Практика Shadowing: Meet the Masters: 2026 Spine Endoscopy Masterclass Talk - Изучайте разговорный английский по видео

Выберите режим практики

Каждый режим открывает полноэкранную комнату практики.

254 предложений

Если предложения слишком короткие или длинные, нажмите Edit, чтобы их изменить.

I was assigned a very simple topic called Global Consensus Endoscopy as the New Standard.

As a disclosure, I am a consultant for Eloquence.

And what I want to talk about is what I call LESS,

Lumbar Endoscopic Spine Surgery, which you have to admit is a very cool name for a melaninvasive procedure.

But I call this procedure, for me, the oldest state-of-the-art procedure that I have in my toolbox because it has been around for a long time.

So back in 1999, this paper was published.

That means that it's been around for like 30 years.

And even before that, there's been other papers.

And since then, that paper was the transferaminal uniportal approach.

we now can do interlaminar surgery.

We can do it in the cervical, thoracic, and lumbar spine.

And we can do it from uniportal, and we can do it biportal.

And a lot has happened.

So the first thing I want to point out is that there's still people that demand more evidence, more proof that this works.

So just at any time, go to PubMed and just type in something that you want to compare traditional mini open surgery for with endoscopic.

So this is the most common one.

You have a herniated disc.

What are the results of?

Lumbar microdiscectomy.

And you get a bunch of studies, like a thousand.

What do you think happens when you type in lumbar endoscopic spine surgery?

Over a thousand.

And if you do this for the treatment of spondy, fusions, a bunch of stuff, you'll be surprised at how many peer-reviewed publications are out there for endoscopic surgery.

It's tremendous.

So the question of does endoscopy work?

that that's that's like old news it totally works all the data shows

that it works to me the more important question than

that about whether it works is if it's

so great how come the adoption rate is

so low how come is it

that in all of san diego there's just two people

that does like real endoscopy like full on endoscopy two people in california there's probably no more than like five or ten,

at least on the level of like Dr. Kang and I.

So the important question is if it's so great why is the adoption so poor?

I'm not sure what the answer is but there's probably two reasons.

The first is this whole reimbursement and cost issue.

That's not an area of expertise for me.

The second one is the learning curve and I think we all recognize these two issues but it's

so uncommon for us to ask the next question.

So here's the next question in my mind that's important.

Not only do we kind of appreciate that the learning curve is difficult, we have to ask a very important question.

How can we improve upon it?

And we don't have that discussion nearly as often as we should.

And I'm not here to tell you what what the answer to that is, but I can tell you that a lot of the discussions that I hear,

we have to have some goals when we adopt a new technology.

And if you really think hard about it, if you're a resident, you can do a case and be in the learning curve.

But if you're already in attending, in practice, there's very few patients that you'll sit in front of and think to yourself,

this patient doesn't matter to me as much.

I think I can try this and

if it doesn't go well it's going to be okay

that patient hardly ever comes up and it should never come up

so we have to work backwards you have to make the first case go well

so i can tell you three things of what not to do

when you first do your endoscopic case you ready what not

to do is number one do not be unprepared number two do not be unorganized and number three do not unrealistic.

These are all three things that you can solve pretty much immediately if you put your mind to it.

Now I'll give you an example.

One of the biggest problems when you start endoscopy is that everything is totally new.

The room setup is new.

You have two monitors potentially up, one for flora and one for endoscopy, and you've got foot pedals, and you have to look around.

So if you don't have everything set up, if you don't have all the equipment coming at you

when you want it and not having missing items for your first case, that makes things a lot easier.

You just need to worry about the surgery.

Not on your first case, is everything there when I need it.

So look at the picture on the left.

That's my old way of keeping a checklist.

And I would demand that they print that out.

And if something's missing, I ask them, like, let me see the checklist

and they have to produce a piece of those pages with checks check marks on it

if they don't and something's missing it gets ugly in the

OR so here's the problem on a checklist like

that the first 80 things is easy it's the last five things that's buried in the checklist

so one thing you can easily do is have a checklist that's easy to use it's 2026 make it

so that it's electronic.

Another example, setting up the room.

You want everything where you want it

because you have to look up at a screen

and you can use the picture on the left or you can use an interactive model on the right.

Here's another example in terms of being realistic.

I can't tell you how many times somebody picks the hardest first case to do

and also thinking that you're going to remember everything.

So it's all about the first few cases because what I noticed is that if you can get through the first three,

four, five cases successfully and then on the sixth case you have a problem, you'll probably do a seventh case because you'll think, I know what I did wrong.

