Transnasal 3D endoscopic skull base surgery: questionnaire-based analysis of the learning curve in 52 procedures

Abstract

In the past decade, surgical treatment of skull base pathologies has greatly advanced through the advent of the endoscope and later of the high definition endoscope. Recently a new type of three dimensional (3D) scope has been introduced to permit the surgeon a real stereoscopic vision of the operating field and to overcome the limitations of the 2D endoscopic set up. As with all new technologies a formalized adaptation period is essential for the surgeon to secure steady outcomes and low complications. To determine the subjective difficulties that one may encounter during this sensitive period we therefore devised and analyzed a questionnaire that evaluated the first ten procedures with the 3D device of junior and senior ENT and neurosurgeons. 52 consecutive patients were treated with purely 3D transnasal endoscopy for skull base pathologies. Sensation of strain or dizziness, difficulties in anatomical orientation and difficulties in performing the surgical gesture were assessed for each surgeon. The learning curve and difficulties of junior and senior surgeons are discussed and strategies to overcome the initial problems are devised. Our results confirm that after only few procedures, the advantages of the 3D endoscopic system including better visualization and depth perception are able to outweigh the inconveniences that go hand in hand with the learning of a new skill set.

Novel Treatments for Chronic Rhinosinusitis

“…Developments in microchip technology have allowed dual optical channels to be placed in endoscopes, relaying an output in 3D, which may be viewed either through a special 3D headset or through two separate conventional 2D images. Small case series have piloted the use of 3D endoscopic views in sinus and pituitary surgery; 38,39 it appears to be a safe and feasible technology, but whether it offers genuine advantage over 2D views remains to be seen. The 3D views in head and neck surgery are already obtainable via robotic systems.…”

Rhino-Neurochirurgie

“…Die allgemeine Einführung der 3-D-Endoskopie wird mit der Behebung verbliebener Unzulänglichkeiten (z. B. sperrige Endoskope; eingeschränktes Blickfeld; Einschränkungen bei Bildschärfe und Kontrast; Anfälligkeit für Verschmutzung) erwartet [45,75,129,131,315,[734][735][736][737][738][739][740]. Weitere Entwicklungszweige sind die intraoperative Bildgebung oder allgemein die Bildbearbeitung und Bildfusion mit Einfügen virtueller Daten [10,14,344].…”

Ethmoidal adenocarcinoma treated by exclusive endoscopic approach: Focus on learning curve and modification of management

“…Any surgery requires a learning process, which is specially long in the case of endoscopy due to a complex anatomy, conversion of 3D anatomy and 3D surgery to 2D vision, a dedicated, eventually powered, instrumentation for the need to get used to “4‐hand” surgery, to a mix of soft tissue dissection and bone work, and at last to be able to convert basic techniques to oncologic surgery. The learning curve in endoscopic endonasal skull base surgery is long and this subject has recently been pointed out …”

“…The learning curve in endoscopic endonasal skull base surgery is long and this subject has recently been pointed out. [23][24][25] The purpose of this study, based on a series of consecutive cases of ethmoidal adenocarcinomas treated in curative intent by exclusive endoscopic surgery, was to investigate the influence of the learning curve on (i) the rate and delay of recurrence and (ii) the rate of early and late complications. If appropriate, the secondary goal was to define which decisive factors may account for the differences observed on the learning curve and to describe the change in surgical management.…”