Glocalization of Neuroendoscopic Surgery in Japan

Abstract

Original Japanese devices and ingenious techniques discovered during the last quarter of a century has impacted the development of neuroendoscopic surgery. First, the refinement of the neuroendoscope in Japan. The world‒leading flexible endoscope has evolved from a fiberscope to a videoscope with a CCD at the tip. It has been used for removing intraven-tricular hematoma, ventricular lavage, and choroid plexus coagulation, which are frequently indicated in low‒ and middle‒income countries to avoid cerebral spinal fluid shunt. A unique holder for a rigid endoscope with a passive robotic arm system has been designed in collaboration with neurosurgeons and Japanese companies. This enables the surgeons to effortlessly release and fix the scope with nitrogen gas pres-sure. Currently, it is widely used for keyhole and skull base surgeries in foreign countries. Second, transparent sheath is a simple and world‒famous device. This sheath transformed the hematoma removal surgery into an endoscope solo procedure in Japan. The procedure has been disseminated worldwide and applied to the biopsy or excision of intraparenchymal lesions. Finally, the novel concept of cylinder neurosurgery was developed. Along with the development of equipment and techniques, the first certified system for neuroendos-copy was established in Japan. Some training courses using simulation models were designed simultane-ously to standardize basic procedures and guarantee safety. This serves as a useful reference for education and training in foreign countries. Pioneers in Japan encouraged‘glocalization’of some equipments and techniques ridiculed as Galápagos syndrome. Next generation should take pride in this history and continue best original inventions.