My other five patients are doing great.

I'm going to go again.

If you have a problem on the first case, it's very likely that you're going to think, this is not for me.

This doesn't work.

This is BS.

I'm never doing this again.

It's almost like a really awkward first date.

You just don't even want to see that person ever again.

So you can deal with right now.

So all of you that's just going to start up and just do it, do that, but do not make those first three mistakes.

So having said that, and there's a lot more work to do, what else could we do to drive adoption?

Now, if you just look at the history, you know how I said this is 30 years old?

In the last five years, there's been this unbelievable adoption of endoscopic surgery.

And the single biggest reason is the advent and adoption and recognition of bipolar endoscopic surgery.

So I'm often at the podium proudly stating

that the best spine surgeons in the world are the Korean spine surgeons from Korea.

100

because they were the, they did a lot of MIS and if it wasn't for Biportal,

101

I think we'd still be struggling and I think this is going to help drive what I call the tipping point.

102

So this whole discussion, somebody asked me like, talk about Biportal, will you?

103

Because you're a Uniportal guy and I'm like the straw man here.

104

So what do I think about Uniportal versus Biportal?

105

I kind of look at it like this like left twix

106

versus right twix in my mind it doesn't really matter

107

that much what's more important is that it's endoscopic not whether it's uniportal

108

or biportal and just imagine a world where you can do multi-portal

109

and I just did that yesterday there's no reason why you can't make three ports

110

so example your biportal you can't get through the other side for some reason, you just make a port on the other side.

111

Yesterday I had to do an interlaminar and a transraminal approach on the same level,

112

which kind of sucked, but still there's no reason to open it or do a fusion on something like that.

113

The way I deal with this whole situation is I encourage you to look to the future

114

because right now it is very nice to be able to use somebody else's equipment, use a bunch of old equipment, put it all together like we're in Cuba or something like

115

that and prove to somebody like how well it works

116

but in my mind the future is

117

that we're spine surgeons we get our own equipment we own our own equipment

118

and that equipment is purely designed to accomplish the goals

119

that we want not a system that was designed for the knee

120

or the shoulder that we configured to the spine using a combination of open stuff

121

and other anatomy stuff so simple thing is that

122

if you have a uniportal system you can go by portal anytime i start everything uniportal, same target site, same work,

123

and I only create the second port if I need it.

124

If I don't need it, I just don't.

125

If I need it, I say, give me the knife.

126

I make the second port, give me the T-handle, and then open up the basic spine trait.

127

So in the interest of time, I'm going to pass through this, but one simple advantage is that you can find the second port without necessarily chop-slicking the whole time.

128

You can do it in direct vision, and you can swap back and forth where you work.

129

So let me give you a case example.

130

She's in her 80s.

131

She's got back pain and neurogenic claudication.

132

Flexing extension views with these findings.

133

All right, now I want you guys to think about how you would treat this patient.

134

Now this patient is my 84 year old mom.

135

This is her now at age 90.

136

How many of you would do a two level MIS-T lip or a diffusion of some type?

137

How many of you would just do a decompression only?

138

How many of you guys think I just did a How many of you guys think she had an MIS-T lift?

139

I didn't do it.

140

Okay, she had a two-level MIS-T lift But that was six years ago

141

If she presented today I would want her to have a biportal endoscopic laminectomy

142

Because I remember the day when I thought there's nothing better than a blackberry

143

and then I'm like oh my god The iPhone I remember

144

when I used to love going to Blockbuster on the weekends with my family

145

and going back and forth into the aisles I was picking a video.

146

Now we do that just sitting in front of the TV.

147

I remember when I had a package of wires everywhere.

148

Now I just do everything by magic and the ether.

149

And all this is related to what I call a simple process called evolution.

150

Because all surgeries evolve to become less invasive.

151

And there's nothing more less invasive than endoscopic surgery.

152

So with that, thank you.

153

I have no idea if I ran over, but I suspect I did.

154

Hello.

155

Again, Ivan Samanov from Mexico.

156

I was wondering, how do you deal with insurance companies when doing navigation on endoscopic surgeries?

157

Because at least in our country, if you explain that you are going to do navigation on an obese patient,

158

the insurance first asks you to send the patient to bariatric surgery

159

or something else so that's like a huge problem to us i was wondering

160

if you have like the same issues here thanks yeah you know i have the same issues

161

so to address the obesity question right

162

if it is emergency like the klanakwana you have no choice right

163

but for elective t-lifts you have i think of you you know you have to prove to the insurance

164

and also So for the benefit of the patient and to make your surgery easy,

165

do everything to have that patient reduce some weight.

