Neurosurgery Department, East Jeddah Hospital, 2277 King Abdullah Rd, Al Sulaymaniyah, 22253, Jeddah, Saudi Arabia.
Otolaryngology and Head and Neck Surgery Department, King Abdullah Medical Complex, Prince Nayef Street, Northern Abhor, 23816, Jeddah, Saudi Arabia.
BMC Surg. 2024 May 5;24(1):135. doi: 10.1186/s12893-024-02418-y.
The endoscopic endonasal transsphenoidal approach (EETA) has revolutionized skull-base surgery; however, it is associated with a steep learning curve (LC), necessitating additional attention from surgeons to ensure patient safety and surgical efficacy. The current literature is constrained by the small sample sizes of studies and their observational nature. This systematic review aims to evaluate the literature and identify strengths and weaknesses related to the assessment of EETA-LC.
A systematic review was conducted following the PRISMA guidelines. PubMed and Google Scholar were searched for clinical studies on EETA-LC using detailed search strategies, including pertinent keywords and Medical Subject Headings. The selection criteria included studies comparing the outcomes of skull-base surgeries involving pure EETA in the early and late stages of surgeons' experience, studies that assessed the learning curve of at least one surgical parameter, and articles published in English.
The systematic review identified 34 studies encompassing 5,648 patients published between 2002 and 2022, focusing on the EETA learning curve. Most studies were retrospective cohort designs (88%). Various patient assortment methods were noted, including group-based and case-based analyses. Statistical analyses included descriptive and comparative methods, along with regression analyses and curve modeling techniques. Pituitary adenoma (PA) being the most studied pathology (82%). Among the evaluated variables, improvements in outcomes across variables like EC, OT, postoperative CSF leak, and GTR. Overcoming the initial EETA learning curve was associated with sustained outcome improvements, with a median estimated case requirement of 32, ranging from 9 to 120 cases. These findings underscore the complexity of EETA-LC assessment and the importance of sustained outcome improvement as a marker of proficiency.
The review highlights the complexity of assessing the learning curve in EETA and underscores the need for standardized reporting and prospective studies to enhance the reliability of findings and guide clinical practice effectively.
经鼻内镜颅底外科手术（EETA）已经彻底改变了颅底外科手术；然而，它与陡峭的学习曲线（LC）相关，需要外科医生额外关注，以确保患者安全和手术效果。目前的文献受到研究样本量小和观察性研究性质的限制。本系统评价旨在评估文献，并确定与评估 EETA-LC 相关的优势和劣势。
根据 PRISMA 指南进行系统评价。使用详细的搜索策略在 PubMed 和 Google Scholar 上搜索有关 EETA-LC 的临床研究，包括相关的关键词和医学主题词。选择标准包括比较外科医生经验早期和晚期纯 EETA 颅底手术结果的研究，评估至少一个手术参数学习曲线的研究，以及以英文发表的文章。
系统评价确定了 34 项研究，共纳入 2002 年至 2022 年期间发表的 5648 例患者，重点关注 EETA 学习曲线。大多数研究为回顾性队列设计（88%）。注意到了各种患者分类方法，包括基于组和基于病例的分析。统计分析包括描述性和比较性方法，以及回归分析和曲线建模技术。最常见的研究疾病是垂体腺瘤（PA）（82%）。在所评估的变量中，EC、OT、术后脑脊液漏和 GTR 等变量的结果有所改善。克服初始 EETA 学习曲线与持续的结果改善相关，中位数估计病例需求为 32 例，范围为 9 至 120 例。这些发现强调了评估 EETA-LC 的复杂性，以及将持续的结果改善作为熟练程度的标志的重要性。
本综述强调了评估 EETA 学习曲线的复杂性，并强调需要标准化报告和前瞻性研究，以提高发现的可靠性，并有效指导临床实践。
