Gadjradj Pravesh Shankar, Schutte Pieter, Vreeling Arnold, Depauw Paul, Harhangi Biswadjiet S
Department of Neurosurgery, Park Medical Center, Rotterdam, The Netherlands.
Department of Neurosurgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Neurospine. 2022 Sep;19(3):563-570. doi: 10.14245/ns.2244334.167. Epub 2022 Sep 30.
Percutaneous transforaminal endoscopic discectomy (PTED) is gaining popularity by both surgeons and patients as a less invasive treatment option for sciatica. Concerns, however, exist for its learning curve. No previous study has assessed the learning process of PTED. Hereby we present the learning process of 3 surgeons learning PTED.
This analysis was conducted alongside a multicenter randomized controlled trial. After attending a cadaveric workshop, 3 spine-dedicated surgeons started performing PTED, initially under the supervision of a senior surgeon. After each 5 cases, and up to case 20, the learning process was evaluated using the validated questionnaires (objective structured assessment of technical skills [OSATS], global operative assessment of laparoscopic skills [GOALS]) and a 10-step checklist specifically developed for PTED.
In total, 3 learning curve surgeons performed a total of 161 cases. Based on self-assessment, surgeons improved mostly in the domains "time and motion," "respect for tissue," and "knowledge and handling of instruments." Learning curve surgeons were more able to detect differences in performances on the OSATS than the senior surgeon. Based on the GOALS, the biggest improvements could be seen in "depth-perception" and "autonomy." Based on the 10-item specific checklist, all surgeons performed all 10 steps by case 10, while only 1 surgeon performed all steps adequately by case 15.
Based on these study results, PTED appears to be successfully adopted stepwise by 3 spine-dedicated surgeons. From 15 cases on, most steps are performed adequately. However, more cases might be necessary to achieve good clinical results. Validated tools are needed to determine the cutoff when a surgeon should be able to perform PTED independently.
经皮椎间孔镜下椎间盘切除术（PTED）作为一种治疗坐骨神经痛的侵入性较小的治疗选择，正越来越受到外科医生和患者的欢迎。然而，人们对其学习曲线存在担忧。此前尚无研究评估过PTED的学习过程。在此，我们展示3位外科医生学习PTED的过程。
本分析是在一项多中心随机对照试验的同时进行的。3位脊柱专科外科医生在参加尸体解剖工作坊后，开始在一名资深外科医生的监督下进行PTED手术。每完成5例手术后，直至第20例，使用经过验证的问卷（客观结构化技术技能评估[OSATS]、腹腔镜技能整体手术评估[GOALS]）和专门为PTED制定的10步检查表对学习过程进行评估。
3位学习曲线外科医生共完成了161例手术。根据自我评估，外科医生在“时间与动作”“对组织的尊重”以及“器械知识与操作”等方面有了最大程度的提高。学习曲线外科医生比资深外科医生更能察觉到OSATS上表现的差异。根据GOALS，最大的进步体现在“深度感知”和“自主性”方面。根据10项特定检查表，所有外科医生在第10例手术时都完成了所有10个步骤，而只有1位外科医生在第15例手术时充分完成了所有步骤。
基于这些研究结果，3位脊柱专科外科医生似乎成功地逐步采用了PTED。从第15例手术开始，大多数步骤都能充分完成。然而，可能需要更多的病例才能取得良好的临床效果。需要经过验证的工具来确定外科医生何时能够独立进行PTED手术。
