Korean Spine Endoscopy Technique Draws Global Surgeons for Training

In the fourth-floor operating room at Hallym University Dongtan Sacred Heart Hospital in Dongtan, Gyeonggi Province, a 4K ultra-high-definition monitor displayed real-time footage of thickened yellow ligament compressing spinal nerves being removed layer by paper-thin layer.

Professor Choi Il of the neurosurgery department was demonstrating Unilateral Biportal Endoscopy (UBE) surgery on a spinal stenosis patient using Endovision's surgical solution. As the camera and surgical instruments moved freely through two holes measuring less than 1 centimeter to remove the lesion, one trainee watching the live broadcast exclaimed "fantastic."

The five trainees gathered in the operating room that day came from different countries and backgrounds. Mian Awais, an endoscopic spine surgery specialist from Mian Muhammad Trust Hospital in Pakistan who visited Dongtan Sacred Heart Hospital for UBE training, said the program was "decisive in developing my endoscopic surgery capabilities" through hands-on guidance with free-flowing questions and answers.

"I purchased a Korean-made surgical instrument set to better integrate advanced training into clinical practice when I return home," Awais added.

Spinal endoscopy is a minimally invasive surgical method for treating degenerative spinal conditions including lumbar disc herniation, commonly called "slipped disc," and spinal stenosis. Traditional procedures required large incisions to directly visualize and widen spaces around nerves or remove protruding disc material.

According to the Health Insurance Review and Assessment Service, spinal disease patients increased 14.3% over seven years, from 8.4 million in 2016 to 9.6 million. Including 2.64 million cervical spine patients brings the total to approximately 12.24 million, with those aged 60 and older accounting for more than half.

Most elderly patients have chronic conditions such as diabetes and hypertension, making open spine surgery—with its bleeding risks and prolonged general anesthesia—a significant burden. The introduction of microscopic surgery reduced incision sizes, and spinal endoscopy has recently emerged as the dominant trend.

Spinal endoscopy is divided into unilateral approaches using one incision and bilateral approaches using two. While unilateral endoscopy initially predominated, UBE has expanded the scope of endoscopic surgery applications.

UBE creates two small holes of approximately 0.5 centimeters each—one for the endoscope and another for surgical instruments—to treat lesions. The ultra-high-definition endoscopic camera provides a wider field of view than surgical microscopes, enabling more precise operations.

Most importantly, the fingernail-sized incisions minimize unnecessary tissue damage while preserving nerves and muscles. This reduces complications such as bleeding, decreases postoperative pain and scarring, and speeds recovery.

"The greatest advantage of bilateral spinal endoscopy is that elderly patients with underlying conditions can safely undergo surgery without the burden of general anesthesia," Professor Choi said. "Workers in less physically demanding jobs can return to work quickly, making it popular among younger patients as well."

Since February last year, Hallym University Dongtan Sacred Heart Hospital has partnered with Endovision through a memorandum of understanding to conduct spinal endoscopy training programs for international physicians. Both the international fellowship program—requiring at least one month in Korea for comprehensive training on all spinal conditions—and short-term courses of four to five days at Dongtan Sacred Heart Hospital and nearby Suwon Wiltse Memorial Hospital have received strong responses.

Applications initially came from physicians who saw papers presented at international conferences or published in academic journals. Word of mouth has since brought approximately 50 doctors from 12 countries including Australia, Taiwan, Kazakhstan, Ukraine, Vietnam, Portugal, and Mexico.

The training program serves as a "global outpost" that opens export channels for Korean-made medical devices beyond simple technology transfer.

The neurosurgery research team comprising Professors Choi Il, Jang Jun-su, and Roh Chan-yang is working to expand spinal endoscopy applications beyond degenerative diseases into previously challenging areas including tumors and congenital malformations.

Notable cases include endoscopic removal of schwannoma—a type of neurogenic tumor in the cervical region—and successful decompression surgery for spinal metastatic cancer. Recently, the team surprised the medical community by treating Arnold-Chiari malformation, a congenital structural abnormality where portions of the cerebellum or brainstem descend through the base of the skull into the spinal canal, using endoscopic foramen magnum decompression.

These achievements were possible due to early adoption of spinal endoscopy systems and accumulated experience. "I feel great pride in spreading Korea's excellent spinal endoscopy techniques worldwide and enabling numerous overseas patients to benefit from the latest medical technology," Professor Choi said.

"Bold government-level support is needed so innovative Korean-made equipment can build medical evidence and achieve global competitiveness," he emphasized.