PERCEPTION OF THE LEARNING CURVE FOR ENDOSCOPIC SPINE PROCEDURES, A SURVEY OF SPINAL SURGEONS IN LATAM

ROSS, JORGE ALVARO GONZÁLEZ; SAMPSON, NEAL; MARTINS, DELIO EULALIO; ASTUR, NELSON

doi:10.1590/S1808-185120242303281365

JORGE ALVARO GONZÁLEZ ROSS Correspondence: Jorge Alvaro Gonzalez Ross. 3432, Tarascos Street, Monraz, Guadalajara, Jalisco, Mexico. 44670. dr.gonzalez.ross@gmail.com

significantly contributed to the development of this study

Conceptualization

questionnaire development

data analysis

Hospital Angeles del Carmen, Guadalajara, Jalisco, Mexico

https://orcid.org/0000-0001-5364-8028

NEAL SAMPSON

significantly contributed to the development of this study

Text development

writing

The Panama Clinic Hospital, Panama City, Panama

https://orcid.org/0009-0007-4039-2861

DELIO EULALIO MARTINS

significantly contributed to the development of this study

Text development

writing

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0001-5510-3507

NELSON ASTUR

significantly contributed to the development of this study

Methodology development

data analysis

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil

https://orcid.org/0000-0002-2608-2118

Correspondence:
Jorge Alvaro Gonzalez Ross. 3432, Tarascos Street, Monraz, Guadalajara, Jalisco, Mexico. 44670. dr.gonzalez.ross@gmail.com

All authors declare no potential conflict of interest related to this article.

Reviewed by: Rodrigo Amaral

Tables (5)

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Table 1
Continuous variables description. Its median describes each of the continuous variables of the sample, the Standard Error of the Median (SEM), the minimum value (Min), the first quartile (Q1), the median, the third quartile (Q3), and the maximum value (Max). Those values under Q1 represent 25% of the data, while those less than Q3 represent 75% of the values. N = Number of individuals answered.

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Table 2
Categorical variables description. Each of the categorical variables of the sample is described by the number of individuals who choose the different options.

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Table 3
Categorical variables description. Each of the categorical variables of the sample is described by the number of individuals who choose the different options.

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Table 4
Statistical tests to compare the different variables. The table shows the comparisons between the different variables. Non-parametric tests (Kruskal-Wallis, Mann-Whitney) were performed. P-values less than 0.05 were considered statistically significant and highlighted in red. Refs: DF: Degrees of freedom; W-value: Mann-Whitney statistic; H-statistic: Kruskal Wallis statistic.

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Survey Country of Origin: _______ Age: _____ Basic StudiesΥ NeurosurgeonΥ Orthopedist Current PositionΥ ResidentΥ Specialist (Without a formal training in Spine Surgery)Υ Spine Surgery FellowΥ Spine Surgeon Years of Experience: _____ Type of PracticeΥ PublicΥ Private Υ Mixed (Both Private and Public). Did you have contact with camera-assisted surgery during your training as a resident or specialist? (arthroscopic or endoscopic)Υ YesΥ No Do you perform facet or selective nerve root blocks in your practice?Υ YesΥ No Have you performed or are you performing lumbar spine endoscopic surgery?Υ Yes Υ No Have you had contact with lumbar spine endoscopic surgery? (Observership or workshop)Υ YesΥ No How many surgeries should you perform to master the transforaminal endoscopic technique?______ How many surgeries should you perform to master the interlaminar endoscopic technique?_______ What is the best way to learn a new surgical technique?Υ Cadaveric or model workshopΥ Observership with an expert surgeonΥ Observership + cadaveric workshopΥ Perform the surgery with the support of an expert.Υ All of the above. How many surgeries do you need to perform to master the technique compared to microdiscectomy? How many surgeries do you think you should do to go from soft tissue transforaminal (disc) to foraminoplasty? How many surgeries do you think you should do to go from soft tissue interlaminar (disc) to decompression due to stenosis? How many surgeries do you think you should do to go from lumbar transforaminal to thoracic transforaminal? How many surgeries should you do to start performing endoscopic fusion (ENDOLIF)? Which of the following surgical techniques do you perform that you feel comfortable with or that you consider you have mastered? Several possible options.Υ Lumbar transforaminal (disc)Υ Lumbar transforaminal (foraminoplasty)Υ Lumbar interlaminar (disc)Υ Lumbar interlaminar (lumbar stenosis)Υ Thoracic transforaminalΥ Endoscopic Fusion (ENDOLIF)Υ Posterior cervicalΥ Anterior cervical Do you have someone in your center or practice to help you with endoscopic surgery?Υ YesΥ No *Do you have someone technically proficient to help you? A Proctor, for example.Υ YesΥ No *Do you think mastering endoscopic surgery increases the indication for surgery?Υ YesΥ No *What is your main limitation to perform endoscopic surgery?Υ Lack of financial resourcesΥ Lack of training in endoscopic surgeryΥ I don’t think it is superior to other techniquesΥ The learning curve is very long for the benefits it brings. * In your experience, do you perceive a difficulty in accessing this technology?Υ yesΥ No

