Keerl R, Stankiewicz J, Weber R, Hosemann W, Draf W
Department of Ear, Nose, and Throat Diseases, Head, Neck and Facial Plastic Surgery, Communication Disorders, Hospital Fulda, Academic Teaching Hospital of the University Marburg, Germany.
Laryngoscope. 1999 Apr;109(4):546-50. doi: 10.1097/00005537-199904000-00005.
OBJECTIVE/HYPOTHESIS: The introduction of optical aids for endonasal sinus surgery has not produced the expected drop in the rate of serious intraoperative complications.
STUDY DESIGN/METHODS: 1. Retrospectively, consecutive procedures of different surgeons were analyzed in regard to major complications (periorbital injury, orbital lesion, dural injury, endocranial lesion, damage to the internal carotid artery). The chronological distribution was transformed into a personal learning curve. 2. From our own experience and as surveyors, we analyzed the experiences of surgeons having encountered severe complications and compared them with the above-mentioned learning curve.
In total, 1,500 operations carried out by five surgeons with 16 serious complications were assessed. For the learning curve, the following stages were defined. stage I: greatest risk of complication, with dural injury (1st to 30th operation); stage II, slighter risk of complication, with frequent periorbital injuries (31st to 180th operation); and stage III, least risk, corresponding to an experienced surgeon. Serious complications occur most frequently among experienced surgeons.
The beginner enjoys the most effective type of assistance, in the form of personal guidance of an experienced surgeon who is constantly present during the first 30 operations, and who should then be readily available during the next 70 operative procedures. The use of multimedia software appears to be helpful, though its actual value still remains to be determined. The experienced surgeon in particular must be willing to exercise repeated self-criticism to keep his or her rate of complications to a minimum.
目的/假设：鼻内镜鼻窦手术中引入光学辅助设备并未使严重术中并发症发生率如预期那样下降。
研究设计/方法：1. 回顾性分析不同外科医生连续进行的手术中出现的主要并发症（眶周损伤、眼眶病变、硬脑膜损伤、颅内病变、颈内动脉损伤）。将时间分布转化为个人学习曲线。2. 根据我们自己的经验以及作为调查者，分析遭遇严重并发症的外科医生的经验，并与上述学习曲线进行比较。
共评估了五位外科医生进行的1500例手术，其中有16例严重并发症。对于学习曲线，定义了以下阶段。第一阶段：并发症风险最高，伴有硬脑膜损伤（第1至30例手术）；第二阶段，并发症风险较低，眶周损伤频繁（第31至180例手术）；第三阶段，风险最低，对应经验丰富的外科医生。严重并发症在经验丰富的外科医生中最常出现。
新手能得到最有效的帮助，即由经验丰富的外科医生在最初30例手术期间持续进行个人指导，并且在接下来的70例手术过程中随时提供帮助。多媒体软件的使用似乎有帮助，但其实际价值仍有待确定。尤其是经验丰富的外科医生必须愿意反复进行自我批评，以将其并发症发生率降至最低。
