Doctor Wälchli, you are one of the few spine surgeons in Switzerland who has been regularly performing endoscopic spine surgery for over 15 years. Why did you become interested in this technique early on?
As a senior physician at Balgrist University Hospital, I met patients who had undergone endoscopic surgery for a slipped disc with Dr Thomas Hoogland in Munich. At that time, patients had to be hospitalised for a slipped disc surgery at our clinic for over a week. With the endoscopic technique, patients returned from Munich after only two days and were able to resume work after a few days. That fascinated me and I wanted to learn this technique as well.

As an instructor for endoscopic procedures, you have also been involved in the international development of this technique over the years. Where does Switzerland currently stand in international comparison?
Although endoscopic procedures for spinal surgery were also developed in Switzerland as early as the 1980s at the Balgrist University Hospital, this technique has never really become established in Switzerland. In the rest of Europe, too, there were only a few and mostly privately practising medical doctors who used endoscopy in spinal surgery. These collegues were often ridiculed as exotic. In Asia, especially in South Korea, endoscopy has been used routinely for a long time and has also been further developed. Only a few years ago, interest in endoscopic procedures also increased again in Switzerland. This may also be due to the fact that large academic institutions such as AO Spine began to offer more courses. Now endoscopy is also becoming respectable again in academic centers. Chances are thus intact that in a few years endoscopy will be part of the basic training in spinal surgery, just like microsurgical techniques.

Why is the breakthrough of endoscopy in spine surgery only now happening in Switzerland?
Until now there were no solid studies that could show the advantage of endoscopy over conventional microsurgical techniques. However, more recent studies now show advantages of endoscopy in comparison to other techniques in some respects, e.g. because of the shorter hospitalization or because of less pain immediately after the operation. Incidentally, this has also led to the Dutch government to reinstate endoscopic procedures in the basic coverage of health insurance.

Based on your many years of experience, when is the endoscopic technique a true alternative to the microsurgical technique?
Endoscopy, like other surgical procedures, is a technique to solve a specific surgical problem. But endoscopy also has clear indications and contraindications and thus limits that must be respected. Of course, an experienced surgeon can push the limits of a technique. However, it is important that patients do not suffer any harm.