166

And especially with the GLP-1 agonists out there, that job has gotten a lot easier.

167

But there are some people who actually, despite the medications, do not lose weight.

168

They try everything for whatever reason.

169

And it turns into a vicious cycle because they're in pain.

170

They're not moving they're not exercising, they cannot do therapy, and they don't move,

171

their muscles decondition, so their condition worsens, and then it becomes a vicious cycle, and you have to cut it somewhere,

172

and I feel like if you can provide surgical care to get rid of the pain at least, they can actually move around more and hopefully better themselves.

173

And with regard to reimbursement, actually in the United States if you use stereotactic navigation there is an added code

174

that we can attach to our billing and you end up making more money

175

so hopefully that will encourage some of the surgeons to utilize navigation for the benefit of the patients

176

or you know I use navigation regularly for T-lifts I do

177

not use navigation for decompression only unless it's thoracic disc or something rare where I really need to localize the anatomy.

178

And yeah, so that's been helpful.

179

Let's go in the west coast.

180

I love navigation, but I think our problem is different.

181

You're talking about the mandates and the policies of insurance people and the payers.

182

We don't have that problem.

183

Our problem is that the hospitals and the facilities that we operate at, they have to pay for the navigation because insurance companies don't pay that much.

184

So we have a big obstacle in terms of cost efficiency.

185

And right now it's okay because the hospital is very cost inefficient, but I anticipate in the next five to ten years there's going to be two types of spine surgeons.

186

Just like there are two types of knee surgeons.

187

You know, there's a knee surgeon that does a knee replacement.

188

If you need an ACL reconstruction or a meniscectomy done with an endoscope, arthroscopy, you go to another doctor.

189

So I think there's going to be a large group of young, highly motivated, energetic, entrepreneurial spine surgeons.

190

They're going to gravitate toward the ambulatory surgery center and hardly ever go to the hospital.

191

And some spine surgeons that are almost always at the hospital never go to the surgery center.

192

And the growth is going to be in the surgery centers.

193

And that's where the issue of robotics, navigation, in the setting of endoscopy is going to be a real barrier because of the cost to the facility.

194

The second quick question.

195

When you talk about your mom's case, you told that she was pretty good right now.

196

She improved all of her symptoms without mis relief do you think

197

that doing an endoscopic decompression also the back pain could be could relieve her symptoms nowadays yes

198

and i want to answer that question in a couple of different ways i know a lot of spine surgeons

199

if you ask me how many spine surgeons have had a lumbar fusion on themselves

200

or their immediate family members like their wife their children

201

or their parents I can't name more than about five

202

so that's the first thing so if you ask yourself what would I do

203

if this is my family member which is what I usually do things change

204

so six years ago and my ICF was the great operation

205

but today I would say that I do an endoscopic decompression only

206

and I would be confident that maybe the back pain wouldn't be as well, maybe, because she has no back pain either,

207

but she had mostly neurogenic claudication, so she's not a back pain patient.

208

It wouldn't even be close.

209

Plus, her facet joints didn't have a lot of facet fluid, so I'm confident that they would have a great result.

210

The complication profile would be much less,

211

and that says a lot that I would treat my own mom two totally different ways six years ago versus now.

212

That's how much endoscopy is advanced because I take care of a lot of patients that I would normally do a fusion.

213

I'm just like, key, I hardly ever do any fusions anymore.

214

And I love that surgery.

215

I wish I could do more, but most patients don't want it.

216

And then the ones that I do the decompression, even though I tell them, I think you're going to need a fusion, most of them do not need the fusion.

217

So I just keep moving more toward non-fusions right now.

218

I don't know where that line is going be

219

but i think the fusion line is going to be much

220

further out than it is today the use of antibiotics do you use antibiotics on the irrigation fluid

221

or on the iv

222

and another question is for the far lateral herniations the the use of by portal endoscopy is it really useful

223

or would you do only only portal for far disc herniation thank you all right

224

so i do not use any antibiotics in the saline i think saline itself is like sterile

225

and and you know never say never thankfully haven't had infections

226

so i think there's some literature suggesting

227

that the infection rate is really low with that water-based

228

or saline-based endoscopy to begin with

229

and then for far lateral disc herniation uh i you know

230

i can 5-1 may be challenging whether you are a uniportal guy

231

or a biportal guy

232

but the four five you know three four i've used the biportal uh without issues

233

and then i've shown a case of a thoracic lateral approach um endoscopy is a tool

234

but you know my general recommendation is use whatever works in your hands

235

if you're an open surgeon that's probably the safest surgery that you're going to do it for that patient.

