Analysis of the learning curve of the surgical procedure for the treatment of thoracic disc herniation using anterolateral transthoracic approach with the aid of image-guided system.

Abstract

In surgery, the learning process represents one of the critical topics in the development of a young surgeon where there is often no standardized learning program. The learning curve is defined by plotting proficiency as a function of time, or the number of repetitions. In this study, we analyzed the learning process for a rare and surgically demanding pathology such as thoracic disc herniations (TDHs) treated with an antero-lateral trans-thoracic approach. We analyzed a consecutive series of patients admitted with a diagnosis of TDHs. All patients underwent surgery using a standard antero-lateral trans-thoracic approach, assisted by navigation system based on intraoperative 3D imaging performed with O-Arm™ (Medtronic; Dublin, Ireland) system. Twenty-one patients underwent surgery from January 2012 to June 2017. The time analysis shows a progressive reduction in time from the first to the last case with continued improvement in operating time but progressively less dramatic, this is explicable considering the classic learning curve model. Predictably, a slow learning curve was charted - typical for a technically demanding procedure associated with a rare incidence of pathology. A learning curve is an easy and efficient way to gauge the growth of a surgeon. After 21 cases we obtained an intermediate profile of learning curve between steep and shallow. Despite different alternatives for speeding up the learning process it is not always possible to standardize and reflect them in a learning process. Today, the use of technology is often considered in this but does not always affect the process itself.