surgeons have had switched from the Anesthesia Department. In the
expressed interest in attending a mid-career training beginning, they all received training from an orthopedist
program to focus on the PELD technique. They would and now they collaborate with spine orthopedist to open
have an opportunity to get hands-on operation training training programs. The Association of Chinese Spine
Mini-invasive Surgery ¦ Volume 1 ¦ September 30 107