Tubular endoscopic spine surgery (TESS) for lumbar laminotomy: a technical feasibility study of a hybrid approach

Percutaneous endoscopic spine surgery and tubular minimally invasive surgery (MIS) each offer distinct advantages but also important limitations. We describe a proof-of-concept study of a hybrid technique-tubular endoscopic spine surgery (TESS)-combining a tubular retractor with a 30° endoscope and continuous irrigation, aiming to integrate the advantages of both approaches.

TESS was first evaluated in a cadaveric L4-L5 model and subsequently applied in a single clinical case of L4-L5 lumbar stenosis with right L5 radiculopathy. The technique uses a standard tubular retractor to establish a single paramedian muscle-splitting corridor. A 30° endoscope is introduced through the tube with continuous irrigation, while standard microsurgical instruments are used through the working channel.

The tubular retractor provided a stable, reproducible single-incision transmuscular corridor to the interlaminar space. The addition of the endoscope with irrigation ensured a consistently clear operative field, while maintaining the ergonomics and simplicity of a single working channel. Instrument handling and exchange were straightforward, and no specific technical difficulties were encountered. In the clinical case, adequate decompression was achieved with complete symptom resolution at 6 and 12 months.

TESS is a feasible hybrid technique that combines the familiar ergonomics of tubular MIS surgery with the dynamic visualization of endoscopic systems using irrigation. Further studies are needed to evaluate its clinical value before widespread clinical adoption.