236

So it's just a tool that we're using.

237

I'm a golfer.

238

I don't think, yeah, but I think I agree with you.

239

But here's the way I look at it.

240

If I have a far lateral disc herniation, I'm going to do uniportal because it's easier, it's faster, and there's no need to go biportal.

241

If I do a 4-5 or 5-1 disc herniation, I go uniportal.

242

If I have to do like a decompression, I'm ready to go biportal.

243

If I have to do something complex like an L12 or so, I want to be able to do both.

244

And my guess is that if you saw me do a far lateral endoscopic discectomy uniportal

245

and you saw somebody do a biportal, you'd end up doing a uniportal.

246

So depends on how you ask that question.

247

If you have access to both systems, I strongly encourage you to learn how to do both.

248

I think the reason as to why bipolar endoscopy has taken off is that, you know, if you think about the cases that you do,

249

the majority of cases, right,

250

90 plus, maybe 95 plus of degenerative lumbar decompression work with is inner laminar approach.

251

So I think for that multi-portal endoscopy seems to do better for multiple reasons,

252

including you know, being able to utilize some of the more aggressive tools because I mean,

253

for me personally, I don't want to stay in the operating room for two, three hours during one level landing.

254

You know, in 30 minutes is my limit.

Скачать приложение

Всё для свободной речи

ИИ-оценка произношенияОценка каждой фразы

Практика IPAОсвойте каждый звук

СловарьСоберите свой словарный запас

Игра со словамиУчитесь играя

Сканировать QR

Download on theApp Store Get it onGoogle Play

FOR YOU

Лексика и советы по произношению к этому уроку

В этом видео 254 предложений и 3309 слов для шедоуинга. Речь длится 19:14. Говорящий говорит в естественном темпе, около 172 слов в минуту, близком к повседневной речи. 82% слов входят в 3000 самых частых слов английского языка; остальные стоит разобрать перед занятием.

Ключевая лексика этого видео

15 менее частых слов из видео с произношением и значением:

spine /spaɪn/ (существительное) — позвоно́чник, хребе́т. A series of bones situated at the back from the head to the pelvis of a human, or from the head to the tail of an animal, enclosing the spinal cord and…
surgeon /ˈsɝd͡ʒən/ (существительное) — хиру́рг. One who performs surgery; a doctor who performs operations on people or animals.
navigation /nævɪˈɡeɪʃən/ (существительное) — навига́ция. The theory, practice and technology of charting a course for a road vehicle, ship, aircraft, or spaceship.
fusion /ˈfjuː.ʒən/ (существительное) — ядерный си́нтез. The act of merging separate things, or the result thereof.
disk /dɪsk/ (существительное) — диск. A thin, flat, circular plate or similar object.
adoption /əˈdɑp.ʃən/ (существительное) — усыновле́ние, удочере́ние. The act of adopting.
portal /ˈpɔːɹtl̩/ (существительное) — порта́л. An entrance, entry point, or means of entry.
lateral /ˈlætəɹəl/ (прилагательное) — латера́льный, боково́й. Situated on one side or other of the body or of an organ, especially in the region furthest from the median plane.
knee /ni/ (существительное) — коле́но. In humans, the joint or the region of the joint in the middle part of the leg between the thigh and the shank.
encourage /ɪnˈkʌɹ.ɪd͡ʒ/ (глагол) — ободря́ть, обо́дрить. To mentally support; to motivate, give courage, hope or spirit.
procedure /pɹəˈsiː.d͡ʒə/ (существительное) — процеду́ра, ме́тод. A particular method for performing a task.
versus /ˈvɝsəs/ — про́тив. Against; in opposition to.
curve /kɚv/ (существительное) — изги́б, крива́я. A bend, such as in a road.
antibiotic /ˌæn.taɪ.baɪˈɑ.tɪk/ (существительное) — антибио́тик. Any substance that can destroy or inhibit the growth of bacteria and similar microorganisms, generally transported by the lymphatic system.
infection /ɪnˈfɛkʃən/ (существительное) — инфе́кция, зараже́ние. The act or process of infecting.

