When Daniel Park, MD, began learning endoscopic spine surgery nearly a decade ago, the surgeons coming up behind him barely knew what to make of it. Fellowship applicants would hear “endoscopic” and think arthroscopy. Many had little interest in learning it.
Today, they are requesting it. Fellowship applicants now want to know whether endoscopy is part of the curriculum and whether they will have exposure to it, Dr. Park told Becker’s.
For Dr. Park, a professor of orthopedic spine surgery at Rush Medical College and spine surgeon at Midwest Orthopaedics at Rush in Chicago, that shift carries more weight than the crowds that have gathered around endoscopy demonstrations at spine meetings for years. Those surgeons could have been curious. Today’s trainees are deciding what they want to learn.
“The new generation are the ones that are going to push this,” he said. “When they all want exposure to it, that shows the trend is changing.”
Dr. Park has had an unusually long view of that change. He began performing endoscopic spine surgery around 2017 and became the first U.S. surgeon to perform biportal endoscopic spine surgery.
He also believes endoscopy is entering a new stage in the U.S., but he is less interested in declaring it the future of spine surgery than in defining where it actually belongs. The field has spent years showing what surgeons can do through an endoscope. Dr. Park thinks the harder task now is determining which patients and procedures truly benefit from an endoscopic approach, and when it offers an advantage over established techniques.
The signal coming from fellowship applicants
Dr. Park’s interest in endoscopy began with a problem far removed from the novelty of a new surgical technique.
When he started exploring it, the opioid crisis had intensified scrutiny of postoperative pain and prescription narcotic use. He was practicing in Michigan, a state he said was grappling with particularly high prescription narcotic use. Endoscopy’s potential to reduce the collateral tissue damage of spine surgery caught his attention.
As his experience grew, Dr. Park said he saw patients managing postoperative pain with less medication. Research also began documenting reduced muscle damage on imaging. But he saw why the benefits could be less visible in the U.S.
In parts of Asia where endoscopy gained traction earlier, patients traditionally stayed in the hospital longer after spine surgery. If a less disruptive procedure helped reduce a weeklong hospitalization to three days, the difference was obvious. American spine care had already moved toward shorter stays and same-day discharge.
“In the U.S., when we send patients home the same day, patients may be suffering at home, but unless they call us, we don’t see that,” Dr. Park said. “Seeing the tangible benefits is a little bit harder in the U.S.”
There is another barrier. A surgeon who has spent decades mastering an approach, and is already achieving good outcomes, has to see enough benefit to justify taking on the learning curve of another.
For someone still in training, that calculation looks different. When Dr. Park first began interviewing fellowship applicants, endoscopy barely registered. Now, applicants want to know whether they will leave fellowship knowing how to do it. To him, that is a more meaningful signal of where the field is headed than whether every established surgeon decides to change.
The problem begins when the attending is gone
Interest alone will not solve one of endoscopy’s most persistent barriers: the transition from learning the technique to performing it independently. Dr. Park sees a particular weakness in the U.S. training model once formal training ends. “In America, we have a lot of handholding during residency and fellowship, and once you’re by yourself, you’re by yourself,” he said.
A surgeon can leave fellowship or an endoscopy course comfortable with the technique and return to a hospital where nobody else performs it. Even in a large orthopedic group, spine surgeons may operate on different days.
When a case becomes more complicated, there may be no experienced endoscopic surgeon in the room. That is different from environments where the technique is already widespread and a surgeon can ask a senior colleague to assist. “I think a lot of surgeons can do it,” Dr. Park said. “But all of us are a little risk averse. That’s why we become surgeons, and I think the unknown is a big hurdle.”
The solution, in his view, is not simply more courses. It is more exposure during residency and fellowship, when trainees can watch experienced surgeons navigate difficult cases, encounter complications and decide when to change course.
Endoscopy itself may also make mentorship after fellowship easier. Because the operation is viewed through a camera, surgeons can record an entire case. At Rush, Dr. Park said he and his colleagues have encouraged former fellows beginning to perform endoscopic procedures to send them case recordings for review.
“You can critique your own surgeries as well,” he said.
Dr. Park sees the possibility of taking that model further. He pointed to research exploring whether an experienced surgeon could remotely view another surgeon’s live endoscopic camera feed and offer guidance during a case. For a technique whose U.S. experts remain relatively scattered, remote mentorship could help close the gap between learning endoscopy and performing it independently.
The question isn’t whether it can be done
As endoscopic surgeons become more technically capable, another question emerges: How far should the technique be pushed? Dr. Park’s answer starts with what should not change: the indication for surgery.
“The indications are the same,” he said. “It’s just, how do you go about it?”
That philosophy is part of what drew him to biportal endoscopy. The approach allows surgeons to use familiar surgical instruments while working with magnified visualization close to the surgical target. As surgeons become more experienced, increasingly complex and multilevel operations can be performed this way.
But technical possibility is not the same as practicality. Operating across four or five levels through a minimally invasive approach can become taxing on surgical and anesthesia time. For Dr. Park, that may prove a more meaningful limitation than whether a particular operation can technically be performed through an endoscope.
Endoscopy should not create new indications for surgery. It is another tool for treating patients who already have an indication. That same pragmatism shapes his prediction for how widely the technology will spread.
Why Dr. Park doesn’t expect every spine surgeon to adopt endoscopy
For one of the earliest U.S. adopters of biportal endoscopy, Dr. Park is notably restrained about its eventual reach. “I’m not as optimistic as other endoscopic spine surgeons, where they’re like, ‘Oh yeah, it’s going to be the best thing, and everyone’s going to do it,’” he said.
History gives him reason to be skeptical. Tubular minimally invasive surgery and lateral interbody fusion have been available for decades and have established clinical track records. Neither became universal.
Dr. Park expects endoscopy to follow a similar trajectory. He estimates endoscopic techniques are currently used by roughly 5% to 10% of U.S. spine surgeons. “I don’t know if it’s ever going to be like 100% of spine surgeons are going to do endoscopic,” he said. “I think it’ll probably hover around 40%.”
Even the distinction between uniportal and biportal endoscopy may become less important as adoption grows. “Endoscopy is just a tool,” Dr. Park said.
That may ultimately be a better measure of the technology’s maturity than universal adoption: Endoscopy does not have to become the way every spine surgeon operates. It has to become one of the established ways surgeons can approach the right operation for the right patient. Reaching that point will require something more persuasive than technical sophistication.
The burden shifts to proof
Dr. Park thinks endoscopic spine surgery has reached a point where demonstrating what surgeons can do is no longer enough. “The biggest thing endoscopic spine surgeons can do now is not just show off what we can do,” he said. “The onus is on us to show through clinical research that there is an advantage and a long-term benefit to endoscopic surgery.”
That push for clinical evidence is part of what brought Dr. Park back to Rush in 2026. He pointed to the institution’s research infrastructure and said his team is working to publish more clinical research on endoscopic techniques. “When you have that clinical data, it demystifies the procedure,” he said. “It’s not just a fad.”
The fellowship applicants Dr. Park now meets suggest the next generation is already interested. The question is whether the evidence will justify their enthusiasm. “Our goal is to continue to push the envelope, but also prove that what we’re doing is actually beneficial,” Dr. Park said.
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