Introduction
Transforaminal percutaneous endoscopic lumbar discectomy (tPELD) is a minimally invasive surgical technique for lumbar disc herniation. However, mastering tPELD presents a steep learning curve, particularly for junior surgeons. Initial attempts often involve multiple fluoroscopy exposures, increasing radiation risks for both the surgical team and patients, and potentially undermining the confidence of surgeons in training. The crucial role of precise anatomical location in mitigating these challenges and promoting Lower Learning difficulty in tPELD is an area requiring thorough investigation.
Study Objective and Design
This study was designed to evaluate the impact of an accurate preoperative location method on the learning curve associated with tPELD. The primary focus was to determine if such a method could lead to lower learning difficulty, specifically measured by reduced fluoroscopy time and operative durations for surgeons in the early stages of their tPELD experience. A retrospective study was conducted, comparing two groups of patients who underwent tPELD performed by two different junior surgeons.
Methods and Patient Groups
The study retrospectively analyzed the first 80 tPELD procedures performed by two junior surgeons between January 2012 and August 2014. Surgeon A utilized a novel accurate preoperative location method (Group A), while Surgeon B employed the conventional fluoroscopy-guided technique (Group B). Key surgical metrics were meticulously recorded and compared between the groups, including total operation time, fluoroscopy time, preoperative location time, and puncture-channel establishment time.
Key Findings: Reduced Operative Times and Fluoroscopy Exposure
The results demonstrated a significant reduction in operative times for the group utilizing the accurate preoperative location method. For the initial 20 cases, Group A exhibited an average operation time of 99.75 minutes, compared to 115.7 minutes in Group B. When considering all 80 cases, Group A maintained a shorter average operation time (88.36 minutes) than Group B (98.26 minutes). Crucially, fluoroscopy times were also significantly lower in Group A (26.78 minutes) compared to Group B (33.98 minutes). Furthermore, both preoperative location time and puncture-channel time were significantly shorter in Group A, indicating a more efficient and potentially less stressful initial phase of the surgery.
Correlations and Clinical Outcomes
Statistical analysis revealed moderate correlations between preoperative location time and puncture-channel time, as well as between preoperative location time and fluoroscopy times. A mild correlation was also observed between preoperative location time and overall operation time. These correlations suggest that efficient preoperative location directly contributes to reduced puncture time and overall surgical duration, leading to decreased fluoroscopy exposure. Importantly, despite the differences in surgical technique and efficiency metrics, there were no significant differences in patient-reported outcomes such as Visual Analogue Scale (VAS) scores for back and leg pain, Japanese Orthopaedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, or Macnab satisfaction scores between the two groups. Recurrence rates and postoperative disc remnants were also comparable, indicating that the improved efficiency in Group A did not compromise clinical effectiveness.
Limitations and Implications for Surgical Training
While the accurate preoperative location method demonstrated clear benefits in reducing learning difficulty as evidenced by decreased operative and fluoroscopy times, the study acknowledges that it is just one aspect of mastering tPELD. Junior surgeons must still develop crucial subjective skills in needle manipulation and gain broader experience in endoscopic discectomy. However, these findings strongly suggest that incorporating accurate preoperative location techniques into surgical training programs can significantly facilitate the initial learning phase of tPELD. By reducing the technical challenges associated with initial localization, these methods can contribute to a more positive learning experience, potentially increasing surgeon confidence and reducing radiation exposure during training.
Conclusion: Enhancing Surgical Learning and Safety
This study concludes that employing an accurate preoperative location method in tPELD surgery effectively lowers the learning difficulty for junior surgeons. This is evidenced by significant reductions in operation time, fluoroscopy time, preoperative location time, and puncture-channel time. By streamlining the initial stages of the procedure, accurate preoperative location methods can contribute to a smoother learning curve, decreased radiation exposure, and enhanced efficiency in tPELD training, ultimately benefiting both surgeons and patients.
