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Related Experiment Video

Updated: Apr 15, 2026

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

Audrey Demand1, Samuel B Kankam1,2, Chris Oake1,3

  • 1Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX 77030, USA.

Journal of Clinical Medicine
|April 14, 2026
PubMed
Summary

This study shows that real-time instrument tracking significantly reduces radiation exposure and time for physicians in training (PITs) learning the trans-Kambin approach. Familiarizing PITs with instrument location can decrease the learning curve by 70%.

Keywords:
2D Fluoroscopic navigationendoscopic spine surgeryminimally invasive spine surgeryradiation

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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%.