Abstract
Purpose:
To determine the learning curve for endoscopic endonasal dacryorhinostomy (DCR) performed by three surgeons (A, B, C) in three different tertiary hospitals.
Methods:
The 386 eyes of 337 patients (A: 66 eyes of 60 patients, B: 160 eyes of 144 patients, C: 160 eyes of 133 patients), who underwent endoscopic endonasal dacryorhinostomy for nasolacrimal duct obstruction and were followed up for more than 6 months, were analyzed retrospectively. Success was defined at the final follow-up and the success rate was compared by dividing patients by 20, 30, 40 and 50 eyes to determine the minimum number of surgeries required to stabilize the success rate.
Results:
The overall success rate was 86.0%, and each success rate was 83.3% (A), 85.0% (B) and 88.1% (C) (p=0.391). Patients were divided by 20, 30, 40 and 50 eyes for comparison. When patients were divided by 20 eyes, the success rate of surgeon A and C increased after surgeries of 40 eyes (p=0.037, p=0.002). When patients were divided by 30 eyes, the success rates of all three surgeons were significantly increased and maintained after the first 30 surgeries (p=0.020, p=0.037, p=0.024). When patients were divided by 40 eyes, the success rate of surgeon C increased after the first 40 surgeries (p=0.000). When patients were divided by 50 eyes, the success rate of surgeon B and C increased after the first 50 surgeries (p=0.001, p=0.000). After the 30 surgeries, in which the success rate was stabilized, the overall success rate reached 93.6% and each success rate was 94.4% (A), 91.5% (B) and 95.4% (C)(p=0.224).
Conclusions:
To achieve high stable DCR success rates, it is believed that at least 30 surgeries would be required.
Keywords: 579 learning •
465 clinical (human) or epidemiologic studies: systems/equipment/techniques