My journey to MISS

I has always feel unhappy with the results of my low back surgeries.I wish i can do better.My patients are very nice people,most local Malay Kelantanese.They prefer to said nice rather than complaining but i know are not very happy.50 or 60 plus old with severe claudication:my usual prescription:decompression fusion with pedicle screws

I have a very prejudiced view on minimal invasive surgery.When i was in Rush University in Chicago in 2001,my professor used to say:You need to do 30 cases before you can be comfortable with the procedure and i do not want to mess up 30 of my patients to try the procedure.

In 2004, a korean surgeon did a live surgery and cadaveric workshop in Putrajaya hospital. I just went and saw without any intention to practice myself.After all it was a sponsored registration.

However my deep feeling push me to keep going for a better alternative. So in 2006 , in Ramadhan , I attended an endoscopic workshop done in Ripas Hospital facilitated by Dr Destandau.Few days before my trip to Brunei that i got a book on MISS and found a chapter written by Dr Anthony Yeung.But  what i saw  during the Brunei course was totally different from what I read.Of course I was still ignorance of the concept.I thought all procedures of MISS are the same.

Then in MOA-IMLAS Langkawi 2007,  MISS surgeries basically all about transforaminal by speakers Dr Gore(India)Dr John Chiu(California)Dr Anthony Yeung(Phoenix)Dr Hoogland(Germany), Dr Lee San Ho(Korea) and Martin Knight(UK).So it thrilled me about this new technique.

So I planned for my sabbatical leave to learn endoscopic surgery with Dr Satish Gore.Then in December 2007while in  Kyoto attending  world research on spine I met Dr Rajasekharan who invited me to attend a microspic spine workshop at his place in Coimbatoire,India. So slight modification to my sabbatical plan and make a trip to Ganga Hospital at Coimbatoire.Then my next plan will be going to Pune to meet with Dr Gore.I have my perennial companion with me,Dr Ahmad tajuddin, state Trengganu head of orthopaedic surgeons.However my sponsor wanted me also visited Dr Rohidas at Kolhapur.

I was happy at Coimbatoire and found  how simple to do spine works under microscope and Dr Rajasekharan has been very good in teaching me tips and tricks with microscope.He is a bit negative on endoscopic works. In Combaitoire i tried to contact Dr Gore but failed and hence i drop the idea of visiting his place.(furthermore the hospital where he works demand me some amount of money for the attachment).Then i went to Kolhapur from Coimbatoire via Bombay.I never met with Dr Rohidas but his hospitality is worth mentioning here.He personally pick both of us-Tajuddin and me- and for  a week at Kolhapur, he send his driver to transport us from the Hill resort to his clinic everyday the round trip of about 40km.We only paid for our hotel others were free and he used his operating sets for the saw-bone workshop.During this period i started understanding "the world of  spine endoscopy" and which approach and why?I am really thankful to Allah for bringing me to such good person and learning something very beneficial to my people.I'm proud that my sabbatical leave lead me to another window of new service to my countrymen.

I invited Dr Rohidas to come to my hospital and he came and gave me his thoughts and insight and from my early cases i found  problems and his invaluable advice still fresh in my mind.

In 2009 I went to Bourdeaux France to attend the advanced endoscopic workshop and met with Dr Destandau.I stayed for few more days after the workshop and gained more exposure to the technique from the person who devised it.

May 2010, Dr Destandau came to my place,operated on  three cases (2 cervical and one revision lumbar) and in conjunction with his visit we organised a Second National Endoscopic Workshop held in UKM/Hospital Assunta

At Assunta Hospital 2010

After going through early experiences and my understudy Dr Eskandar has already become expert in the technique, our cases are done with more confidence and less hassle and become a routine.Almost 90% of our cases are done endoscopically.We modified few things as it suits our patient that include the marking of levels,the positioning and the extensive use of high speed burr.