Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 2 of 18 in Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
Biportal Endoscopic Spine Surgery: What It Is and How It Works
August 5, 2026
Biportal endoscopic spine surgery uses two small ports, one for a camera and light source and one for surgical instruments, to treat spine problems such as disc herniation and spinal stenosis without a large incision. This technique, a recent addition to spine surgery, can now handle around 90 percent of spinal procedures.
How biportal endoscopy works
Biportal endoscopic spine surgery works much like arthroscopy of the knee or shoulder, or laparoscopy of the abdomen, except that it is performed under a continuous saline fluid medium. One port carries the camera and illumination source, while the second port allows the surgeon to use normal surgical instruments on the spine, the same instruments used in open or tubular approaches.
What biportal endoscopy can treat
Biportal endoscopy is used for procedures including central canal decompression with bilateral root clearance in lumbar canal stenosis, and removal of large, distally migrated herniated discs. In one example, a central canal decompression with bilateral nerve root clearance took about an hour, and the patient was sitting up and walking the same evening, discharged the next day with only a few millimetres of incision and absorbable sutures.
Recovery after biportal endoscopic surgery
Because biportal endoscopic spine surgery uses such small ports, patients typically recover very quickly. In cases of large herniated disc removal, the procedure itself takes 45 minutes to an hour, and patients are walking pain-free the next day with just two small ports and a couple of sutures. Dr. Puneet Girdhar of BLK-Max Super Speciality Hospital has performed thousands of these procedures without a major complication.
← Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved | Series index | When to See a Spine Specialist: Warning Signs You Shouldn't Ignore →
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Chairman, Max Institute of Robotics and Minimal Invasive Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Puneet Girdhar taught doctors across Africa on August 10, 2025.
FROM THE LIVE Q&A
Dr. Frank, referring physician, Ghana
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?
Dr. Puneet Girdhar
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
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Frequently Asked Questions
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.▼
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?▼
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
What is biportal endoscopic spine surgery?▼
It is a technique that uses two small ports, one carrying a camera and light source and the other for surgical instruments, to treat conditions such as disc herniation and spinal stenosis without a large incision.
How is biportal endoscopy different from open spine surgery?▼
Rather than opening the back, biportal endoscopy works much like arthroscopy of the knee or shoulder, performed under a continuous saline fluid medium through two small ports instead of one large incision.
What conditions can biportal endoscopy treat?▼
It can address around 90 percent of spinal procedures, including central canal decompression with bilateral root clearance for lumbar canal stenosis and removal of large, distally migrated herniated discs.
How long does biportal endoscopic surgery take and what is recovery like?▼
A central canal decompression can take about an hour, with the patient sitting up and walking the same evening and going home the next day. Large herniated disc removal takes 45 minutes to an hour, with patients typically walking pain free the following day.
How safe is biportal endoscopic spine surgery?▼
Dr. Puneet Girdhar of BLK-Max Super Speciality Hospital has performed thousands of these procedures without a major complication.
In This Series: Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
- 1.Advances in Spinal Surgery
- 2.Biportal Endoscopic Spine Surgery: What It Is and How It Works
- 3.Cervical Disc Replacement: Treating Neck Disc Herniation While Preserving Motion
- 4.Growth Rods for Early-Onset Scoliosis in Young Children
- 5.Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity
- 6.Herniated Disc Surgery: Biportal Endoscopic Discectomy Explained
- 7.Kyphoplasty for Osteoporotic Spinal Fractures: A Same-Day Procedure
- 8.Lumbar Canal Stenosis: Symptoms and Modern Minimally Invasive Treatment
- 9.Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery
- 10.Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved
- 11.Navigation and Robotics in Spine Surgery: Why They Improve Accuracy and Safety
- 12.Prolonged Sitting and Disc Degeneration: Why Desk Jobs Are a Spine Risk
- 13.Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect
- 14.Robotic Spine Surgery for Complex and Revision Cases
- 15.Scoliosis and Kyphosis in Children: Types and Warning Signs
- 16.Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed
- 17.Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis
- 18.When to See a Spine Specialist: Warning Signs You Shouldn't Ignore