A young patient aiming to be a professional athlete had a herniated disc between the 5th lumbar vertebra (L5) and sacrum. We performed minimally invasive endoscopic surgery so he can return to work quickly and continue to play sports.
PELD is a minimally invasive surgery to remove herniated tissue using a spinal endoscopy. With PELD we only need to make an 8-mm incision. This means that the patient can leave the hospital on the same day as the procedure, and can return to work in as little as two or three days. This is particularly good news for patients who are reluctant to take much time off from their jobs. And because the incision is small, recurrences of the hernia are much less likely than with conventional surgery.
The herniated tissue to be removed is right next to irreproducible nerves. If you fail to recognise the position of the herniated tissues and the nerves, there is a risk that the patient could remain impaired. It’s essential to have a clear idea of their positional relations. Before the surgery, I usually simulate the procedures in three dimensions in my head based on my past experiences. It’s crucial that the image on the monitor we check during the surgery should be same as the simulation. The image quality makes a real difference to PELD.
To recognise slow tissue movement and judge whether it’s a nerve are really important as a surgeon. 4K has a clear advantage in grasping tiny movements of blood vessels and other surrounding tissue and allows us to view the tissue with a far better sense of depth.
Although it takes a long time to educate young professionals in this field, I expect that the kind of high-quality 4K image would be very useful in mastering a skill in a short time.
When we turn A.I.M.E. on, I can see that it compares very favourably with our own images. In particular, the A.I.M.E.-enhanced images are very bright, and the areas of interest to me—as a surgeon—are very clear and easy to see.
 With A.I.M.E. turned off, the image is watery and blurred. When you turn A.I.M.E. on, the entire area seems to gain focus. In addition, I think the A.I.M.E. contrast enhancements may make the image easier to read
 In this example, A.I.M.E. seems to improve the overall red contrast, so that the image may be easier to view
It allows me to recognise the blood current and to discriminate between tissues easily. Although we often perform surgery while seeing dark images, A.I.M.E. shows dynamic image quality changes more clearly and sharply, allowing me to proceed with the surgery with a conscious awareness of positional relations. It was so helpful to differentiate between tissues with confidence.
I also notice that, even in cases where the endoscopic camera was focusing on the foreground, the areas further back—that you would expect to be out of focus—are clear as well. I think this would probably reduce the need to move the camera around during surgery.
This time I only looked at some still images, but what I have seen seems extremely interesting. I think the (A.I.M.E) imaging technology might additionally be quite useful for other clinics, whose endoscopic cameras might not be as up-to-date as our clinic’s – since these enhancements can provide a significant improvement in imaging quality.
*Its effectiveness in clinical situations has not been verified. The comments in this article do not guarantee the outcome of using a 4K monitor.
After graduating from Chiba University Medical School in 1980, Dr. Dezawa served successively as the director of orthopaedic surgery at Yokohama-higashi National Medical Centre, Chief of Outpatient Centre at Chiba City Ryõiku Centre, Lecturer in Orthopaedic Surgery at Teikyo University Medical School, and Associate Professor of Orthopaedic Surgery at Teikyo University Medical Centre’s Mizonokuchi Hospital.
In 2004, he was appointed full professor and head of orthopaedic surgery at Teikyo University. In 2005, he also began a role as advisor to Mizonokuchi’s Deputy Directory.
Dr. Dezawa specialises in spinal surgery, hip joint surgery, electrophysiology, and minimally invasive surgery. In 2003, he introduced the use of Percutaneous Endoscopic Discectomy (PED) in Japan and, continues to achieve excellent results with this procedure. He started the Dezawa PED Centre in 2014. He has also started a PED research group – and participates actively in research and dissemination of the procedure.