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

2. 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.

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

4. Advantages
Enable to interbody fusion

5. Advantages
No muscular damage(especially M.Multifudys)

6. 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 Apr;24(4): doi: / SPINE Epub 2016 Jan 1.

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

8. 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).

9. 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.

12. 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.

13. Case 1-32 Y M L5-S1 disc herniation

14. Cleaning of dorsal surface of lamina with RF probe

15. Laminotomy

16. Excision of lig.flavum

17. Removing the herniated part of the disc

18. L5 root and discectomy

19. Case 2-36 F L5-S1 sequestrated disc herniation

21. Postoperative MRI

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