Endoscopic and arthroscopic technology has been around for a number of years, aiding surgeons’ visualization to treat patients in much less invasive ways than were previously possible. Prior to the introduction and adoption of these types of technology, surgeons were faced with invasive, more traumatic procedures and sometimes limitations on visualization based on anatomy. Less invasive approaches have allowed patients to benefit from less risk, shorter hospital stays and, in many cases, quicker healing.

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Endoscopic approaches to spine surgery have been in use for over 10 years, but the market hasn’t experienced transformative growth. All the patient benefits align with adoption trends, so why hasn’t endoscopic spine surgery grown at a similar rate? What does the future hold for this field? Choll Kim, MD, PhD, a pioneer in minimally invasive spine surgery, shares insights into his practice, focusing on specific endoscopic spinal techniques. He helps us understand the pros and cons of the technology’s adoption curve and where he believes the market is headed.

Treating Patients with Endoscopic Microdiscectomy

One of the most common procedures performed with endoscopic spine surgery is microdiscectomy. This technique is used to treat herniated discs, a condition that affects millions of people worldwide, causing debilitating pain and nerve compression. Unlike traditional open surgery, where surgeons make large incisions and remove significant portions of muscle and bone to access the disc, endoscopic microdiscectomy uses a tiny camera and instruments inserted through a small incision.

Dr. Kim notes that while the procedure itself has been a game-changer for eligible patients, its adoption has been slow. “Patients who undergo endoscopic microdiscectomy often experience less pain, a faster return to normal activities, and lower risks of complications. The results speak for themselves, but the real challenge has been on the surgeon’s side.”

The Biggest Clinical Learning Curves

Despite its benefits, endoscopic spine surgery presents one of the steepest learning curves in modern medicine. Unlike open surgery, where the entire spine is visible, endoscopic techniques rely on limited visualization through a camera, requiring an entirely different approach to spatial awareness and hand-eye coordination. Dr. Kim compares it to learning to perform surgery through a keyhole: “You don’t get the luxury of seeing the whole picture; instead, you work with a magnified but restricted view.”

Furthermore, traditional spine surgeons are often trained in open techniques first, making the shift to endoscopy a paradigm shift rather than a simple skill upgrade. “It’s like asking a painter who has always worked on large murals to suddenly create intricate miniatures,” says Dr. Kim.

What Makes It Such a Technically Challenging Procedure

The challenges of endoscopic spine surgery extend beyond visualization. The procedure demands extreme precision, as working with delicate spinal nerves requires millimeter-level accuracy. Additionally, specialized instruments and navigation techniques must be mastered.

Dr. Kim recalls early frustrations when adopting the procedure: “I thought I had great surgical skills until I started doing endoscopic surgery. There were days I questioned whether I could ever be proficient.” The narrow working space and reliance on indirect feedback rather than direct tactile sensation make endoscopic spine surgery as much an art as a science.

The Biggest “Aha” Moments for the Procedure

For many surgeons, the breakthrough moment comes after weeks or even months of practice. Dr. Kim describes his own “aha” moment: “The first time I performed a smooth decompression without struggling, it felt like magic. It was suddenly clear why this approach was the future. The patient’s pain relief was almost immediate, and their recovery was shockingly fast.”

One particularly striking case was a young athlete suffering from sciatica due to a herniated disc. Traditional open surgery would have sidelined him for months. Instead, after an endoscopic microdiscectomy, he was back in the gym within weeks. “Seeing a patient walk out of the hospital on the same day, pain-free, is the moment you realize why this technology is worth mastering,” says Dr. Kim.

“I believe we’re at the tipping point. In the next decade, we’ll see a significant shift as more surgeons master the technique, and technology continues to refine the process.” – Dr Kim

Training Activities for Surgeons

Given the high learning curve, proper training is critical. Dr. Kim emphasizes that standard surgical training programs don’t always offer robust endoscopic education. Instead, many surgeons rely on specialized training workshops, cadaver labs, and mentorship programs.

Medical device companies have also stepped in to fill the gap, offering hands-on simulators that allow surgeons to practice virtually before ever touching a real patient. These programs use augmented reality (AR) and virtual reality (VR) to simulate real-life procedures, helping new surgeons shorten the learning curve. “We’re seeing an explosion of AR and VR applications in surgical training. I think these tools will be the key to accelerating adoption,” Dr. Kim predicts.

The Future of Endoscopic Spine Surgery

Despite the challenges, the future of endoscopic spine surgery looks bright. Innovations in robotics, AI-driven navigation, and better imaging technologies are making procedures more precise and accessible. Companies like Globus Medical and Medtronic are investing heavily in AI-assisted surgical tools to enhance real-time decision-making.

Dr. Kim envisions a future where these advancements will make endoscopic surgery the norm rather than the exception. “I believe we’re at the tipping point. In the next decade, we’ll see a significant shift as more surgeons master the technique, and technology continues to refine the process.”

With increasing patient demand for minimally invasive options and a growing body of research supporting its benefits, endoscopic spine surgery is set to transform how spinal conditions are treated. The road has been challenging, but as Dr. Kim says, “The best things in medicine often start as the hardest to adopt. But once the momentum builds, there’s no turning back.”