What is the Difference Between Uniportal and Biportal Endoscopy?

Endoscopic spine surgery represents a significant advancement in minimally invasive techniques, offering patients reduced tissue damage, smaller scars, and faster recovery times compared to traditional open procedures. Within this field, uniportal and biportal endoscopy are the two primary approaches, distinguished fundamentally by their product design and surgical mechanics.

The core difference lies in the number of portals, or small incisions, used to access the surgical site.

Uniportal Endoscopy: The Single Keyhole Approach

Uniportal endoscopy (UE), often referred to as full-endoscopy, utilizes a singular portal (a single small incision) through which both the endoscope (for viewing) and the specialized surgical instruments are passed.

Product Focus and Design:

• Integrated System: The uniportal system is characterized by its highly specialized, all-in-one endoscope, which contains both the viewing channel (a high-definition camera) and the working channel for instruments. This is a crucial product feature—the entire operation is funneled through one narrow tube.
• Specialized Instruments: Due to the confined space of the single portal, uniportal surgery necessitates the use of dedicated, elongated, and often curved endoscopic instruments designed to navigate the singular working channel. These instruments are specific to the uniportal product line.
• Less Invasive Incision: This technique is often associated with the absolute smallest possible incision, truly living up to the “keyhole” moniker. It is a highly muscle-preserving approach.

Surgical Implications:

• Learning Curve: The primary limitation is a relatively steep learning curve for surgeons, as the instrumentation’s movement is restricted to the single axis of the portal, demanding high skill in single-handed or constrained two-hand maneuvers.
• Vision and Maneuverability: While providing a very close, high-definition view of the pathology, the maneuverability of instruments can be restricted compared to a two-portal system.

Biportal Endoscopy: The Two-Portal Workhorse

Biportal endoscopy employs two separate incisions (portals) for the procedure. This distinct product design significantly alters the surgical experience. One portal is typically used for the endoscope and viewing, while the other is designated as the working channel for instruments.

The most recognized name for this technique in spine surgery is Unilateral Biportal Endoscopy (UBE).

Product Focus and Design (UBE):

• Separated Channels: Unilateral biportal endoscopy is defined by the separation of the viewing and working portals. This two-channel design is its main product innovation.
• Standard Instruments: A key advantage of the UBE technique is that it allows surgeons to use a wider array of familiar, standard, non-endoscopic surgical instruments through the working portal. This is a major factor in its adoption, as it reduces the need for entirely new, highly specialized product sets required by the uniportal technique.
• Flexible Visualization: The endoscope (arthroscope) in UBE can be maneuvered and angled independently of the working instruments, offering the surgeon flexible viewing angles and a potentially wider visual field.
• Continuous Irrigation: The UBE system is typically performed under a continuous flow of saline solution, which helps manage bleeding and maintain a clear, panoramic view.

Surgical Implications:

• Maneuverability and Dexterity: The dual-portal design grants surgeons a greater degree of freedom, allowing for triangulated access to the surgical target. This mimics the two-handed dexterity of traditional open surgery, making the technique feel more intuitive and leading to an easier, shallower learning curve for many experienced spine surgeons.
• Decompression Efficiency: The ability to use standard, robust instruments can be advantageous for extensive bony work or complex decompression procedures, potentially leading to greater decompression efficiency in certain cases, such as lumbar spinal stenosis.

Summary of Core Differences

Ultimately, both uniportal and biportal endoscopy (like Unilateral biportal endoscopy) are highly effective, ultra-minimally invasive options that represent the future of spinal care. The choice between the systems often comes down to the surgeon’s training, the specific pathology, and their preference for a particular product’s system design and instrumentation.