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Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon

BACKGROUND: Transforaminal endoscopic lumbar discectomy (TELD) has well-recognized advantages and disadvantages in the literature. Some of the mentioned disadvantages are insufficient discectomy, higher recurrence rate and long learning curve (LC). The objective of this study is to describe the LC a...

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Autores principales: Fleiderman, Valenzuela José, Lecaros, Bahamondes Javier, Cirillo, Totera Juan Ignacio, Álvarez Lemos, Facundo, Osorio, Valdivia Pedro, Wolff, Benavides Nicolás
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331491/
https://www.ncbi.nlm.nih.gov/pubmed/37435320
http://dx.doi.org/10.21037/jss-22-54
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author Fleiderman, Valenzuela José
Lecaros, Bahamondes Javier
Cirillo, Totera Juan Ignacio
Álvarez Lemos, Facundo
Osorio, Valdivia Pedro
Wolff, Benavides Nicolás
author_facet Fleiderman, Valenzuela José
Lecaros, Bahamondes Javier
Cirillo, Totera Juan Ignacio
Álvarez Lemos, Facundo
Osorio, Valdivia Pedro
Wolff, Benavides Nicolás
author_sort Fleiderman, Valenzuela José
collection PubMed
description BACKGROUND: Transforaminal endoscopic lumbar discectomy (TELD) has well-recognized advantages and disadvantages in the literature. Some of the mentioned disadvantages are insufficient discectomy, higher recurrence rate and long learning curve (LC). The objective of this study is to describe the LC and analyze the survival rate of patients operated through TELD. METHODS: Retrospective study of 41 cases operated through TELD by the same surgeon from June 2013 to January 2020, with a minimum follow-up of 6 months. Demographic data and information on operative time (OT), complications, hospital stay, hernia recurrence and reoperations were collected. LC of the TELD was analyzed using a cumulative sum (CUSUM) test for parameter stability for linear regression coefficients, using the CUSUM from recursive residuals. RESULTS: Thirty-nine patients, 24 men (61.54%) and 15 women (38.46%), were included in the present cohort, and a total of 41 TELD were performed. The average OT was 96 minutes (SD =30) and the CUSUM of the recursive residuals shows learning of the TELD in the case 20. The mean OT in the first 20 cases was 114 minutes (SD =30) versus 80 minutes (SD =17) in the last 21 cases (P=0.0001). The rates of recurrent Dh were 17%, and 12% need reoperation. CONCLUSIONS: We consider that the LC of TELD requires operating 20 cases to perform the procedure with a significant reduction in OT, with minimal rates of reoperation and complications.
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spelling pubmed-103314912023-07-11 Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon Fleiderman, Valenzuela José Lecaros, Bahamondes Javier Cirillo, Totera Juan Ignacio Álvarez Lemos, Facundo Osorio, Valdivia Pedro Wolff, Benavides Nicolás J Spine Surg Original Article BACKGROUND: Transforaminal endoscopic lumbar discectomy (TELD) has well-recognized advantages and disadvantages in the literature. Some of the mentioned disadvantages are insufficient discectomy, higher recurrence rate and long learning curve (LC). The objective of this study is to describe the LC and analyze the survival rate of patients operated through TELD. METHODS: Retrospective study of 41 cases operated through TELD by the same surgeon from June 2013 to January 2020, with a minimum follow-up of 6 months. Demographic data and information on operative time (OT), complications, hospital stay, hernia recurrence and reoperations were collected. LC of the TELD was analyzed using a cumulative sum (CUSUM) test for parameter stability for linear regression coefficients, using the CUSUM from recursive residuals. RESULTS: Thirty-nine patients, 24 men (61.54%) and 15 women (38.46%), were included in the present cohort, and a total of 41 TELD were performed. The average OT was 96 minutes (SD =30) and the CUSUM of the recursive residuals shows learning of the TELD in the case 20. The mean OT in the first 20 cases was 114 minutes (SD =30) versus 80 minutes (SD =17) in the last 21 cases (P=0.0001). The rates of recurrent Dh were 17%, and 12% need reoperation. CONCLUSIONS: We consider that the LC of TELD requires operating 20 cases to perform the procedure with a significant reduction in OT, with minimal rates of reoperation and complications. AME Publishing Company 2023-04-13 2023-06-30 /pmc/articles/PMC10331491/ /pubmed/37435320 http://dx.doi.org/10.21037/jss-22-54 Text en 2023 Journal of Spine Surgery. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Fleiderman, Valenzuela José
Lecaros, Bahamondes Javier
Cirillo, Totera Juan Ignacio
Álvarez Lemos, Facundo
Osorio, Valdivia Pedro
Wolff, Benavides Nicolás
Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
title Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
title_full Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
title_fullStr Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
title_full_unstemmed Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
title_short Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
title_sort transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331491/
https://www.ncbi.nlm.nih.gov/pubmed/37435320
http://dx.doi.org/10.21037/jss-22-54
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