Фразовые глаголы, которые вы услышите

talk about (глагол) — ну и, вот э́то. Used to draw attention to the speaker's characterization of someone or something.
deal with (глагол) — справляться с. To handle verbally or in some form of artistic expression; to address or discuss as a subject.
think about /ˈθɪŋk əˌbaʊt/ (глагол) — обду́мывать, обду́мать. To ponder.
come up (глагол) — поднима́ться, подня́ться. To emerge or become known, especially unexpectedly.
end up (глагол) — зака́нчиваться, зако́нчиться. To bring to a conclusion.
set up /ˌsɛt ˈʌp/ (глагол) — устана́вливать, установи́ть. To make ready for use.
go back (глагол) — возвраща́ться, возврати́ться. To return to a place or state after having been there at a previous time.
go by (глагол) — проходи́ть, проходи́ть ми́мо. To pass or go past without much interaction.

Произношение, на которое стоит обратить внимание

Говорящий использует 67 сокращённых и редуцированных форм, например don't, I'm, you're. Произносите их коротко, так, как слышите.

Звуки «th»: sixth /sɪksθ/, seventh /ˈsɛvənθ/, thoracic /θəˈɹæsɪk/, ether /ˈi.θɚ/
Звуки «sh» и «zh»: navigation /nævɪˈɡeɪʃən/, fusion /ˈfjuː.ʒən/, adoption /əˈdɑp.ʃən/, infection /ɪnˈfɛkʃən/, vicious /ˈvɪʃəs/
Длинные слова — следите за ударением: navigation /nævɪˈɡeɪʃən/, antibiotic /ˌæn.taɪ.baɪˈɑ.tɪk/, anatomy /əˈnætəmi/, necessarily /ˌnɛs.əˈsɛɹ.ə.li/, recognition /ˌɹɛkəɡˈnɪʃ(ə)n/

Как заниматься с этим видео

Прослушайте всё видео один раз молча и выпишите незнакомые слова.
Начните со скорости 0,75×, повторяйте предложение за предложением и вернитесь к обычной скорости, когда станет легко.
Запишите себя и сравните с оригиналом, обращая внимание на такие слова, как spine, surgeon, navigation.

Грамматика в этом видео

Конструкции, которые говорящий использует чаще всего, с точными словами из видео:

Конструкция	В видео
Условные предложения if + предложение, will/would + глагол — условие и его результат	If she presented today I would want · if you ask yourself what would I
Present Perfect have/has + причастие прошедшего времени — прошлое действие, важное сейчас	has been · it's been · there's been
Пассивный залог be + причастие прошедшего времени — важно, что происходит, а не кто это делает	was assigned · was published · be unprepared
Придаточные определительные who / which + предложение — уточнение о человеке или предмете	people who actually · member which is

Что такое техника Shadowing?

Shadowing — это научно обоснованная техника изучения языка, изначально разработанная для подготовки профессиональных переводчиков и популяризированная полиглотом доктором Александром Аргуэльесом. Метод прост, но эффективен: вы слушаете аудио на английском от носителей языка и немедленно повторяете вслух — как тень, следующая за говорящим с задержкой в 1–2 секунды. В отличие от пассивного прослушивания или грамматических упражнений, Shadowing заставляет мозг и мышцы рта одновременно обрабатывать и воспроизводить реальные речевые паттерны. Исследования показывают, что это значительно улучшает точность произношения, интонацию, ритм, связную речь, понимание на слух и беглость речи — что делает его одним из самых эффективных методов для подготовки к IELTS Speaking и реального общения на английском.

Техника шедоуинга: читать полное пошаговое руководство →

Практика Shadowing: Meet the Masters: 2026 Spine Endoscopy Masterclass Talk - Изучайте разговорный английский по видео

Выберите режим практики

Скачать приложение

Рекомендуемое видео

SVINutes: Super Large Bore Thrombectomy

Blindboy discovers the link between gut health and mental health

Leaders of Neurosurgery: Jacques Morcos, MD, FAANS, FACS interviewed by Gregory Zipfel, MD, FAANS

Dr. Andy Galpin: Does Cardio Ruin Muscle Growth?.

UROLIFT - PHƯƠNG PHÁP ĐIỀU TRỊ BỆNH SÓN TIỂU VÀ NHIẾP HỘ TUYẾN LỚN Ở NAM GIỚI

Sequential, Multiple Assignment, Randomized Trial Designs With Dr Kidwell

Stories of Transformation - Dominique

Fight brain-rot with Worked Examples

Day in the Life as a Doctor

What Actually Works for Your Skin? A Stanford-Trained Plastic Surgeon Explains

Scoliosis: How to medically classify scoliosis (the Lenke System for AIS)

SurGenTec Bioskills lab