Variable	N	Median	SEM	SD	Min	Q1	Median	Q3	Max
Age (years)		44,848	0.59	10,146	26	37	43	52	76
Experience (years)	296	14,162	0.707	12,159	0	5	11	20	100
How many surgeries do you think you should perform to:
Master the transforaminal endoscopic technique?		26.9	1.16	19.89	0	12	20	30	100
Master the interlaminar endoscopic technique?		26.74	1.23	21.2	0	10	20	30	100
How many surgeries do you think you need to perform to go:
From soft tissue transforaminal (disc) to foraminoplasties?	296	22.86	1.06	18.28	0	10	20	30	100
From performing soft tissue interlaminar (disc) to decompressions for stenosis?		27.52	1.24	21.32	0	12	20	35	100
From lumbar transforaminal to thoracic transforaminal?		35.95	1.52	26.09	0	18	30	50	100
How many surgeries do you think you should perform to start performing endoscopy fusion (ENDOLIF)?		37.09	1.59	27.35	0	19	30	50	100
How many additional surgeries do you have to perform to master the technique compared to surgery under a microscope or microdiscectomy?		23.4	1.08	18.6	0	10	20	30	100

Variable	Subcategory	Count	Percentage (%)
Country (by regions)	North	84	28.38
	Central	42	14.19
	Brazil	103	34.8
	South	67	22.64
Specialty	Neurosurgeon	106	35.81
Specialty	Orthopedist	190	64.19
Experience	Junior	82	27.7
	Middle	68	22.97
	Senior	70	23.65
	Subsenior	76	25.68

Variable	Subcategory	Count	Percentage (%)
Had contact with camera-assisted surgery? (arthroscopic or endoscopic)	No	142	47.97
	Yes	154	52.03
Do you perform facet or selective root blocks in your practice?	No	38	12.84
	Yes	258	87.16
Have you performed or performed lumbar endoscopic surgery?	No	121	40.88
Have you performed or performed lumbar endoscopic surgery?	Yes	175	59.12
Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)	No	62	20.95
	Yes	234	79.05

