Time is of the Essence: Understanding Surgical Times for Endoscopic and Minimally Invasive Spine Procedures

Introduction: Lumbar spinal stenosis is a common cause of back pain and disability affecting more than 100 million people worldwide. Minimally invasive spine (MIS) surgery aims to minimize incision size and tissue damage. Endoscopy is the least invasive of these techniques, and potentially yields shorter hospital stays and fewer complications. However, concerns have been raised regarding the steep learning curve for both OR staff and surgeons. Our study examines the performance of a new endoscopic spine surgery program and compares it with that of the established MIS tubular program.

Methods: A retrospective analysis was conducted of patients who underwent lumbar laminectomy or discectomy at our tertiary care center between 2021 and 2024 (n=181). Surgical event timing was collected including in-room time, incision time, closing time, procedure finish time, and out-of-room time. T-tests were used to evaluate equality of means between endoscopy and MIS for in-room-to-incision time, incision-to-closing time, closing-to-procedure finish time, and total in room-to-out of room time with p values ≤ 0.05 considered significant. Levene’s test was used to determine equal variances. Endoscopic surgeries (n=80) with 49 laminectomies were compared to MIS procedures (n=101) with 24 laminectomies.

Results: Compared with MIS, endoscopic discectomies had shorter in-room-to-incision time (mean difference=5.4 minutes, p=0.017) and closing-to-procedure finish time (mean difference=6.0 minutes, p=0.000), and there was no difference in incision-to-closing time (p=0.15) or total in-room-to-out of room time (p=0.47). Laminectomies were significantly faster in all categories: in-room-to-incision, incision-to-closing, closing-to-procedure, and total-in-room-to-out-of-room time(mean difference=5.9 minutes, p=0.021; mean difference=47.5 minutes p=0.000: mean difference=6.0 minutes, p=0.001: mean difference=55.9 minutes, p=0.00). Compared to MIS-discectomy, MIS-laminectomy had slower in-room-to-incision time (p=0.02), incision-to-closing time (p=0.0), and total in-room-to-out of room time (p=0.0). However, there was no significant difference between endoscopic laminectomy and endoscopic discectomy surgical times.

Conclusion : Over the first 80 cases of a new endoscopic spine program, endoscopic laminectomy was faster than MIS-laminectomy in all time intervals, and setup and take-down times were faster for endoscopic-discectomy than for MIS-discectomy. Our experience suggests that starting an endoscopic spine program is feasible and may add benefits even in the beginning.