The slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries
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ORIGINAL ARTICLE - PITUITARIES
The slope of the learning curve in 600 consecutive endoscopic transsphenoidal pituitary surgeries Iyan Younus 1 & Mina M. Gerges 1 & Rafael Uribe-Cardenas 1 & Peter Morgenstern 1 & Ashutosh Kacker 2 & Abtin Tabaee 2 & Vijay K. Anand 2 & Theodore H. Schwartz 1,2,3,4 Received: 18 April 2020 / Accepted: 19 June 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has become a mainstay of treatment over the last two decades and it is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement. Objective The objective of this study was to assess the slope of the learning curve over a long period of time for a variety of outcomes measures. Methods We examined outcomes and complications in a consecutive series of 600 EETS for pituitary adenoma grouped into quartiles based on date of surgery. Results GTR significantly increased across quartiles from 55 to 79% in the last quartile (p < 0.005). The rate of intraoperative CSF leak significantly decreased from 60% in the first quartile to 33% in the last quartile and the rate of lumbar drain placement from 28% in the first quartile to 6% in the last quartile (p < 0.005). Hormonal remission for secreting adenomas increased from 68% in the first quartile to 90% in the last quartile (p < 0.05). The rate of post-operative CSF leak trended lower (3% in first quartile to 0.7% in last two quartiles). The greatest improvement in outcome occurred between the first and second quartiles (19.9%), but persistent improvement occurred between the second and third (6.7%) and third and fourth quartiles (8.0%). Conclusion Although the slope of the learning curve is steeper earlier in a surgeon’s experience, the slope does not plateau and continues to increase even over more than a decade. Keywords Endonasal . Endoscopic . Transsphenoidal . Follow-up . Outcomes . Learning curve . Tail end . Complication . Surgery . Gross total resection
Introduction
This article is part of the Topical Collection on Pituitaries * Theodore H. Schwartz [email protected] 1
Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
2
Department of Otolaryngology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
3
Department of Neuroscience, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
4
Departments of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th St. Box #99, New York, NY, USA
Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has evolved over the last 20 years to become a mainstay of treatment. The transsphenoidal approach was first successfully carried out by Hermann Schloffer in 1907. It was further refined by Harvey Cushing who performed the sublabial procedure, Oskar Hirsch who introduced the endonasal procedure,
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