Learning curve in endoscopic sinus surgery.

The existence of a long learning curve for endoscopic sinus surgery has been proposed as a reason for rigorous and extensive training to prepare physicians to perform this surgery. In this article, the author--who participated in this type of training program--examines his experience over a 5-year period to assess the effect of rigorous training on the learning curve for endoscopic sinus surgery. Beginning with the first day of practice after training, 5 years with 393 cases were evaluated for complications and the need for revision surgery. The results were analyzed in 100-case groups. The results show no difference in major and serious complications or revision surgery rates. However, a statistically significant difference in the minor-complication rate, specifically frontal-sinus stenosis, was found from the first half to the second half of the experience. These findings show that, with rigorous training of the physician, the learning curve can largely be completed during residency training, allowing the new practitioner to perform endoscopic sinus surgery safely and with good results.