Spine surgeons are increasingly interested in adopting endoscopic surgery techniques into their practices. However, acquiring the appropriate skills to effectively perform the procedures takes more effort than a weekend course or device company demonstration. Physicians will need months of training and observation before performing endoscopic procedures, and the learning curve is steep, says Bryan Massoud, MD, a spine surgeon with Spine Centers of America in Fair Lawn, N.J. "It will take time and commitment from the surgeons," says Dr. Massoud. "There are certain requirements that are needed to be an excellent endoscopic spine surgeon."
Dr. Massoud discusses the four steps he believes every spine surgeon should take to incorporate endoscopic surgery into his or her practice.
1. Complete a spine surgery fellowship. Physicians electing to perform endoscopic spine surgery should be fellowship-trained spine surgeons, or they should perform the procedures under the supervision of a fellowship trained spine surgeon due to the potential for complication this critical area, says Dr. Massoud. The spine fellowship provides the surgeon with experience in open spinal procedures, giving them intimate knowledge of the back's anatomy. This knowledge is imperative for physicians as they begin using the endoscope because the physician can't see the spine beyond the view provided by the endoscope.
2. Complete advanced endoscopic training. Surgeons need to complete extensive educational courses and training with the endoscope before using it with their patients. The endoscope acts as the "eye" during the procedure. The surgeon inserts the endoscope through a small incision and leaves it over the surgery site, allowing it to project the patient's anatomy on a large screen. The physician uses these images as guidance during the surgery to make sure he or she is not disrupting any nerves. The ability to look at the screen while manually navigating the surgery is much different from open surgery and is a skill that takes many hours to acquire. There are a few minimally invasive and endoscopic educational labs around the country which allow physicians to enroll in the programs and gain experience before becoming more focused on the different techniques.
Beyond the physical aspects of using the endoscope, the surgeon must know how to regulate fluid pressures and keep the field clean so the lenses don't fog up, says Dr. Massoud. "It's very important to have experience in all these areas," he says.
3. Follow a mentor. Following and observing a mentor can help physicians overcome the challenging learning curve and give the surgeon an advantage over others. Dr. Massoud followed Martin Knight, MD, an English physician, and learned his technique. "Because it's an emerging field, the different surgeons learning and performing endoscopic spine surgery have their own techniques they developed over time," says Dr. Massoud. "Taking the experience of a mentor physician who has actually done a number of cases can move the training physician higher on the learning curve before tackling his or her own cases."
Dr. Massoud is willing to speak with and mentor spine surgeons aspiring to learn endoscopic technique. He has been performing several techniques at his practice, including cervical endoscopic discectomy and cervical endoscopic laminotomy.
4. Perform live surgeries with a mentor. After observing several endoscopic procedures, surgeons are ready to perform cases of their own. However, to ensure the best results in the beginning, the surgeon should keep his or her mentor handy in the operating room for assistance. Since endoscopic spine surgery is a vastly different procedure than traditional spine surgery, it takes several surgeries before surgeons are comfortable performing them and achieving the best results. The mentor can make sure the surgeon is performing the procedure correctly and remain available as an expert in endoscopic spine surgery in the event of complications.
Learn more about Spine Centers of America:
1501 Broadway Suite 20, Fair Lawn, N.J. 07410
877-722-6008 info@spinecentersofamerica.com
Read more coverage on spine surgery:
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 10 Articles for Successful Spine Practice Management
- Styker's David Veino: In Support of Vertebroplasty
Dr. Massoud discusses the four steps he believes every spine surgeon should take to incorporate endoscopic surgery into his or her practice.
1. Complete a spine surgery fellowship. Physicians electing to perform endoscopic spine surgery should be fellowship-trained spine surgeons, or they should perform the procedures under the supervision of a fellowship trained spine surgeon due to the potential for complication this critical area, says Dr. Massoud. The spine fellowship provides the surgeon with experience in open spinal procedures, giving them intimate knowledge of the back's anatomy. This knowledge is imperative for physicians as they begin using the endoscope because the physician can't see the spine beyond the view provided by the endoscope.
2. Complete advanced endoscopic training. Surgeons need to complete extensive educational courses and training with the endoscope before using it with their patients. The endoscope acts as the "eye" during the procedure. The surgeon inserts the endoscope through a small incision and leaves it over the surgery site, allowing it to project the patient's anatomy on a large screen. The physician uses these images as guidance during the surgery to make sure he or she is not disrupting any nerves. The ability to look at the screen while manually navigating the surgery is much different from open surgery and is a skill that takes many hours to acquire. There are a few minimally invasive and endoscopic educational labs around the country which allow physicians to enroll in the programs and gain experience before becoming more focused on the different techniques.
Beyond the physical aspects of using the endoscope, the surgeon must know how to regulate fluid pressures and keep the field clean so the lenses don't fog up, says Dr. Massoud. "It's very important to have experience in all these areas," he says.
3. Follow a mentor. Following and observing a mentor can help physicians overcome the challenging learning curve and give the surgeon an advantage over others. Dr. Massoud followed Martin Knight, MD, an English physician, and learned his technique. "Because it's an emerging field, the different surgeons learning and performing endoscopic spine surgery have their own techniques they developed over time," says Dr. Massoud. "Taking the experience of a mentor physician who has actually done a number of cases can move the training physician higher on the learning curve before tackling his or her own cases."
Dr. Massoud is willing to speak with and mentor spine surgeons aspiring to learn endoscopic technique. He has been performing several techniques at his practice, including cervical endoscopic discectomy and cervical endoscopic laminotomy.
4. Perform live surgeries with a mentor. After observing several endoscopic procedures, surgeons are ready to perform cases of their own. However, to ensure the best results in the beginning, the surgeon should keep his or her mentor handy in the operating room for assistance. Since endoscopic spine surgery is a vastly different procedure than traditional spine surgery, it takes several surgeries before surgeons are comfortable performing them and achieving the best results. The mentor can make sure the surgeon is performing the procedure correctly and remain available as an expert in endoscopic spine surgery in the event of complications.
Learn more about Spine Centers of America:
1501 Broadway Suite 20, Fair Lawn, N.J. 07410
877-722-6008 info@spinecentersofamerica.com
Read more coverage on spine surgery:
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 10 Articles for Successful Spine Practice Management
- Styker's David Veino: In Support of Vertebroplasty