OBJECTIVE: Percutaneous transforaminal endoscopic discectomy (PTED) is gaining popularity by both surgeons and patients as a less invasive treatment option for sciatica. Concerns, however, exist for its learning curve. No previous study has assessed the learning process of PTED. Hereby we present the learning process of 3 surgeons learning PTED. METHODS: This analysis was conducted alongside a multicenter randomized controlled trial. After attending a cadaveric workshop, 3 spine-dedicated surgeons started performing PTED, initially under the supervision of a senior surgeon. After each 5 cases, and up to case 20, the learning process was evaluated using the validated questionnaires (objective structured assessment of technical skills [OSATS], global operative assessment of laparoscopic skills [GOALS]) and a 10-step checklist specifically developed for PTED. RESULTS: In total, 3 learning curve surgeons performed a total of 161 cases. Based on self-assessment, surgeons improved mostly in the domains "time and motion," "respect for tissue," and "knowledge and handling of instruments." Learning curve surgeons were more able to detect differences in performances on the OSATS than the senior surgeon. Based on the GOALS, the biggest improvements could be seen in "depth-perception" and "autonomy." Based on the 10-item specific checklist, all surgeons performed all 10 steps by case 10, while only 1 surgeon performed all steps adequately by case 15. CONCLUSION: Based on these study results, PTED appears to be successfully adopted stepwise by 3 spine-dedicated surgeons. From 15 cases on, most steps are performed adequately. However, more cases might be necessary to achieve good clinical results. Validated tools are needed to determine the cutoff when a surgeon should be able to perform PTED independently.
OBJECTIVE: Percutaneous transforaminal endoscopic discectomy (PTED) is gaining popularity by both surgeons and patients as a less invasive treatment option for sciatica. Concerns, however, exist for its learning curve. No previous study has assessed the learning process of PTED. Hereby we present the learning process of 3 surgeons learning PTED. METHODS: This analysis was conducted alongside a multicenter randomized controlled trial. After attending a cadaveric workshop, 3 spine-dedicated surgeons started performing PTED, initially under the supervision of a senior surgeon. After each 5 cases, and up to case 20, the learning process was evaluated using the validated questionnaires (objective structured assessment of technical skills [OSATS], global operative assessment of laparoscopic skills [GOALS]) and a 10-step checklist specifically developed for PTED. RESULTS: In total, 3 learning curve surgeons performed a total of 161 cases. Based on self-assessment, surgeons improved mostly in the domains "time and motion," "respect for tissue," and "knowledge and handling of instruments." Learning curve surgeons were more able to detect differences in performances on the OSATS than the senior surgeon. Based on the GOALS, the biggest improvements could be seen in "depth-perception" and "autonomy." Based on the 10-item specific checklist, all surgeons performed all 10 steps by case 10, while only 1 surgeon performed all steps adequately by case 15. CONCLUSION: Based on these study results, PTED appears to be successfully adopted stepwise by 3 spine-dedicated surgeons. From 15 cases on, most steps are performed adequately. However, more cases might be necessary to achieve good clinical results. Validated tools are needed to determine the cutoff when a surgeon should be able to perform PTED independently.
Authors: Pravesh S Gadjradj; Mark P Arts; Maurits W van Tulder; Wim J R Rietdijk; Wilco C Peul; Biswadjiet S Harhangi Journal: Spine (Phila Pa 1976) Date: 2017-12-01 Impact factor: 3.468
Authors: Pravesh S Gadjradj; Sidney M Rubinstein; Wilco C Peul; Paul R Depauw; Carmen L Vleggeert-Lankamp; Ankie Seiger; Job Lc van Susante; Michiel R de Boer; Maurits W van Tulder; Biswadjiet S Harhangi Journal: BMJ Date: 2022-02-21
Authors: Pravesh Shankar Gadjradj; Hana M Broulikova; Johanna M van Dongen; Sidney M Rubinstein; Paul R Depauw; Carmen Vleggeert; Ankie Seiger; Wilco C Peul; Job L van Susante; Maurits W van Tulder; Biswadjiet S Harhangi Journal: Br J Sports Med Date: 2022-02-20 Impact factor: 18.473
Authors: Pravesh S Gadjradj; Biswadjiet S Harhangi; Jantijn Amelink; Job van Susante; Steven Kamper; Maurits van Tulder; Wilco C Peul; Carmen Vleggeert-Lankamp; Sidney M Rubinstein Journal: Spine (Phila Pa 1976) Date: 2021-04-15 Impact factor: 3.241