A Fixed Left-Sided Surgeon Position in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation: A Technical Note with Variations According to Herniation Type

BACKGROUND: Unilateral biportal endoscopy (UBE) is increasingly used for the treatment of lumbar disc herniation. In this bimanual technique, adapting surgeon positioning according to herniation laterality may negatively affect ergonomics and operating room workflow. The feasibility and clinical impact of a fixed surgeon-positioning strategy independent of herniation laterality remain insufficiently documented. RESEARCH QUESTION: Can a fixed surgeon positioning strategy be safely and effectively applied across all lumbar disc herniation types in UBE? METHODS: A standardized left-sided surgeon positioning strategy is described for the treatment of lumbar disc herniations, including central, paramedian, foraminal, extraforaminal, and calcified or migrated herniations. Interlaminar, transforaminal, and extraforaminal approaches are detailed, with technical adaptations allowing maintenance of a constant left-sided surgeon position. This strategy was evaluated in a retrospective consecutive case series including all patients who underwent UBE for symptomatic lumbar disc herniation between August 2024 and December 2024, with a 3-month follow-up. RESULTS: Sixty-seven patients were included. Left-sided disc herniations accounted for 57% of cases (n = 38), while right-sided herniations represented 43% (n = 29). The standardized left-sided surgeon positioning strategy was feasible in all cases, with no conversion to open surgery and no change in surgeon position. Mean operative time was 35 ± 11 minutes for left-sided herniations and 42 ± 14 minutes for right-sided herniations (P = 0.021). CONCLUSIONS: Maintaining a constant left-sided surgeon position in UBE allows safe decompression across the full spectrum of lumbar disc herniation types without compromising surgical access or visualization.