Learning Curve for Lumbar Decompressive Laminectomy in Biportal Endoscopic Spinal Surgery Using the Cumulative Summation Test for Learning Curve
The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM). The surgeon was proficient in open and microscopic decompressive lam...
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| Veröffentlicht in: | World neurosurgery 2019-02, Vol.122, p.e1007-e1013 |
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| container_title | World neurosurgery |
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| creator | Park, Sang-Min Kim, Ho-Joong Kim, Gang-Un Choi, Min-Ho Chang, Bong-Soon Lee, Choon-Ki Yeom, Jin S. |
| description | The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM).
The surgeon was proficient in open and microscopic decompressive laminectomy in lumbar spinal stenosis but did not have any experience with BESS or other endoscopic surgery techniques. The learning curve of BESS was investigated using LC-CUSUM analysis. Procedure success was defined as an operative time |
| doi_str_mv | 10.1016/j.wneu.2018.10.197 |
| format | Article |
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The surgeon was proficient in open and microscopic decompressive laminectomy in lumbar spinal stenosis but did not have any experience with BESS or other endoscopic surgery techniques. The learning curve of BESS was investigated using LC-CUSUM analysis. Procedure success was defined as an operative time <75 minutes, the mean operative time with microscopic decompression laminectomy.
The present study included the first 60 patients who had undergone single-level decompressive laminectomy using BESS by a single orthopedic surgeon. The mean operative time for decompressive laminectomy by BESS was 83.8 ± 37.9 minutes. The mean operative time in the early learning period (≤30 cases) and late learning period (second 30 cases) was 105.3 ± 39.7 minutes and 62.4 ± 19.9 minutes, respectively. The overall complication rate was ∼10%. The LC-CUSUM signaled competency for surgery at the 58th operation, indicating that sufficient evidence had accumulated to prove that the surgeon was competent. Thus, a trainee with no experience with BESS had reached adequate performance at 58 cases.
The results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2018.10.197</identifier><identifier>PMID: 30404053</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biportal endoscopic spinal surgery ; Clinical Competence ; Decompression, Surgical - education ; Decompression, Surgical - methods ; Decompression, Surgical - trends ; Degenerative spine ; Female ; Humans ; Laminectomy - education ; Laminectomy - methods ; Laminectomy - trends ; Learning Curve ; Lumbar spine ; Lumbar Vertebrae - diagnostic imaging ; Lumbar Vertebrae - surgery ; Male ; Middle Aged ; Neuroendoscopy - education ; Neuroendoscopy - methods ; Neuroendoscopy - trends ; Retrospective Studies ; Spinal stenosis ; Spinal Stenosis - diagnostic imaging ; Spinal Stenosis - surgery</subject><ispartof>World neurosurgery, 2019-02, Vol.122, p.e1007-e1013</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-2ee9b0c7d6322dbea433c9d2c1a4d1f06a0040056d4817d1cfc4c21512aa61683</citedby><cites>FETCH-LOGICAL-c356t-2ee9b0c7d6322dbea433c9d2c1a4d1f06a0040056d4817d1cfc4c21512aa61683</cites><orcidid>0000-0001-6171-3256 ; 0000-0002-8241-5335</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S187887501832504X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30404053$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Park, Sang-Min</creatorcontrib><creatorcontrib>Kim, Ho-Joong</creatorcontrib><creatorcontrib>Kim, Gang-Un</creatorcontrib><creatorcontrib>Choi, Min-Ho</creatorcontrib><creatorcontrib>Chang, Bong-Soon</creatorcontrib><creatorcontrib>Lee, Choon-Ki</creatorcontrib><creatorcontrib>Yeom, Jin S.</creatorcontrib><title>Learning Curve for Lumbar Decompressive Laminectomy in Biportal Endoscopic Spinal Surgery Using the Cumulative Summation Test for Learning Curve</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM).
The surgeon was proficient in open and microscopic decompressive laminectomy in lumbar spinal stenosis but did not have any experience with BESS or other endoscopic surgery techniques. The learning curve of BESS was investigated using LC-CUSUM analysis. Procedure success was defined as an operative time <75 minutes, the mean operative time with microscopic decompression laminectomy.
The present study included the first 60 patients who had undergone single-level decompressive laminectomy using BESS by a single orthopedic surgeon. The mean operative time for decompressive laminectomy by BESS was 83.8 ± 37.9 minutes. The mean operative time in the early learning period (≤30 cases) and late learning period (second 30 cases) was 105.3 ± 39.7 minutes and 62.4 ± 19.9 minutes, respectively. The overall complication rate was ∼10%. The LC-CUSUM signaled competency for surgery at the 58th operation, indicating that sufficient evidence had accumulated to prove that the surgeon was competent. Thus, a trainee with no experience with BESS had reached adequate performance at 58 cases.
