Abstract
BackgroundVideo-assisted thoracoscopic sympathectomy (VATS) is a common procedure unusually practiced by neurosurgeons due to lack of training.ObjectiveTo evaluate the learning curve for VATS in a young neurosurgeon with no previous experience in open sympathectomy techniques or extracranial endoscopic procedures.MethodsThis is a retrospective review and analysis of prospectively collected data in 50 consecutive cases admitted to our facility with the diagnosis of essential palmar and axillary hyperhidrosis operated by a neurosurgical trainee under strict supervision of 2 experienced mentors. After an initial training phase, cumulative sum mation (CUSUM) analysis was used to evaluate the surgical performance of the trainee in terms of operating time, blood loss, hospital stay and failures.ResultsImprovement in operating time was noticed after the first 20 cases with significant affection by changes in OR team. The blood loss was significantly improved after the first 10 cases with less sensitivity to changes in OR team. Hospital stay and failures were steady and within expected values throughout the study.ConclusionAn average of 20 cases may be enough for a neurosurgeon with basal knowledge to attain technical competence in VATS sympathectomy. Mentored surgical training on VATS sympathectomy is a safe and effective training method with failures within expected limits. The experience of the OR team plays an important role in the rapid improvement and consistency of performance.
Highlights
Since its first performance in 1889 [1], surgical sympathectomy has been evolving over years
An average of 20 cases may be enough for a neurosurgeon with basal knowledge to attain technical competence in Video-assisted thoracoscopic sympathectomy (VATS) sympathectomy
Study design Cumulative summation (CUSUM) analysis of a case series of video-assissted thoracoscopic sympathectomy (VATS) for essential hyperhidrosis operated by a neurosurgical trainee mentored by the authors
Summary
Since its first performance in 1889 [1], surgical sympathectomy has been evolving over years. Despite being commonly performed by thoracic and vascular surgeons; video-assisted thoracoscopic sympathectomy (VATS) is rarely practiced by neurosurgeons who favor open sympathectomy or case referral because of anatomical unfamiliarity and lack of training. The aim of this study was to evaluate the learning curve for VATS in a young neurosurgeon with no previous experience in open sympathectomy techniques or extracranial endoscopic procedures. Video-assisted thoracoscopic sympathectomy (VATS) is a common procedure unusually practiced by neurosurgeons due to lack of training
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