Park Sang-Min, Kim Ho-Joong, Kim Gang-Un, Choi Min-Ho, Chang Bong-Soon, Lee Choon-Ki, Yeom Jin S
Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.
World Neurosurg. 2019 Feb;122:e1007-e1013. doi: 10.1016/j.wneu.2018.10.197. Epub 2018 Nov 4.
The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM).
The surgeon was proficient in open and microscopic decompressive laminectomy in lumbar spinal stenosis but did not have any experience with BESS or other endoscopic surgery techniques. The learning curve of BESS was investigated using LC-CUSUM analysis. Procedure success was defined as an operative time <75 minutes, the mean operative time with microscopic decompression laminectomy.
The present study included the first 60 patients who had undergone single-level decompressive laminectomy using BESS by a single orthopedic surgeon. The mean operative time for decompressive laminectomy by BESS was 83.8 ± 37.9 minutes. The mean operative time in the early learning period (≤30 cases) and late learning period (second 30 cases) was 105.3 ± 39.7 minutes and 62.4 ± 19.9 minutes, respectively. The overall complication rate was ∼10%. The LC-CUSUM signaled competency for surgery at the 58th operation, indicating that sufficient evidence had accumulated to prove that the surgeon was competent. Thus, a trainee with no experience with BESS had reached adequate performance at 58 cases.
The results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.
本研究旨在使用学习曲线累积求和检验（LC-CUSUM）确定双门内镜脊柱手术（BESS）治疗腰椎管狭窄减压性椎板切除术的学习曲线。
外科医生精通腰椎管狭窄的开放和显微减压性椎板切除术，但没有BESS或其他内镜手术技术的经验。使用LC-CUSUM分析研究BESS的学习曲线。手术成功定义为手术时间<75分钟，即显微减压性椎板切除术的平均手术时间。
本研究纳入了由一名骨科医生使用BESS进行单节段减压性椎板切除术的前60例患者。BESS减压性椎板切除术的平均手术时间为83.8±37.9分钟。早期学习阶段（≤30例）和后期学习阶段（后30例）的平均手术时间分别为105.3±39.7分钟和62.4±19.9分钟。总体并发症发生率约为10%。LC-CUSUM在第58例手术时表明手术能力达标，这表明已有足够证据证明外科医生具备能力。因此，一名没有BESS经验的受训者在58例手术时达到了足够的手术表现。
本研究结果表明，在使用BESS进行腰椎减压性椎板切除术时，可能需要相当长的学习期才能达到足够的手术表现。