How many surgeries do you need to master:	Variable	DF	H-value/W value	p-value	Test
Transforaminal endoscopic technique	Age (ranges)	2	3.59	0.166	Kruskal- Wallis
	Country (Region)	3	2.47	0.48	Kruskal- Wallis
	Specialty	-	15,608.5	0.85	Mann- Whitney
	Experience	3	1.48	0.687	Kruskal- Wallis
	Position	3	2.08	0.557	Kruskal- Wallis
	Professional practice	2	0.18	0.915	Kruskal- Wallis
	Have you had contact with camera-assisted surgery? (arthroscopic or endoscopic)	-	22,138	0.149	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?	-	6316	0.168	Mann- Whitney
	Have you performed or performed lumbar endoscopic surgery?	-	17,119	0.236	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)	-	9,069	0.817	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?	-	25,771	0.911	Mann- Whitney
	Do you think the indication for surgery increases with expertise in endoscopy techniques?	-	15,206	0.242	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?	-	17,859.5	0.572	Mann- Whitney
Interlaminar endoscopic technique	Age (ranges)	2	2.95	0.229	Kruskal- Wallis
	Country (Region)	3	4.26	0.235	Kruskal- Wallis
	Specialty	-	14,954	0.261	Mann- Whitney
	Experience	3	1.32	0.725	Kruskal- Wallis
	Position	3	2.33	0.506	Kruskal- Wallis
	Professional practice	2	0.32	0.852	Kruskal- Wallis
	Have you had contact with camera-assisted surgery? (arthroscopic or endoscopic)	-	22,985	0.009	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?	-	6217	0.24	Mann- Whitney
	Have you performed or performed lumbar endoscopic surgery?	-	17,592.5	0.601	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)	-	8,881.5	0.584	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?		26,037	0.631	Mann- Whitney
	Do you think that with expertise in endoscopy techniques, the indication for surgery increases?		14,697	0.67	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?		18,430.5	0.819	Mann- Whitney
Endoscopy fusion (ENDOLIF)	Age (ranges)	2	2.44	0.295	Kruskal- Wallis
	Country (Region)	3	15.47	0.001	Kruskal- Wallis
	Specialty		15,940.5	0.777	Mann- Whitney
	Experience	3	2.11	0.55	Kruskal- Wallis
	Position	3	3.07	0.381	Kruskal- Wallis
	Professional practice	2	5.44	0.066	Kruskal- Wallis
	Had contact with camera-assisted surgery? (arthroscopic or endoscopic)		21,044	0.954	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?		5,478.5	0.738	Mann- Whitney
	Have you performed or perform lumbar endoscopic surgery?		16,179	0.013	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)		7,598.5	0.007	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?		23,955.5	0.016	Mann- Whitney
	Do you think that with expertise in endoscopy techniques, the indication for surgery increases?		14,905.5	0.467	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?		18,801.5	0.459	Mann- Whitney
	Variable	DF	H-value/W value	p-value	Test
How many additional surgeries do you think you have to perform to	Age (ranges)	2	0,44	0,804	Kruskal- Wallis
	Country (Region)	3	1.44	0.695	Kruskal- Wallis
	Specialty		16,004.5	0.708	Mann- Whitney
	Experience	3	0.27	0.966	Kruskal- Wallis
	Position	3	4.46	0.216	Kruskal- Wallis
Master the technique compared to surgery under a microscope or microdiscectomy?	Professional practice	2	0.39	0.824	Kruskal- Wallis
	Had contact with camera-assisted surgery? (arthroscopic or endoscopic)		21,751	0.364	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?		6,623	0.045	Mann- Whitney
	Have you performed or perform lumbar endoscopic surgery?		18,197	0.751	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)		9,068.5	0.817	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?		25,420.5	0.708	Mann- Whitney
	Do you think that with expertise in endoscopy techniques, the indication for surgery increases?		14,795.5	0.569	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?		18,236.5	0.968	Mann- Whitney
How many surgeries do you think you need to perform to go:	Variable	DF	H-value/W value	p-value	Test
From soft tissue transforaminal (disc) to foraminoplasties?	Age (ranges)	2	0.24	0.888	Kruskal- Wallis
	Country (Region)	3	0.39	0.942	Kruskal- Wallis
	Specialty		16,792.5	0.134	Mann- Whitney
	Experience	3	0.81	0.847	Kruskal- Wallis
	Position	3	3.72	0.294	Kruskal- Wallis
	Professional practice	2	1.29	0.524	Kruskal- Wallis
	Had contact with camera-assisted surgery? (arthroscopic or endoscopic)		20,464	0.395	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?		6,722	0.027	Mann- Whitney
	Have you performed or perform lumbar endoscopic surgery?		18,840	0.225	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)		9,576	0.535	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?		25,360.5	0.647	Mann- Whitney
	Do you think that with expertise in endoscopy techniques, the indication for surgery increases?		14,744.5	0.621	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?		18,211.5	0.941	Mann- Whitney
From performing soft tissue interlaminar (disc) to decompressions for stenosis?	Age (ranges)	2	1.6	0.45	Kruskal- Wallis
	Country (Region)	3	6.97	0.073	Kruskal- Wallis
	Specialty		15,953.5	0.763	Mann- Whitney
	Experience	3	4.69	0.196	Kruskal- Wallis
	Position	3	2.88	0.411	Kruskal- Wallis
	Professional practice	2	0.45	0.799	Kruskal- Wallis
	Had contact with camera-assisted surgery? (arthroscopic or endoscopic)		19,937.5	0.116	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?		6,002	0.464	Mann- Whitney
	Have you performed or perform lumbar endoscopic surgery?		17,840	0.859	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)		8,717.5	0.412	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?		24,058.5	0.024	Mann- Whitney
	Do you think that with expertise in endoscopy techniques, the indication for surgery increases?		14,471	0.924	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?		18,551	0.693	Mann- Whitney
From lumbar transforaminal to thoracic transforaminal?	Age (ranges)	2	0.82	0.662	Kruskal- Wallis
	Country (Region)	3	16.29	0.001	Kruskal- Wallis
	Specialty		15,509.5	0.743	Mann- Whitney
	Experience	3	3.89	0.274	Kruskal- Wallis
	Position	3	4.64	0.2	Kruskal- Wallis
	Professional practice	2	3.18	0.204	Kruskal- Wallis
	Had contact with camera-assisted surgery? (arthroscopic or endoscopic)		21,273.5	0.8	Mann- Whitney
	Do you perform facet or selective root blocks in your practice?		5542	0.838	Mann- Whitney
	Have you performed or perform lumbar endoscopic surgery?		16,270	0.019	Mann- Whitney
	Have you had contact with endoscopic lumbar spine surgery? (Observership or workshop)		8,052	0.053	Mann- Whitney
	Do you have someone to help you in your learning curve, in your center, or a proctor of endoscopic surgery?		24,115.5	0.029	Mann- Whitney
	Do you think that with expertise in endoscopy techniques, the indication for surgery increases?		14,727	0.64	Mann- Whitney
	In your experience, do you perceive difficulty in accessing this technology?		18,804	0.457	Mann- Whitney

