The Learning Curve in Stapes Surgery and Its Implication for Training

Yung, Matthew; Oates, John

doi:10.1159/000098861

Cited by 30 publications

(41 citation statements)

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“…This finding is consistent with studies of stapedectomy which demonstrated that approximately 60-100 cases were necessary for surgeons to reach full skill and comfort with this otologic procedure, [11][12][13] except that in our study the trend toward increased efficiency continued beyond 100 procedures. In the current study there was a substantial population of cases that did not fit this inverse correlation of surgeon experience and surgical time; instead, there were numerous instances of long surgical duration despite considerable surgeon volume.…”

Section: Discussionsupporting

confidence: 92%

Time of cochlear implant surgery in academic settings

Schuman¹

2009

Otolaryngology - Head and Neck Surgery

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OBJECTIVE-Establish time required to perform cochlear implantation (CI) in academic settings.STUDY DESIGN-Historical cohort study. SETTING-German and American academic centers.PATIENTS-2,639 patients underwent CI (1997CI ( -2007, excluding patients receiving experimental device or technique with abnormal cochlear anatomy or incomplete charts, leaving 2,253 for analysis.INTERVENTION-Unilateral, bilateral and revision CI with devices approved in USA and Europe. MAIN OUTCOME MEASURES-Mean surgical time (ST) and total OR time (TORT).RESULTS-Mixed model analysis was employed; estimated marginal means given in minutes after adjusting for random effect of individual surgeon. No differences between unilateral (ST=171, TORT=245) and revision CI (ST=160, TORT=232), but bilateral procedures were longer than (ST=295, TORT=377, p=0.000). Unilateral surgeries -Cochlear Limited (CL) devices were

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Section: Discussionsupporting

confidence: 92%

Time of cochlear implant surgery in academic settings

Schuman¹

2009

Otolaryngology - Head and Neck Surgery

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“…A sensorineural hearing loss is also possible in the event of incorrect surgical procedures. These possible complications, the microscopic field, and the complex anatomy of the middle ear are a cause of concern and indecision for young inexperienced surgeons [29][30] .…”

Section: Discussionmentioning

confidence: 99%

“…The residency-training program should provide a long period of instruction during which the trainee acquires adequate surgical skills and anatomical knowledge to carefully perform stapes surgery [29][30][31][32] . Therefore, achieving surgical competency in this kind of surgery represents a challenge to both the trainee and trainer.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Iannella

Marcotullio²,

Re³

et al. 2017

Int Adv Otol

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OBJECTIVE:Comparing the endoscopic and microscopic approaches in stapes surgery, and establishing the surgical approach that allows better results in terms of visualization of the middle ear structures and aids assistant's training. MATERIALS and METHODS:Twenty-one residents from the first to the fifth year of training in Otolaryngology were enrolled in this prospective study. A questionnaire specifically designed to investigate the understanding of middle ear anatomy, the surgical steps, and a personal opinion about endoscopic stapes surgery was submitted to each resident. RESULTS:Statistical differences between the endoscopic and microscopic approaches were evident about identification of stapes and long process of the incus (p=0.03) and stapes footplate and the oval window (p=0.03). No substantial difference between the two surgical approaches emerged regarding the visualization of the tympanic membrane and the other middle ear structures (p>0.5). A substantial difference in favor of the endoscopic approach emerged regarding the identification of the hole creation in the footplate of the stapes. CONCLUSION:Endoscopic stapes surgery could favor an easier understanding of the surgical technique for assistants in training with little knowledge of the anatomy and surgical steps.

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“…Depending on the procedure and experience of the surgeon, the learning curve can be as few as ≤ 10 procedures, as in the case of minimally invasive total knee arthroplasty, or > 80 procedures for other types of surgery. 24,35 Specifically in neurosurgery, Nowitzke 28 defined the learning curve of microendoscopic discectomy at ~ 30 procedures, after which time the operative time and complications have stabilized. McLoughlin and Fourney 25 described the learning curve of the minimally invasive microdiscectomy to be ~ 15 cases, suggesting that the 15-case difference may be related to Nowitzke's use of the endoscope, which is often unfamiliar to practicing neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

O’Malley

Grady²,

Gabel³

et al. 2008

FOC

173

116

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Object The endoscopic endonasal approach for resection of pituitary lesions is an effective surgical option for tumors of the sella turcica. In this study the authors compared outcomes after either purely endoscopic resection or traditional microscope-aided resection. They also attempted to determine the learning curve associated with a surgical team converting to endoscopic techniques. Methods Retrospective data were collected on patients who were surgically treated for a pituitary lesion at the Hospital of the University of Pennsylvania between July 2003 and May 2008. Age, sex, race, presenting symptoms, length of hospital stay, surgical approach, duration of surgery, tumor pathological features, gross-total resection (GTR) of tumor, recurrence of the lesion, and intraoperative and postoperative complications were noted. All procedures were performed by the same senior neurosurgeon, who was initially unfamiliar with the endoscopic endonasal approach. Results A total of 25 patients underwent microscopic resection and 25 patients underwent endoscopic resection performed by a single skull base team consisting of the same senior neurosurgeon and otorhinolaryngologist (M.S.G. and B.W.O.). In the microscopically treated cohort, there were 8 intra- or postoperative complications, 6 intraoperative CSF leaks, 17 (77%) of 22 patients had GTR on postoperative imaging, 5 patients underwent ≥ 2 operations, and 10 (59%) of 17 patients reported total symptom resolution at follow-up. The endoscopically treated group had 7 intraor postoperative complications and 7 intraoperative CSF leaks. Of the patients who had pre- and postoperative imaging studies, 14 (66%) of 21 endoscopically treated patients had GTR; 4 patients had ≥ 2 operations, and 10 (66%) of 15 patients reported complete symptom resolution at follow-up. The first 9 patients who were treated endoscopically had a mean surgical time of 3.42 hours and a mean hospital stay of 4.67 days. The next 8 patients treated had a mean surgical time of 3.11 hours and a mean hospital stay of 3.13 days. The final 8 patients treated endoscopically had a mean surgical time of 2.22 hours and a mean hospital stay of 3.88 days. The difference in length of operation between the first 9 and the last 8 patients treated endoscopically was significantly different. There was a trend toward decreased CSF leaks and other complications from the first 2 groups compared with the third group. Conclusions In this subset of patients, the use of endoscopic endonasal resection results in a similar complication and symptom resolution rate compared with traditional techniques. The authors postulate that the learning curve for endoscopic resection can be ≤ 17 procedures.

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The Learning Curve in Stapes Surgery and Its Implication for Training

Abstract: This is a mismatch of trainers and trainees in stapes surgery. If the current trend of decline in stapes surgery continues, it will take many years for some otolaryngologists to complete their learning curves.

Cited by 30 publications

References 0 publications

Time of cochlear implant surgery in academic settings

Time of cochlear implant surgery in academic settings

Endoscopic vs Microscopic Approach in Stapes Surgery: Advantages in the Middle Ear Structures Visualization and Trainee's Point of View

Comparison of endoscopic and microscopic removal of pituitary adenomas: single-surgeon experience and the learning curve

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