背景:内镜经蝶入路手术(ETSS)正在成为一种有效的,垂体窝脑肿瘤的微创手术技术。使用手术内窥镜,外科医生可以获得更广泛的,更近,和更明显的视野与最小的钥匙孔入口。然而,ETSS可能需要陡峭的学习曲线来实现技术能力和相关成果。此外,关于ETSS的学习过程没有共识。我们旨在回顾和确定ETSS的技术熟练程度,并讨论如何加快学习曲线。
方法:核心数据库,包括PubMed,Embase,还有Cochrane图书馆,使用数值数据系统地搜索学习曲线研究,以证明ETSS对垂体腺瘤的临床结果和学习状态。使用纽卡斯尔-渥太华量表对纳入的文章进行质量评估。基于各种结果测量来评估截止点。
结果:十篇全文文章,代表2,780个案例,从317项筛选的研究中选出。结果指标是手术时间,肿瘤切除,内分泌结果,视野,和手术并发症。学习曲线中的平稳点或截止点的平均值为103±139.43(范围,9-500)案例。
结论:ETSS是治疗垂体瘤的一种有效且微创的替代手术选择。高原点可能根据结果衡量标准而有所不同,患者选择,培训状况,和手术条件。因此,在解释学习曲线时应该非常小心。系统的培训计划对于改善神经内镜手术的学习过程至关重要。
Endoscopic transsphenoidal surgery (ETSS) is emerging as an effective, minimally invasive surgery technique for brain tumors of the pituitary fossa. Using a surgical endoscope, surgeons can obtain a broader, nearer, and more apparent visual field with minimal keyhole entrance. However, ETSS may require a steep learning curve to achieve technical competence and relevant outcomes. Moreover, there is no consensus on the learning process of ETSS. We aimed to
review and determine the technical proficiency points of ETSS and discuss how to accelerate the learning curve.
Core databases, including PubMed, Embase, and the Cochrane Library, were systematically searched for learning curve studies that demonstrated the clinical outcomes and learning status of ETSS for pituitary adenomas using numerical data. Quality assessments of the included articles were performed using the Newcastle-Ottawa scale. The cutoff points were evaluated based on various outcome measures.
Eleven full-text articles, representing 2780 cases, were selected from 317 screened studies. The outcome measures were operative time, tumor removal, endocrinological results, visual field, and surgical complications. The plateaus or cutoff points in the learning curve varied with a mean of 103 ± 139.43 (range, 9-500) cases.
ETSS is an efficient and minimally invasive alternative surgical option for pituitary tumors. Plateau points may differ according to outcome measures, patient selection, training status, and surgical conditions. Therefore, great care should be taken when interpreting the learning curve. A systematic training program is essential to improve the learning process of endoscopic neurosurgical procedures.