Hisashi Koga1, Jin Ye Yeo2
1Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan; 2JSS Editorial Office, AME Publishing Company
Correspondence to: Jin Ye Yeo. JSS Editorial Office, AME Publishing Company. Email: jss@amegroups.com
This interview can be cited as: Koga H, Yeo JY. Meeting the Editorial Board Member of JSS: Dr. Hisashi Koga. J Spine Surg. 2024. Available from: https://jss.amegroups.org/post/view/meeting-the-editorial-board-member-of-jss-dr-hisashi-koga.
Expert introduction
Dr. Hisashi Koga (Figure 1) is the Director of Iwai FESS Clinic, and the head of the Education and Training Center of Iwai Orthopaedic Medical Hospital (Tokyo, Japan). He obtained his MD in the University of the Ryukyu Faculty of Medicine (Okinawa, Japan) and PhD in the Graduate Medical School of Kumamoto University (Kumamoto, Japan).
His research interest focuses on endoscopic spinal surgery and minimally invasive spinal surgery. He has authored more than 30 articles on his research field in the last 5 years (including in Japanese). He also obtained a research grant from the Humboldt Foundation.
Figure 1 Dr. Hisashi Koga
Interview
JSS: What inspired you to focus your research on endoscopic and minimally invasive spinal surgery?
Dr. Koga: 15 years ago, full-endoscopic spine surgery (FESS) was not popular in Japan yet. Only microendoscopic descectomy (MED) had been performed in Japan in the field of minimally invasive spinal surgery. When I experienced FESS for the first time, I was fascinated by the clear and the higher magnified operative field. At that time, I thought that FESS would be one of the major surgical procedures in this field in the near future. I, therefore, immediately started FESS on my own.
JSS: Could you provide an overview of the current publications in endoscopic spinal surgery? How have these findings impacted the field of spinal surgery?
Dr. Koga: In the initial stage of FESS, FESS was only applied for the treatment of lumbar disc herniation (LDH). Even for the treatment of LDH, some kinds of LDH (e.g., highly migrated LDH) require special techniques that only experts can do. After the development of surgical instruments and the establishment of the training system, such kind of techniques were not “special” anymore.
Furthermore, not only lumbar, but cervical and thoracic lesions also became the target area of FESS. Regarding diseases, FESS has already been applied to other diseases such as spinal canal stenosis and spondylolisthesis. The short-term outcomes compared with conventional strategies have been reported by many investigators, and their non-inferiority has been proven.
The next stage of the studies is shifting to the long-term outcomes and expanding the operative indications (e.g., tumor, scoliosis).
JSS: As the Director of Iwai FESS Clinic, how do you incorporate advancements in endoscopic and minimally invasive techniques into your clinical practice?
Dr. Koga: In addition to being the Director of Iwai FESS Clinic, I have been working as the advisor of several companies producing FESS-related instruments and software. Therefore, I could introduce the most recent technology of FESS to our clinical practice. We (the companies and myself) are currently developing an endoscope for FESS with a completely new concept.
JSS: What are some of the key benefits and limitations of endoscopic spinal surgery compared to traditional approaches?
Dr. Koga: There are so many benefits of FESS. If I had to choose three, they would be the minimal invasiveness (preservation of surrounding tissues), the clear operative field (washing out of intraoperative bleeding by saline irrigation), and the higher magnification (placing the endoscope close to the target tissue). The limitations at the moment are the 2-D view and the difficulty of a dural suture. However, these limitations might be soon overcome by new technologies.
JSS: In your role as the head of the Education and Training Center at Iwai Orthopaedic Medical Hospital, what are your primary goals for educating and training the next generation of spinal surgeons?
Dr. Koga: This is the most important aspect of my life work. The training of the next generation is the key to further development of FESS itself. For domestic trainees, we are offering 6-12 months training course in our institute. For foreign trainees, we are offering a 2-month training course. We have already accepted more than 10 foreign trainees from 2019. The primary goal of the courses is for the trainees to be able to perform FESS independently. Further information is available from the following website: https://global.iwai.com/en/for-medical/training/.
JSS: Looking ahead, what future developments or innovations in spinal surgery are you most excited about?
Dr. Koga: The combination of the navigation system and FESS is the breakthrough in reducing intraoperative radiation exposure. The current system is somewhat complicated to operate and too large. I expect the emergence of a simpler and smaller navigation system for FESS with higher accuracy. The final goal is to control such a system automatically with robot technology.
JSS: How has your experience been as a long-standing Editorial Board Member of JSS?
Dr. Koga: It is my great honor to have been a board member for so long. During these periods, JSS has been developing rapidly. I am also happy to be able to work with this dramatic development. I hope JSS will continue to provide high-quality articles in an open-access format in the future.
JSS: As an Editorial Board Member, what are your goals and expectations for JSS?
Dr. Koga: I hope that JSS will be one of the top priority journals for spine surgeons worldwide.