The results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biportal endoscopic spinal surgery</subject><subject>Clinical Competence</subject><subject>Decompression, Surgical - education</subject><subject>Decompression, Surgical - methods</subject><subject>Decompression, Surgical - trends</subject><subject>Degenerative spine</subject><subject>Female</subject><subject>Humans</subject><subject>Laminectomy - education</subject><subject>Laminectomy - methods</subject><subject>Laminectomy - trends</subject><subject>Learning Curve</subject><subject>Lumbar spine</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Lumbar Vertebrae - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neuroendoscopy - education</subject><subject>Neuroendoscopy - methods</subject><subject>Neuroendoscopy - trends</subject><subject>Retrospective Studies</subject><subject>Spinal stenosis</subject><subject>Spinal Stenosis - diagnostic imaging</subject><subject>Spinal Stenosis - surgery</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UctOHDEQtKKggIAfyAH5mMsufsxT4pJseEkjcVg4W167h3g1tif2GLR_kU_GwwJSLtiS3SpXl7u7EPpOyZISWp1vl88O0pIR2ixnrK2_oCPa1M2iqav260dckkN0GuOW5MVp0dT8GzrkpMi75EfoXwcyOOMe8SqFJ8C9D7hLdiMD_g3K2zFAjCY_dNIaB2rydoeNw7_M6MMkB3zptI_Kj0bh9WhcRtYpPELY4Yc4y05_IEvbNMhpllkna3PkHb6HOO2_-6-CE3TQyyHC6dt9jB6uLu9XN4vu7vp29bNbKF5W04IBtBuial1xxvQGZMG5ajVTVBaa9qSSJHdIykoXDa01Vb0qFKMlZVJWtGr4Mfqx1x2D_5tyLcKaqGAYpAOfomCUU1bMR6ayPVUFH2OAXozBWBl2ghIxmyG2YjZDzGa8Ym2dk87e9NPGgv5IeR99JlzsCZC7fDIQRFQGnAJtQp6z0N58pv8CAwidVw</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Park, Sang-Min</creator><creator>Kim, Ho-Joong</creator><creator>Kim, Gang-Un</creator><creator>Choi, Min-Ho</creator><creator>Chang, Bong-Soon</creator><creator>Lee, Choon-Ki</creator><creator>Yeom, Jin S.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6171-3256</orcidid><orcidid>https://orcid.org/0000-0002-8241-5335</orcidid></search><sort><creationdate>201902</creationdate><title>Learning Curve for Lumbar Decompressive Laminectomy in Biportal Endoscopic Spinal Surgery Using the Cumulative Summation Test for Learning Curve</title><author>Park, Sang-Min ; Kim, Ho-Joong ; Kim, Gang-Un ; Choi, Min-Ho ; Chang, Bong-Soon ; Lee, Choon-Ki ; Yeom, Jin S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-2ee9b0c7d6322dbea433c9d2c1a4d1f06a0040056d4817d1cfc4c21512aa61683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biportal endoscopic spinal surgery</topic><topic>Clinical Competence</topic><topic>Decompression, Surgical - education</topic><topic>Decompression, Surgical - methods</topic><topic>Decompression, Surgical - trends</topic><topic>Degenerative spine</topic><topic>Female</topic><topic>Humans</topic><topic>Laminectomy - education</topic><topic>Laminectomy - methods</topic><topic>Laminectomy - trends</topic><topic>Learning Curve</topic><topic>Lumbar spine</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Lumbar Vertebrae - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neuroendoscopy - education</topic><topic>Neuroendoscopy - methods</topic><topic>Neuroendoscopy - trends</topic><topic>Retrospective Studies</topic><topic>Spinal stenosis</topic><topic>Spinal Stenosis - diagnostic imaging</topic><topic>Spinal Stenosis - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Park, Sang-Min</creatorcontrib><creatorcontrib>Kim, Ho-Joong</creatorcontrib><creatorcontrib>Kim, Gang-Un</creatorcontrib><creatorcontrib>Choi, Min-Ho</creatorcontrib><creatorcontrib>Chang, Bong-Soon</creatorcontrib><creatorcontrib>Lee, Choon-Ki</creatorcontrib><creatorcontrib>Yeom, Jin S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Park, Sang-Min</au><au>Kim, Ho-Joong</au><au>Kim, Gang-Un</au><au>Choi, Min-Ho</au><au>Chang, Bong-Soon</au><au>Lee, Choon-Ki</au><au>Yeom, Jin S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Learning Curve for Lumbar Decompressive Laminectomy in Biportal Endoscopic Spinal Surgery Using the Cumulative Summation Test for Learning Curve</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2019-02</date><risdate>2019</risdate><volume>122</volume><spage>e1007</spage><epage>e1013</epage><pages>e1007-e1013</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><abstract>The purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM).
The surgeon was proficient in open and microscopic decompressive laminectomy in lumbar spinal stenosis but did not have any experience with BESS or other endoscopic surgery techniques. The learning curve of BESS was investigated using LC-CUSUM analysis. Procedure success was defined as an operative time <75 minutes, the mean operative time with microscopic decompression laminectomy.
The present study included the first 60 patients who had undergone single-level decompressive laminectomy using BESS by a single orthopedic surgeon. The mean operative time for decompressive laminectomy by BESS was 83.8 ± 37.9 minutes. The mean operative time in the early learning period (≤30 cases) and late learning period (second 30 cases) was 105.3 ± 39.7 minutes and 62.4 ± 19.9 minutes, respectively. The overall complication rate was ∼10%. The LC-CUSUM signaled competency for surgery at the 58th operation, indicating that sufficient evidence had accumulated to prove that the surgeon was competent. Thus, a trainee with no experience with BESS had reached adequate performance at 58 cases.
The results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30404053</pmid><doi>10.1016/j.wneu.2018.10.197</doi><orcidid>https://orcid.org/0000-0001-6171-3256</orcidid><orcidid>https://orcid.org/0000-0002-8241-5335</orcidid></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Biportal endoscopic spinal surgery Clinical Competence Decompression, Surgical - education Decompression, Surgical - methods Decompression, Surgical - trends Degenerative spine Female Humans Laminectomy - education Laminectomy - methods Laminectomy - trends Learning Curve Lumbar spine Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - surgery Male Middle Aged Neuroendoscopy - education Neuroendoscopy - methods Neuroendoscopy - trends Retrospective Studies Spinal stenosis Spinal Stenosis - diagnostic imaging Spinal Stenosis - surgery |
| title | Learning Curve for Lumbar Decompressive Laminectomy in Biportal Endoscopic Spinal Surgery Using the Cumulative Summation Test for Learning Curve |
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