Biportal Endoscopy

A Gentler Approach to Spine Surgery

Less invasive. Less pain. Faster recovery.

Why this matters for patients

When Back Pain Affects Your Daily Life

Living with spine-related pain can significantly limit your mobility, independence, and overall quality of life.

Degenerative conditions of the spine are among the most common health issues people experience over the course of their lifetime. These conditions develop gradually and can be influenced by various factors. The most frequent pathologies include herniated discs and spinal stenosis.

When conservative treatments such as medication, physical therapy, or injections no longer provide sufficient relief, surgical treatment may be considered as a next step.

The goal of an endoscopic decompression procedure is to relieve pressure on the affected nerves, thereby reducing pain and improving mobility and overall function.

What Is Endoscopic Spine Surgery?

Endoscopic spine surgery is a minimally invasive technique that allows surgeons to treat spine problems through very small skin openings, instead of one larger incision. Note that not every surgical technique is suitable for every patient. Your spine surgeon will advise on the best option for you.

What Does “Biportal” Mean?

“Biportal” means using two small access points — one for the endoscopic camera and one for the surgical instruments. Each incision is typically less than 1 cm

What is Biportal Endoscopic Spine Surgery (UBE/BESS)?

  • The biportal approach with two portals gives the surgeon great freedom of movement and control, while keeping the procedure gentle for the patient.
  • The surgeon is provided with a clear, magnified, high-definition view of the spine and the affected area on a monitor, enabling highly precise and controlled surgery.
  • Tissues are protected and continuously maintained in a saline-irrigated environment, supporting gentle handling and clear visibility.

Less invasive

Biportal endoscopic surgery is performed through two small incisions. Instead of cutting muscles, the instruments are gently guided between natural muscle fibers, helping to preserve healthy tissue and spinal stability

Highly Aesthetic

Very small incisions lead to significantly smaller and more discreet scars compared to open or traditional minimally invasive surgery.

Less Pain

Because muscles and surrounding tissues are largely preserved, patients typically experience less post-operative pain, often requiring less pain medication.

Faster Recovery

The precise endoscopic view in combination with the very small incisions, allows targeted treatment with minimal trauma. This supports smoother healing, enabling many patients to return home sooner and resume daily activities faster. In addition, the continuous use of saline fluid during the procedure helps keep the surgical area clean and supports good wound healing.

Testimonials

Giulia Bonetti

was totally within her rights to actively search a surgeon with the necessary biportal endoscopy experience.

Giulia had been living with pain from her L4/L5 spinal stenosis because she had a tremendous fear of surgery. Research had led her to the relatively new technique of biportal endoscopy. Her dentist son had helped translate the clinical studies into something understandable, and clearly biportal endoscopy was receiving rave reviews in terms of surgeon performance and critically in terms of patient satisfaction and return to work timeframes – now it was about finding a surgeon with the right experience that she could trust.

Mehmet Deniz

seemed to lack interest in his proposed surgery and the possible outcomes – why?

Mehmet was not the type of person to question his physician. His six years of back and leg pain would be handled by his surgeon. However, his mind changed following reading an article on back pain in his Turkish newspaper. Biportal endoscopic spine surgery seemed to be increasingly popular in Turkey, but he had never heard of it. Furthermore, there were a host of patient benefits associated with endoscopy that clearly would make a difference to him coaching his football team. Mehmet took responsibility for his treatment, and underwent biportal endoscopy. He was back light training within one month of the operation, and fully took back control of his team by the end of the quarter!

Ivana 

surgeon was planning an endoscopic spine surgery, but she lacked the understanding to tell the difference between mono- and biportal- surgery

Upon questioning Ivana found out that her surgeon had performed 35 mono-portal endoscopic procedures. While her research also uncovered the longer learning curve for surgeons applying the mono-portal technique she lacked medical knowledge to fully understand what that meant. By chance, her friend Giulia had undergone a similar operation and could explain to her in simple terms the differences between the two techniques. Ivana asked her surgeon to recommend his colleague who had equal experience (31) but with biportal endoscopy procedures.

Klaus Hügli

had a small window of opportunity in his busy work schedule to contemplate his long-awaited spine surgery. His problem was the options under consideration both had relatively long recovery times.

Klaus was pleased with a new option of a Lateral MIS procedure over an Open TLIF, because he was really concerned about reported pain, and time off work from the latter. However, Klaus remained unaware of the choice of an endoscopic procedure for his ailment, because his surgeon had never wanted to take the time to be retrained to perform endoscopy. While patient outcome and satisfaction data looked superior, the surgeon was happy with his older methods, even when the studies showed endoscopy was a viable option for this case.

Your Recovery: What to expect and how to support a successful outcome

🩹 Mild discomfort Is normal

You may feel mild soreness or tenderness around the two small incisions. This is a normal part of healing and can be managed with oral pain medication. This is usually mild and short-lasting — and very different from deep muscle pain after open surgery.

 

📈 Recovery Is not always linear – “Good Days and Bad Days”

Some days will feel better than others. This is completely normal and part of the healing process.

 

🚫 Temporary activity restrictions

For a short time, you may need to avoid complete bending, heavier lifting, and twisting.
These restrictions are only temporary and are key to ensuring a complete and lasting recovery.

 

⏳ Patience leads to lasting results

Many patients feel relief early, but full recovery may take 1-3 months. The goal is not just short-term pain relief — it is long-lasting mobility, comfort, and quality of life.