Minimizing Individual Learning Curves in a Mature Endoscopic Fetal Surgery Program

Area of Science:

• Fetal Surgery
• Maternal-Fetal Medicine
• Minimally Invasive Procedures

Background:

• Twin-to-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin pregnancies.
• Endoscopic laser treatment for TTTS is infrequent, posing challenges for skill maintenance and training.
• Maintaining proficiency in rare procedures is critical for optimal patient outcomes.

Purpose of the Study:

• To evaluate the impact of a dual mentoring program on the proficiency and outcomes of endoscopic laser treatment for TTTS.
• To determine if continuous mentoring stabilizes program outcomes despite staff turnover.
• To test the hypothesis that a structured mentoring approach enhances surgical team competency.

Main Methods:

• Analysis of 146 endoscopic laser ablation cases for TTTS from 2000-2019.
• Utilized learning curve-cumulative summation and rolling averages to assess outcomes and operative times.
• Recorded patient and pregnancy characteristics, operative time, and survival rates.

Main Results:

• Overall twin survival was 69%, with at least one twin surviving in 89% of cases.
• Mean operative time decreased from 71 to 49 minutes over the study period.
• Program outcomes and operative times remained stable, unaffected by the introduction of new surgeons.

Conclusions:

• A dual mentoring program effectively maintains stable outcomes in endoscopic laser treatment for TTTS.
• This creative mentoring strategy ensures program proficiency despite changes in surgical team composition.
• The dual mentoring model is potentially applicable to other rare fetal surgery procedures.