Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate

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Abstract

Objectives

Since few studies on surgical training and learning curves have been performed, majority of inexperienced surgeons are anxious about performing operations. We aimed to access the results and learning curve of septoplasty with radiofrequency volume reduction (RFVR) of the inferior turbinate.

Methods

We included 270 patients who underwent septoplasty with RFVR of the inferior turbinate by 6 inexperienced surgeons between January 2009 and July 2011. We analyzed success score, cases of revision, cases of complication, operation time, and acoustic rhinometry.

Results

Success score was relatively high and every surgeon had few cases of revision and complication. No significant difference was found in success score, revision, complication case, or acoustic rhinometry values between early cases and later cases. Operation time decreased according to increase in experience. However, there was no significant difference in the operation time after more than 30 cases.

Conclusion

We can conclude that 30 cases are needed to develop mature surgical skills for septoplasty with RFVR of the inferior turbinate and that training surgeons do not need to be anxious about performing this operation in the unskilled state.

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Most cited references 18

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The financial impact of teaching surgical residents in the operating room.

Susan M Bridges, D Diamond (1998)

There have been no published data regarding the cost of training surgical residents in the operating room. At the University of Tennessee Medical Center-Knoxville, in addition to resident-performed teaching cases, some cases are performed without the assistance of residents by the same faculty. Sixty-two case categories involving 14,452 cases were compared for operative times alone. In 46 case categories (10,787 procedures), resident operative times were longer than faculty alone. In 16 case categories, resident operating times were shorter than faculty times. The net incremental operative time cost was 2,050 hours between July 1993 and March 1997. Assuming 4 years of operative training for 11 graduating chief residents, the cost per graduating resident was $47,970. Extrapolated to a national annual cost for the 1,014 general surgery residents who completed training in the 1997 academic year, the annual cost of training residents in the operating room is $53 million. This high monetary cost suggests the need for digital skills, selection criteria, the development of training curriculum and resource facilities, the pre-operating room need for suturing and stapling techniques, and perhaps the acquisition of virtual surgery training modules.

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The "cost" of operative training for surgical residents.

S Sentovich, James Becker, T Babineau … (2004)

There is an increase in the amount of time required to perform an operation when the procedure involves training a surgical resident. This increased time does not translate into a financial burden for the hospital. Retrospective review of prospectively collected data. During the study period, surgeons and residents were blinded to the study's intent. We compared the operative times of academic surgeons performing 4 common surgical procedures before and after the introduction of a postgraduate year 3 resident into a community teaching hospital. Between January 1, 2001, and June 30, 2002, 4 academic surgeons performed operations without a resident in a community hospital that was recently integrated into a tertiary medical center system. During that period, surgeons operated alone (hernia surgery) or assisted one another (laparoscopic cholecystectomy, colectomy, and carotid endarterectomy). From July 1, 2002, through March 31, 2003, these same 4 surgeons were assisted by a postgraduate year 3 resident on similar procedures. Community hospital recently integrated into a tertiary medical center system. Four experienced academic surgeons operating in the community setting and patients undergoing 1 of 4 surgical procedures (inguinal hernia repair, laparoscopic cholecystectomy, partial colectomy, or carotid endarterectomy) from January 1, 2001, through March 31, 2003. The introduction of a postgraduate year 3 surgical resident rotation into a community hospital in which the same academic surgeons had been performing operations without a resident for 18 months. Mean operating time with and without a postgraduate year 3 resident participating in 4 common surgical procedures. Result For the 4 procedures studied, there was a significant increase in the operative time required to complete such procedures. There is an increased time cost associated with the operative training of surgical residents. This "cost" primarily impacts the attending surgeon.

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Endoscopic transsphenoidal pituitary surgery: a single surgeon experience and the learning curve.

R Bokhari, Beryl Davies, Terrence Diamond (2013)

Endoscopic transsphenoidal surgery for pituitary adenomas has been introduced as an alternative to transsphenoidal microsurgery. This is the first Australian study to evaluate a single surgeon's experience by comparing our results with other series and attempting to identify a learning curve. Retrospective analysis was carried out on 79 consecutively treated patients by fully endoscopic transsphenoidal surgery by a single neurosurgeon over a period spanning from July 1998 to September 2010 at St George Public and Private hospitals. The mean age at time of surgery was 56.7 years (SD ± 16.3, range 26-85) and the mean follow-up period was 38.2 months (SD ± 33, range 1-136). Gross total resection (GTR) was noted in 63% of patients, endocrinological cure was achieved in 53% and visual field improvements were noted in 86% of patients. Intra-operative CSF leaks occurred in 19% of procedures, while the rates of post-operative CSF rhinorrhea was 3% and post-operative diabetes insipidus was 13%. There was one post-operative death (1%). Compared to microsurgery, intra-operative CSF leaks and meningitis seem less frequent with an endoscopic approach. With increasing experience, we found a non-statistically significant trend towards higher rates of GTR, and improved visual fields. Endocrinological cure rates were clearly better with experience (p < 0.01). There may be a learning curve that can be overcome in 30-40 cases. Endoscopic transsphenoidal surgery provides similar tumour and patient outcomes when compared to transsphenoidal microsurgery. In this single surgeon's experience, there was a trend to indicate improved performance with more case experience.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Exp Otorhinolaryngol

Journal ID (iso-abbrev): Clin Exp Otorhinolaryngol

Journal ID (publisher-id): CEO

Title: Clinical and Experimental Otorhinolaryngology

Publisher: Korean Society of Otorhinolaryngology-Head and Neck Surgery

ISSN (Print): 1976-8710

ISSN (Electronic): 2005-0720

Publication date (Print): December 2013

Publication date (Electronic): 29 November 2013

Volume: 6

Issue: 4

Pages: 231-236

Affiliations

Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University School of Medicine, Daegu, Korea.

Author notes

Corresponding author: Jung Soo Kim. Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea. Tel: +82-53-200-5777, Fax: +82-53-423-4524, profsookim@ 123456gmail.com

Article

DOI: 10.3342/ceo.2013.6.4.231

PMC ID: 3863672

SO-VID: f8d36c8c-221e-4711-9cc8-9ed138e062eb

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 13 April 2013

Date revision received : 21 June 2013

Date accepted : 24 June 2013

Learning Curve of Septoplasty with Radiofrequency Volume Reduction of the Inferior Turbinate

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Abstract

Objectives

Methods

Results

Conclusion

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Multimodal Learning Material

Most cited references 18

The financial impact of teaching surgical residents in the operating room.

The "cost" of operative training for surgical residents.

Endoscopic transsphenoidal pituitary surgery: a single surgeon experience and the learning curve.

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