Guidelines on endoscopic spinal surgery
1. Before endoscopic spinal surgery, preparatory steps need to be taken in accordance with the rules prevailing at the facility concerned.
2. Thoracoscopic surgery should be performed under the supervision of a surgeon qualified by JOA to perform endoscopic spinal surgery, who has acquired sufficient skills in open chest surgery and can cope with any complications arising during or after surgery appropriately (hereinafter called “skill-qualified surgeon”).
3. Laparoscopic or posterior laparoscopic surgery should be performed under the supervision of a skill-qualified surgeon who has acquired sufficient skills in open abdominal surgery and the retroperitoneal approach and can cope with any complications arising during or after surgery appropriately.[5]
4. If thoracotomy or laparotomy is required during endoscopic surgery, the surgery should be immediately switched to open chest or open abdominal surgery. It must be ensured that cooperation from a thoracic surgeon or an abdominal surgeon is always available, in the event of being needed.[6]
5. Preoperative and postoperative patient management is conducted under a system in which the surgeon plays a central role.
6. Requirements before endoscopic spinal surgery.
(1) Learning open chest/abdominal surgery procedure and perioperative management and how to deal with complications; (2) Understanding the anatomical structure and relative position of each organ during endoscopy; (3) Mastering the approaches with a thoracoscope, laparoscope and posterior/posterolateral spinal endoscope; (4) Mastering the sense of depth under two-dimensional video monitor images; (5) Mastering the sense of organ touch by remote control; (6) Mastering coordination between visual sense and finger motions under magnified images; (7) Mastering how to use special tools/devices; (8) Mastering the special skills required for endoscopic surgery (ligating method, etc.).
Of those listed above, 2 through 8 should be studied and fully mastered by attending the endoscopic spinal surgery education/training courses provided or authorized by the JOA.
7. Requirement of surgeons performing anterior approach endoscopic spinal surgery: having experienced the anterior approach spinal surgery in at least 20 cases.
8. Requirement of surgeons performing posterior/posterolateral approach endoscopic spinal surgery: having experienced the posterior/posterolateral approach spinal surgery in at least 30 cases.
9. Informed consent, based on a decision made by the patient after sufficient explanation, must be obtained before endoscopic spinal surgery.
10. In the event of a near-miss or an actual accident during endoscopic spinal surgery, primary emphasis needs to be placed on securing of the patient’s safety and appropriate actions must be taken promptly in accordance with all relevant hospital rules. At the same time, an endoscopic spinal surgery near-miss/accident report needs to be submitted to the “Endoscopic Spinal Surgery Skill Qualification Committee” (c/o JOA Secretariat).[6]
Educational system and maintenance of qualified skills
Training methods can be roughly divided into training with the use of animals (pigs, sheep), participation in training courses, supervision by endoscopic surgeons, implementation of existing open chest/abdominal surgery under endoscopic guidance, and so on. Japanese Society for the Study of Endoscopic and Minimally Invasive Spine Surgery (JESMISS) established in 1999 and changed the name with Japanese Society of Minimally Invasive Spine Surgery (JASMISS) in 2015. JESMISS has been making efforts to implement training with the use of pigs for coping with the qualification system. In the field of orthopedic surgery, 5 in vitro training sessions on spinal endoscopy were officially provided, beginning with the 14th Arthroscopy Seminar in July 1996, and an in vivo training session was provided during the First Endoscopic Spinal Surgery Seminar in September 1997. To date, 14 JASMISS training sessions and 13 JOA training sessions have been provided, involving a total of 1,020 participants [Figure 1].
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