Physicians in Training Learning Endoscopy: Reduction in Radiation Exposure with Optical Navigation Technology

Area of Science:

• Spine Surgery
• Minimally Invasive Procedures
• Medical Education

Background:

• The endoscopic spine approach, particularly accessing Kambin's triangle, presents a steep learning curve and significant radiation exposure.
• Real-time instrument tracking via 2D fluoroscopic navigation aids trans-Kambin approaches but its impact on training has not been evaluated.

Purpose of the Study:

• To assess the impact of real-time instrument tracking on the learning curve for physicians in training (PITs) performing trans-Kambin approaches.
• To quantify reductions in procedure time and radiation exposure with instrument tracking.

Main Methods:

• Physicians in training (PITs) performed trans-Kambin approaches on a gel sawbone model.
• PITs were randomized by spinal level, technology used, and approach side.
• Time to access Kambin's triangle and radiation dose were recorded, with analysis using linear regression.

Main Results:

• Experience correlated moderately with reduced time (R = -0.52) and radiation (R = -0.60).
• Instrument tracking reduced procedure time by 40% (6.6 min to 4.0 min) and radiation exposure by 91% (2.52 mGy to 0.23 mGy).
• Even inexperienced PITs showed significant benefits with instrument tracking.

Conclusions:

• Prior endoscopic experience significantly improves Kambin's triangle accessibility, reducing time and radiation exposure.
• Instrument tracking drastically cuts radiation exposure by approximately 90%, irrespective of prior experience.
• Familiarity with instrument tracking can reduce the learning curve for inexperienced PITs by up to 70%.