Unilateral Biportal Endoscopy (UBE): a "Fourth Generation" of Endoscopic Spine Surgery

Unilateral Biportal Endoscopy (UBE) is considered by many to represent a "fourth generation" in the evolution of minimally invasive endoscopic spine surgery. It builds upon earlier full endoscopy techniques like transforaminal and interlaminar approaches, incorporating elements of microscopic surgery to offer a unique and advanced method for treating a range of spinal conditions.

Evolution of UBE as a 'Fourth Generation' technique

• 1st Generation :UBE was initially developed and applied for lumbar discectomy procedures to address herniated discs in the lower back.
• 2nd Generation : The technique expanded to include lumbar laminotomy, paraspinal approaches, and contralateral decompression procedures, broadening its application for various lumbar spinal pathologies.
• 3rd Generation : UBE advanced to enable lumbar interbody fusion procedures, offering a minimally invasive alternative to open fusion techniques with similar clinical outcomes.
• 4th Generation (Conceptual) : The concept of a fourth generation UBE envisions the integration of advanced technologies like robotics, neuro-navigation, and augmented reality to further enhance efficiency and precision in UBE procedures.

Key Principles of UBE

• Two portals : UBE utilizes two small incisions - one for the endoscope (viewing portal) and another for surgical instruments (working portal). This allows for independent control and maneuverability of the endoscope and instruments within the surgical field.
• 2nd Generation : The technique expanded to include lumbar laminotomy, paraspinal approaches, and contralateral decompression procedures, broadening its application for various lumbar spinal pathologies.
• 3rd Generation : UBE advanced to enable lumbar interbody fusion procedures, offering a minimally invasive alternative to open fusion techniques with similar clinical outcomes.
• 4th Generation (Conceptual) : The concept of a fourth generation UBE envisions the integration of advanced technologies like robotics, neuro-navigation, and augmented reality to further enhance efficiency and precision in UBE procedures.
• Minimally invasive : By using smaller incisions and minimizing muscle disruption, UBE reduces tissue damage, blood loss, and the risk of complications associated with traditional open surgery.
• Enhanced visualization : The endoscope provides a high-definition, magnified view of the surgical area, enabling surgeons to perform precise and delicate procedures with greater accuracy.
• Faster recovery : Reduced invasiveness translates to less postoperative pain, shorter hospital stays, and quicker recovery times, allowing patients to return to their normal activities sooner.

Advantages of UBE

• Reduced tissue damage : Smaller incisions and less disruption of muscle and surrounding tissues.
• Minimal blood loss : The minimally invasive nature of the procedure leads to less bleeding.
• Shorter hospital stay : Patients can often be discharged the same day or within a few days after the surgery.
• Faster recovery time : Reduced pain and minimal invasiveness enable quicker rehabilitation and return to daily activities.
• Lower risk of complications : Minimized surgical trauma may lead to a lower incidence of complications such as infection.
• Patient can do all his /her work immediately like climbing stairs , riding 2 wheeler , rountine daily work

Conclusion

UBE represents a significant advancement in minimally invasive spinal surgery, offering advantages such as reduced tissue damage, faster recovery, and lower complication rates compared to traditional open techniques. However, surgeons must undergo specialized training due to the technique's learning curve, and the potential for complications should be acknowledged. Ongoing research and the integration of technologies like robotics and augmented reality are expected to further improve and broaden the applications of UBE.