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NewTechniques

SIXTEEN

New Techniques

Endoscopic

Microdiscectomy

London Neurosurgery Partnership

On behalf of the London Neurosurgery Partnership, Mr Irfan Malik is very proud to bring the

technique of Endoscopic Microdiscectomy to London Bridge Hospital. He is the first surgeon

in England to offer and perform this technique. This development is part of the ongoing

commitment of the London Neurosurgery Partnership to introduce the latest techniques to

improve patient care, while ensuring that before its introduction each technique has been

vetted for its efficiency and safety.

Endoscopic Microdiscectomy

Endoscopic Microdiscectomy is a new

technique that completely avoids the

need for open surgery in suitable cases.

The procedure has several advantages

in those patients that are suitable for the

intervention.

Firstly, as opposed to a several centimetre

incision (5cm to 10cm on average)

in even the smallest conventional

microdiscectomy, the endoscope allows

the whole operation to be performed

through an incision no bigger than a

needle puncture.

Secondly, because the endoscope is far

more gentle and precise as a technique,

there is much less tissue damage and

scarring.This means that the incidence

of subsequent pain (both muscle and

wound) is much less; indeed most patients

are able to go home the same day.

Thirdly, again because of the precision

and gentleness of the system, it is

virtually bloodless.

As the whole procedure is literally

performed through a needle puncture

it is usually done without the need for

general anaesthesia, using sedation and

local anaesthetic alone; which avoids the

risks inherent in general anaesthesia.

The Procedure

The patient is positioned either on their

side or lying on their front and because

of the sedation used and the tiny needle

incision required, feels no pain during

the whole procedure.

The surgeon guides the endoscope to

the surgical area where the offending

disc is to be found under X-ray guidance.

At this point, while viewing the whole

procedure via a high definition screen, the

surgeon is able to remove the protruding

disc under constant observation.

The Evidence

The endoscopic surgery technique and

equipment used by Mr Malik on behalf

of the London Neurosurgery Partnership

has been developed and validated in

Germany over the last five years and early

studies confirm a success rate of over

93%; which compares

very well to the

more conventional

open techniques.

1&2

Mr Malik is the first

surgeon to perform

the technique in

England, having

undergone extensive

training in Germany and subsequent

supervision here in London with the

same German team, before practising the

technique independently. He has had the

technique vetted and approved by the

governance committees of both King’s

College London NHS Trust and London

Bridge Hospital, and following many

successful cases undertaken within the

NHS, he is now offering the technique

at London Bridge Hospital.