J Minim Invasive Spine Surg Tech.  2025 Jan;10(Suppl 1):S27-S33. 10.21182/jmisst.2024.01704.

Why the Large Working Channel Uniportal Endoscope is Better for Patients With Obesity Than the Unilateral Biportal Endoscope at Lower Lumbar Levels: A Technical Note

• Shamim P
• Park CW

• KMID: 2566277
• DOI: http://doi.org/10.21182/jmisst.2024.01704

Abstract

The large working channel (LWC) uniportal endoscope offers significant advantages over the traditional unilateral biportal endoscopy for obese patients at lower lumbar levels. The LWC features a broader working channel (diameter > 5.5 mm) that accommodates larger surgical instruments, enhancing its ability to perform complex procedures with greater precision and efficiency. This expanded channel reduces the need for multiple incisions, minimizes surgical trauma, provides clear vision due to good water outflow channels, and increases surgical precision, which is particularly beneficial in patients with obesity who may have more challenging anatomy and an increased risk of complications. The improved instrument mechanism of LWC and enhanced visibility also enable better access and navigation within the restricted operative field, leading to more effective and less invasive interventions in patients with obesity. Overall, the design addresses the specific challenges of obesity, making it a superior choice for endoscopic procedures in this patient population at lower lumbar levels (L4–5 and L5–S1).

Keyword

Large working channel; Unilateral biportal endoscopy; Obese; Lumbar spine