Biportal Endoskopik Spine Surgery(BESS) Tarık YAZAR, A MERTER Ankara University Medicine School Departmant of Orthopedics and Traumatology Section of Spine Surgery

There are many minimally invasive procedures such as transforaminal endoscopic spine surgery, epiduroscopy, interlaminar endoscopic spine surgery and biportal endoscopic spine surgery. In our clinic, we are using all of these interventions, and recently we started to perform biportal endoscopic spine surgery to lumbar disc herniation and spinal stenosis surgery cases.

Advantages Wider viewing angle compared to the uniportal technique The magnification of the surgical field is similar to that of microscopic spinal surgery.

Advantages Enable to interbody fusion

Advantages No muscular damage(especially M.Multifudys)

BESS Biportal endoscopic surgery2 Uniportal endoscopic surgery2 Wider viewing angle Suitable for more indication Need for arthroscopy and endoscopy experience Long learning curve Bleeding control Total laminectomy can be done Possibility of TLIF implantation when necessary Narrow view angle Inability to do laminectomy Inability to do fusion More difficult to control bleeding 2. Hwa Eum J, Hwa Heo D et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine. 2016 Apr;24(4):602-7. doi: 10.3171/2015.7.SPINE15304. Epub 2016 Jan 1.

Required Equipments Standard arthroscopy instruments Kerrison roungers Radiofrequency probe Artropump Disc forceps

Learning Curve BESS had a relatively short learning curve and the complication rate in the first period of the learning curve was reported as 10.3%. This complication rate can also be reduced by controlling epidural hemorrhage (continuous and pressure saline irrigation).

Learning Curve In this learning curve, we used a spine model and fresh sheep spine model with preserved paraspinal muscles and. Cost-effective and useful to improve triangulation in the endoscope.

Our short case series We perfomed this technique in 10 patients and in the first case the duration of the case was over 2 hours but as we progressed through the learning curve, It is decreasing. We did not encounter any neurological or other complications. Patients were discharged from the hospital on postoperative day 0.

Case 1-32 Y M L5-S1 disc herniation

Cleaning of dorsal surface of lamina with RF probe

Laminotomy

Excision of lig.flavum

Removing the herniated part of the disc

L5 root and discectomy

Case 2-36 F L5-S1 sequestrated disc herniation

Postoperative MRI

Case 3- 34 y M L5-S1 sequestrated disc herniation