Spinal Descompression Trhough a Tubular System with Assisted Endoscopy

Endoscopic surgery has become an important tool in spinal surgery, the ergonomic design and the required length of the instruments, as well as the use of video monitors greatly affect our perception and performance. Some experts are resistant to the use of the endoscope in spinal surgery, because of the limitations in the perceptual information and that this can lead us to commit incorrect actions during the surgical procedure. Since the introduction in 1997 by Smith and Foley of a system consisting of progressive tubular dilators (MED) to later place an endoscopic vision system, the technique has become increasingly popular to this day. Based on this, other authors have documented the use of this endoscopic tubular system called Easy-Go reporting good results, so the authors of this article focus on the intraoperative peculiarities, experience, first impressions and the technical note of this system. (EASY-GO).


Introduction
Endoscopic surgery has become an important tool in spinal surgery, the ergonomic design an the required length of the instruments, as well as the use of video monitors greatly affect our precpetion and performance. Some experts are resistant to the use of the endoscope in spinal surgery, because of the limitations in the perceptual information and that this can lead us to commit incorrect actions during the surgical procedure [5].
Nonetheless, the new improvements and introductions to new endoscope equipment Full HD, and some 3D have shown important results with images commensurable with microscope [1,15]. Since 2007 the high definition HD cameras with LED light are available to endoscopid neurosurgical procedures [6].
Furthermore, since the introduction in 1997 by Smith and Foley of a progressive tubular dilators system (MED) that later it had an endoscopic vision system, the technique has become increasingly popular to this day [2]. Actually this system (MED) it is not only for disectomy, also for a great variety of pathologies, like lumbar stenosis descompression [10,3,16] among others.
Based on this, other authors [6] have been documented the use of the tubular endoscopic system called Easy-Go, reporting good results and proposing a learning curve (6,19) and less extensive training. If exists a nonconformity respect of the use of this new endoscopic system, we have the resource to make the inmediate exchange for the microscopic. While we acquaint with this new technology, consequently the authors of this article focus on the intraoperative peculiarities, experience, first impressions and the technical note of this system. (Easy Go).

Endoscopic system:
The "Easy Go [Gaab-Oertel]" system, consists in a progresive tubular dilators to do a Transmuscular surgical acces ( Figure.   Surgical procedure: The surgical procedure has to be under general anesthesia, in some cases used total intravenous anesthesia (TIVA).
The patient will be in prone-decubitus position, previuous asepsia and antisepsia of the area. Placement of the surgical field, under sight in real time with fluroscopy, make a surgical mark of the area.

Results
After any procedure, you have to make an analysis about the problems, advantages and disadvantages tan the Easy Go-ll system presents.
In the first cases, it was always necessary to contain the microscope ready, when we were in the transition and acquaint with the tubular endoscopic equipment, with the objective to change for a 3D vision with the microscope in the pertinent moment. . Ocasionally we realized the change to the microscope because the decompression Auctores Publishing -Volume 6(2)-112 www.auctoresonline.org ISSN: 2578-8868 Page 4 of 5 was considered too slow and was necessary that followed the chronology of the surgical time in the room of operations and in other occasions by fault of precepction of depth or the no suitable identification of the anatomical structures doing that the surgeon does not seat unsuspecting and/or comfortable regarding the decompression. In two cases we did not have the microscope forcing us therefore to realize the decompression in his whole with the endoscopic system and this generarted more confidence for the following cases, in which it did not have microscope.
The progresive tubular dilator system developed by Smith and Foley [2] was created to treat lumbar hernias, today this system is aplicated for another pathologies of the spine, for example; spinal descompresión by lumbar, cervical or thoracic stenosis among others. The time show us satisfactory results of this technique because is a minimally invasive procedure [17,18]. We adopt this new system since 2017 because in some cases we are not available to have a microscopic and this endoscopic tubular system is portable, flexible an dynamic. Within of the advantages of this system is that the surgical procedure if the surgeon can not feel confortable he can exchange the 2D vision for the 3D vision inmediatly whitout need to lost the surgical deck, this way the surgeon will be training to perform surgeries progressively with the endoscopic system. We can corroborate than the learning curve and the training is fast and short [9], minimizing the surgical times.
In the last years there have been discovered minimal invasive endoscopic techniques with advantages and desadvantages, this system is one of the neurosurgical arsenal (20). Netherless the present study does not excludes any option about the literature. Finally we considered that more studies required in the future for the long term follow up whit this technique to show the advantages and desadvantages of this system.