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Endoscopic transcanal myringoplasty:Is learning curve a myth?

ABSTRACT: Objective:To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme. Methods:In a three year period (August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region. Results:Of the 42 patient, 19 were male and 23 female. The mean age was 26.23 years (range: 15-47 years). In 40 ears, complete perforation closure was achieved at six months (success rate: 90.9%). The mean air conduction PTA preoperatively was 40.84?dB HL and improved to 28.06?dB HL postoperatively (p?

SUBMITTER: Saini A

PROVIDER: S-EPMC6291632 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Endoscopic transcanal myringoplasty:Is learning curve a myth?

Saini Amit A Saroch Munish M Gargi Gaveshna G

Journal of otology 20180518 3

<h4>Objective</h4>To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme.<h4>Methods</h4>In a three year period (August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region.<h4>Results</h4>Of the 42 patient, 19 were male and 23 fem ...[more]

PMID: 30559774

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Project description:ObjectiveFull-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED.MethodsIn the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior surgeon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Furthermore, complications and reoperations were compared. Finally, differences in clinical outcomes between surgeons were compared.ResultsAt 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were comparable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had substantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve surgeons. Finally, when comparing clinical outcomes of patients undergoing PTED versus microdiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons.ConclusionPTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED.

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Endoscopic transcanal myringoplasty:Is learning curve a myth?

Publications

Endoscopic transcanal myringoplasty:Is learning curve a myth?

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