PDF(Pubmed)
Abstract：
BACKGROUND: The endoscopic endonasal transsphenoidal approach (EETA) has revolutionized skull-base surgery; however, it is associated with a steep learning curve (LC), necessitating additional attention from surgeons to ensure patient safety and surgical efficacy. The current literature is constrained by the small sample sizes of studies and their observational nature. This systematic review aims to evaluate the literature and identify strengths and weaknesses related to the assessment of EETA-LC.
METHODS: A systematic review was conducted following the PRISMA guidelines. PubMed and Google Scholar were searched for clinical studies on EETA-LC using detailed search strategies, including pertinent keywords and Medical Subject Headings. The selection criteria included studies comparing the outcomes of skull-base surgeries involving pure EETA in the early and late stages of surgeons\' experience, studies that assessed the learning curve of at least one surgical parameter, and articles published in English.
RESULTS: The systematic review identified 34 studies encompassing 5,648 patients published between 2002 and 2022, focusing on the EETA learning curve. Most studies were retrospective cohort designs (88%). Various patient assortment methods were noted, including group-based and case-based analyses. Statistical analyses included descriptive and comparative methods, along with regression analyses and curve modeling techniques. Pituitary adenoma (PA) being the most studied pathology (82%). Among the evaluated variables, improvements in outcomes across variables like EC, OT, postoperative CSF leak, and GTR. Overcoming the initial EETA learning curve was associated with sustained outcome improvements, with a median estimated case requirement of 32, ranging from 9 to 120 cases. These findings underscore the complexity of EETA-LC assessment and the importance of sustained outcome improvement as a marker of proficiency.
CONCLUSIONS: The review highlights the complexity of assessing the learning curve in EETA and underscores the need for standardized reporting and prospective studies to enhance the reliability of findings and guide clinical practice effectively.
METHODS: A systematic review was conducted following the PRISMA guidelines. PubMed and Google Scholar were searched for clinical studies on EETA-LC using detailed search strategies, including pertinent keywords and Medical Subject Headings. The selection criteria included studies comparing the outcomes of skull-base surgeries involving pure EETA in the early and late stages of surgeons\' experience, studies that assessed the learning curve of at least one surgical parameter, and articles published in English.
RESULTS: The systematic review identified 34 studies encompassing 5,648 patients published between 2002 and 2022, focusing on the EETA learning curve. Most studies were retrospective cohort designs (88%). Various patient assortment methods were noted, including group-based and case-based analyses. Statistical analyses included descriptive and comparative methods, along with regression analyses and curve modeling techniques. Pituitary adenoma (PA) being the most studied pathology (82%). Among the evaluated variables, improvements in outcomes across variables like EC, OT, postoperative CSF leak, and GTR. Overcoming the initial EETA learning curve was associated with sustained outcome improvements, with a median estimated case requirement of 32, ranging from 9 to 120 cases. These findings underscore the complexity of EETA-LC assessment and the importance of sustained outcome improvement as a marker of proficiency.
CONCLUSIONS: The review highlights the complexity of assessing the learning curve in EETA and underscores the need for standardized reporting and prospective studies to enhance the reliability of findings and guide clinical practice effectively.
摘要：
背景：内镜经鼻蝶入路（EETA）彻底改变了颅底手术；然而，它与陡峭的学习曲线（LC）有关，外科医生需要额外的关注，以确保患者安全和手术疗效。目前的文献受到研究样本量小及其观察性质的限制。本系统综述旨在评估文献，并确定与EETA-LC评估相关的优势和劣势。
方法：按照PRISMA指南进行系统评价。使用详细的搜索策略搜索PubMed和GoogleScholar关于EETA-LC的临床研究，包括相关关键词和医学主题词。选择标准包括比较外科医师早期和晚期阶段纯EETA颅底手术结果的研究，评估至少一个手术参数的学习曲线的研究，以及用英文发表的文章。
结果：系统评价确定了2002年至2022年间发表的34项研究，涵盖5,648名患者，重点关注EETA学习曲线。大多数研究为回顾性队列设计（88%）。注意到各种患者分类方法，包括基于群体和基于案例的分析。统计分析包括描述性和比较法，以及回归分析和曲线建模技术。垂体腺瘤（PA）是研究最多的病理学（82％）。在评估的变量中，跨变量的结果改进，如EC，OT,术后脑脊液漏，GTR。克服最初的EETA学习曲线与持续的结果改善有关，估计病例需求中位数为32，范围为9至120例。这些发现强调了EETA-LC评估的复杂性以及持续结果改善作为熟练程度标志的重要性。
结论：该综述强调了评估EETA学习曲线的复杂性，并强调了标准化报告和前瞻性研究的必要性，以提高研究结果的可靠性并有效指导临床实践。
方法：按照PRISMA指南进行系统评价。使用详细的搜索策略搜索PubMed和GoogleScholar关于EETA-LC的临床研究，包括相关关键词和医学主题词。选择标准包括比较外科医师早期和晚期阶段纯EETA颅底手术结果的研究，评估至少一个手术参数的学习曲线的研究，以及用英文发表的文章。
结果：系统评价确定了2002年至2022年间发表的34项研究，涵盖5,648名患者，重点关注EETA学习曲线。大多数研究为回顾性队列设计（88%）。注意到各种患者分类方法，包括基于群体和基于案例的分析。统计分析包括描述性和比较法，以及回归分析和曲线建模技术。垂体腺瘤（PA）是研究最多的病理学（82％）。在评估的变量中，跨变量的结果改进，如EC，OT,术后脑脊液漏，GTR。克服最初的EETA学习曲线与持续的结果改善有关，估计病例需求中位数为32，范围为9至120例。这些发现强调了EETA-LC评估的复杂性以及持续结果改善作为熟练程度标志的重要性。
结论：该综述强调了评估EETA学习曲线的复杂性，并强调了标准化报告和前瞻性研究的必要性，以提高研究结果的可靠性并有效指导临床实践。
