Initial learning curve after switching to uniportal endoscopic discectomy for lumbar disc herniations

摘要

Abstract Purpose The purpose was to investigate the learning curve for elective endoscopic discectomy performed by a single surgeon who made a complete switch to uniportal endoscopic surgery for lumbar disc herniations in an ambulatory surgery center and determine the minimum case number required to safely overcome the initial learning curve.Methods Electronic medical records (EMR) of the first 90 patients receiving endoscopic discectomy by the senior author in an ambulatory surgery center were reviewed. Cases were divided by approach, transforaminal (46) versus interlaminar (44). Patient-reported outcome measures (visual-analog-score (VAS) and the Oswestry disability index (ODI)) were recorded preoperatively and at 2-week, 6-week, 3-month, and 6-month appointments. Operative times, complications, time to discharge from PACU, postoperative narcotic use, return to work, and reoperations were compiled.Results Median operative time decreased approximately 50 for the first 50 patients then plateaued for both approaches (mean: 65?min). No difference in reoperation rate observed during the learning curve. Mean time to reoperation was 10?weeks, with 7(7.8) reoperations. The interlaminar and transforaminal median operative times were 52 versus 73?min, respectively (p?=?0.03). Median time to discharge from PACU was 80?min for interlaminar approaches and 60?min for transforaminal (p?