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01.10.2006 | Original Article | Ausgabe 4/2006

Neurosurgical Review 4/2006

The learning curve in endoscopic pituitary surgery and our experience

Zeitschrift:
Neurosurgical Review > Ausgabe 4/2006
Autoren:
Koc Kenan, Anik İhsan, Ozdamar Dilek, Cabuk Burak, Keskin Gurkan, Ceylan Savas
Wichtige Hinweise
An erratum to this article can be found at http://​dx.​doi.​org/​10.​1007/​s10143-006-0054-4

Comments

Paolo Cappabianca, Naples, Italy The authors report their experience with the endoscopic pituitary approach to the sellar area. They divided their patient series in two groups, named “early” and “late experience” group and studied the tumor removal rate, endocrinological and visual outcome. They were able to conclude that after the first 40 cases, the endoscopic approach gains in effectiveness and in decreasing of operation times.This article is of interest because the authors point their attention on one of the most claimed problems for endoscopic surgery beginners: the learning curve and its impact on the outcome. Their results confirm that a minimum case-load of 40–50 patients is needed to go beyond the steep phase of the learning curve.

Abstract

Experience is the important point in reduction of the complications and in the effectiveness of the surgical procedure in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery, since it requires a steep learning curve for endoscopic skills. In this article, we evaluate our learning curve in two groups, as early and late experience. Purely endoscopic transsphenoidal operations were performed on 78 patients, which were retrospectively reviewed and grouped as early and late experience groups. We used the purely endoscopic endonasal approach to the sella that was performed via an anterior sphenoidotomy, without the use of a transsphenoidal retractor. All patients with adenomas were evaluated considering operation time, endocrinology, ophthalmology, total removal and, especially, modifications of standard technique. On the basis of the experience gained with the use of the endoscope in transphenoidal surgery over the years, modifications can be performed on the different phases of the endoscopic approach. Reviewing our cases in two groups of period due to our experience showed that the effectiveness of endoscopic surgery increases and operation time decreases. In our study, we identified a learning curve in endoscopic pituitary surgery.

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