A spinal surgical technique that can radically expedite patient recovery has been performed for the first time in South Africa. The technique, while highly progressive, can be done with equipment readily available in both private and public facilities.
This is according to Dr Shawn Venter, an orthopaedic spinal surgeon at Netcare Kuils River Hospital, who successfully performed the new unilateral biportal endoscopic surgery (UBE) after completing intensive international training in the technique.
“UBE brings together the specialist fields of orthopaedics and neurosurgery, combining elements of both into a single procedure. It embraces the camera system used in knee and shoulder keyhole surgery – done through very small incisions – with minor adjustments, but enables the surgeon to use the conventional and familiar open neurosurgical spinal decompression and fusion equipment to perform the surgery,” he said.
“This is a perfect marriage between extraordinary visuals of the spinal and neural anatomy, and the skill and finesse of neurosurgical techniques on the spine. The left hand operates the camera system and the right hand operates the neurosurgical spinal equipment. As this equipment is already widely used throughout SA, surgeons in both private and public sectors can perform this surgery cost-effectively, as no investment needs to be made in advanced technology.
“The benefits are numerous and significant. First, with UBE there is much reduced tissue trauma and no muscle damage from large incisions and dissections. This means patients can experience immediate mobility in the muscle groups supporting the back and avoid the major rehabilitation hurdles they would face with conventional surgery.
“The first patient to undergo the procedure we recently performed here at Netcare Kuils River Hospital had a herniated disc causing severe leg pain radiating from the back through the spine and into the leg. After the surgery, the patient experienced pain relief immediately and was discharged the next morning.
“UBE allows us to see what we previously could not, with unmatched capabilities compared to certain other types of spinal surgery, as the camera system provides high definition visuals of anatomical structures as well as visuals of areas that would be considered no-mans-land with other surgical techniques,” added Venter.
“Furthermore, due to the constant irrigation while performing surgery, there is less risk of wound infection, contributing to an improved outcome. Recovery times vary between different spinal conditions, however after undergoing UBE surgery patients recover faster overall and can get back to their lives sooner.”
Venter said many patients who are unable to undergo more conventional forms of spinal surgery can have UBE surgery. “For example, we are seeing an increase in multiple complicated comorbidities among patients who require spinal operations and some have a high risk of anaesthesia-related complications. Spinal endoscopic surgery has bridged the gap for patients like these for whom a less invasive form of surgical intervention can be effective. In certain cases UBE can even be conducted with sedation rather than general anaesthesia.
“There are very few limitations in conditions that can be treated with UBE surgery. It can be used for spinal stenosis, disc herniations, fusions and post operative neurolysis to free up trapped nerves in the cervical, thoracic and lumbar regions.”
The technique began gaining popularity in the global healthcare community five years ago and plans were in place for him to travel for UBE training in 2020. However COVID-19 delayed him bringing the knowledge back to South Africa.
“In June this year I travelled to Turkey year to train under Prof Hayati Aygün, a renowned orthopaedic specialist and protégé of one of the original pioneers of this type of surgery – Prof Sang Kyu Son, an acclaimed spinal surgeon and microsurgery specialist in South Korea.
“My training entailed an intensive week of live surgeries, both observational and hands on. Certification is only given once the professor is satisfied with the understanding and skills acquired. I drew on my previous experience in transforaminal uniportal endoscopic and minimal invasive surgeries, and my knowledge from pain procedures and even open surgery all contributed to understanding the technique’s intricacies. This made the leap fairly straightforward but there are training programmes offering longer term fellowships for inexperienced surgeons.”
UBE surgery forms part of a more comprehensive approach to spinal pathology and enables the team at Netcare Kuils River Hospital to complement other types of minimally invasive surgery already in use.
“While UBE is a very versatile technique, some spinal conditions are still best treated with open surgery. In this way UBE should be seen as supplementary to other spinal surgical techniques, such as minimal invasive surgery, open front/back spinal fusions, revision spinal fusion surgery and deformity correction surgery,” he said.
The Spine Centre at Netcare Kuils River Hospital offers all of these treatments with its team of specialists, all of whom have a special interest in non-surgical interventional pain management.
While UBE surgery requires fairly standard equipment, technology such as the 3D Ziehm fluoroscopy available at the Spine Centre can provide invaluable advantages, such as being able to perform a CT-like scan post-operatively while the patient is still in theatre to ensure adequate decompression. If needed, some of the instrumentation can be navigated to provide even more precise pinpointed accuracy in real time during the surgery.
“South Africa has a rich history of exceptional physicians, and ongoing support and learning opportunities are needed for them to continue reaching new heights. I am thankful for the support of my mentor Dr Jack Eksteen, my partner Dr Reggie King, our colleagues, the Netcare Kuils River Hospital team, our theatre team as well as the companies supplying the necessary technology and equipment in making this dream of UBE in South Africa a reality,” Venter said.
Dirk Truter, general manager of Netcare Kuils River Hospital, said in addition to establishing a four-bed ICU for the centre by the end of the year, the hospital will build new consulting rooms and enlarge the spinal theatre. The upgrade will include technologies like a specialised theatre light system with built-in cameras, enabling access to live video feed in theatre as well as in the consulting rooms to assist in surgeon training. The technology also makes remote access possible for authorised users to further learning opportunities for surgeons situated elsewhere.
“The Spine Centre is well known for its highly specialised services, not only in practice but for the invaluable training and learning opportunities provided to other spinal surgeons. We are honoured to have such experienced specialists practising here,” he said.
Issued by Netcare Kuils River Hospital