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Yang                                                                                                                                                                                          Training system of PELD in China

           Pain and Minimal Invasive Technique was established   system  to  guide  the  training  facilities  and  to  make
           in 2016 and provided a new communication platform   sure only qualified doctors perform PELD.
           for all kind of doctors who performed PELD technique.
                                                              DECLARATIONS
           Although progress has been achieved, short-term
           training programs were still not enough for attendees   Authors’ contributions
           to start practicing PELD. Even after a couple of training   D.H. Yang contributed solely to the paper.
           classes, many doctors were hesitant to undertake their   Financial support and sponsorship
           first operation. This reason can be summed up by the
           Chinese  expression:  “easy  when watching and hard   None.
           while doing”. In the future, the training system should   Conflicts of interest
           focus on “hands on” practice in the operating room.
                                                              There are no conflicts of interest.
           The  PELD technique has become  more and  more     Patient consent
           widely accepted by doctors and patients. New
           indications for the procedure include: spinal canal   Not applicable.
           stenosis,  infections,  and  tumors.  In  addition,  new   Ethics approval
           instruments have been developed. Systematic        Not applicable.
           training or re-training of surgeons is necessary. First,
           the  trainees  need  to  be  classified  according  their   REFERENCES
           background and experience on endoscopic practice.
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           anatomical structure of lumbar spine and more skilled   Spine System (YESS). Surg Technol Int 1999;8:267-77.
           in handling possible pitfalls whereas anesthetists are   2.   Hoogland  T,  Schubert  M, Miklitz  B,  Ramirez  A.  Transforaminal
                                                                 posterolateral endoscopic discectomy with or without the combination
           familiar with punctures. Some doctors come to learn   of a low-dose chymopapain: a prospective randomized study in 280
           from how to perform the technique and others come     consecutive cases. Spine (Phila Pa 1976) 2006;31:E890-7.
           to resolve problems in their practice. Accordingly,   3.   Zhang XF, Zhang L. The past, present and future of spine endoscopic
           the  teaching  methods  and  courses  need  to  fulfill   technology in China. Chin J Pain Med 2015;21:81-5. (in Chinese)
           the  different  expectations.  Second,  training  system   4.   Wang HW, Li CQ, Zhou Y. Application of imaginal thinking in the
                                                                 teaching  of percutaneous transforaminal  endoscopic  discectomy.  J
           needs to be focused on both quantity and quality.     Reg Atan Oper Surg 2013;22:220-1. (in Chinese)
           Besides short-term training, trainees and trainers   5.   Liu FP, Zhao HW, Chen HD, Luo MY. Transforaminal endoscopic
           should  also  focus  on  long-term  hands  on  clinical   spine system for lumbar discectomy:  the learning  curve and our
           training. Third, training needs to be separated into   6.   experiences. Orthop J China 2016;3:235-41. (in Chinese)
                                                                 Wu XB, Fan GX, Gu X, Shen TG, Guan XF, Hu AN, Zhang HL, He
           basic  and  advanced stages.  Two  types  of  training   SS. Learning curves of percutaneous endoscopic lumbar discectomy
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           training. Fourth, the old protocol needs to be revised.   7c01acb8b9465fa83abdeca4aed68a.shtml  (the 5th attachment,  in
           Strict rules should be applied to standard certification   Chinese). [Last accessed on 6 Jul 2017]




















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