The learning curve in stapes surgery and its implication to training

Area of Science:

• Otolaryngology
• Surgical Education
• Neurosurgery

Background:

• Stapes surgery, specifically stapedotomy, is a common procedure for otosclerosis.
• Understanding the learning curve is crucial for effective surgical training and patient safety.

Purpose of the Study:

• To identify the learning curve associated with primary stapedotomy for two United Kingdom-based otolaryngologists.
• To analyze the relationship between surgical experience and patient outcomes in stapedotomy.

Main Methods:

• A retrospective review of the first 100 stapedotomy operations for each of two surgeons.
• Learning curves were plotted using postoperative air-bone gaps, with success defined as a 20 dB or better air-bone gap.
• A postal survey assessed the incidence of stapes surgery among UK otolaryngologists.

Main Results:

• No definitive endpoint was observed for the learning curves, but a landmark point appeared between 60 and 80 cases for both surgeons.
• Both surgeons experienced one 'dead ear' complication within their first 15 cases.
• A postal survey revealed variability in training practices, with some trainers performing limited stapes surgery and some experienced surgeons not being trainers.

Conclusions:

• The study supports the existence of a learning curve in stapes surgery.
• Establishing networked learning centers could optimize training by providing targeted experience for trainees demonstrating aptitude.
• This approach may enhance the development of otologists with the necessary skills and temperament.