Operative Learning Curve after Transition to Endoscopic Transsphenoidal Pituitary Surgery.

Operative Learning Curve after Transition to Endoscopic Transsphenoidal Pituitary Surgery.

World Neurosurg. 2017 Mar 11;:

Authors: Shikary T, Andaluz N, Meinzen-Derr J, Edwards C, Theodosopoulos P, Zimmer LA

Abstract
OBJECTIVES: No clear consensus yet defines the endpoints for operative learning curves in the transition to minimally invasive endoscopic techniques. This retrospective review of our first 202 patients who underwent endoscopic pituitary resection examines the statistical learning curve related to operative times--a measure of our surgical team's efficiency and complication rates, a reflection of surgical skill and maturity.
METHODS: Retrospective chart review included patient demographics, tumor type, operative times, complication rates, and follow-up. During the 5-year period, surgeries were performed by an otolaryngology-neurosurgery team. Statistical analysis by Pearson's correlation delineated a learning curve for operative time and complications.
RESULTS: Our learning curve showed comparable plateaus: 120 cases (48% men, 52% women) for operative times (mean 134 minutes, range 62-307 minutes) and 100 cases for incidence of cerebrospinal fluid (CSF) leak. Risk of CSF leak significantly declined with the surgeon's increasing experience. Complication rates were 9.9% temporary nasal obstruction, 8.4% CSF leak, 7% postoperative epistaxis, 4.5% sinusitis, 2.4 % septal osteomyelitis, 1.5 % postoperative sellar hematoma, 0.5 % anosmia, and 0.5 % septal perforations. Overall CSF leak rate included 5.5% intraoperative and 2.9% postoperative; most resolved with a lumbar drain, 4 (2%) patients had postoperative surgical repair and lumbar drainage.
CONCLUSION: Our learning curve defined endpoints for two measures, operative time and complication rates, supports improved outcomes for reduced CSF leaks, the most common complication, with increasing operative experience. We continue to examine the implications related to safety, efficacy, and need for sub-specialization in this minimally invasive surgery.

PMID: 28300715 [PubMed - as supplied by publisher]

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