Survey
Country of Origin: _______
Age: _____

Basic Studies Υ Neurosurgeon Υ Orthopedist

Current Position Υ Resident Υ Specialist (Without a formal training in Spine Surgery) Υ Spine Surgery Fellow Υ Spine Surgeon

Years of Experience: _____

Type of Practice Υ Public Υ Private Υ Mixed (Both Private and Public).
Did you have contact with camera-assisted surgery during your training as a resident or specialist? (arthroscopic or endoscopic) Υ Yes Υ No
Do you perform facet or selective nerve root blocks in your practice? Υ Yes Υ No
Have you performed or are you performing lumbar spine endoscopic surgery? Υ Yes Υ No
Have you had contact with lumbar spine endoscopic surgery? (Observership or workshop) Υ Yes Υ No
How many surgeries should you perform to master the transforaminal endoscopic technique? ______
How many surgeries should you perform to master the interlaminar endoscopic technique? _______
What is the best way to learn a new surgical technique? Υ Cadaveric or model workshop Υ Observership with an expert surgeon Υ Observership + cadaveric workshop Υ Perform the surgery with the support of an expert. Υ All of the above.
How many surgeries do you need to perform to master the technique compared to microdiscectomy?

How many surgeries do you think you should do to go from soft tissue transforaminal (disc) to foraminoplasty?

How many surgeries do you think you should do to go from soft tissue interlaminar (disc) to decompression due to stenosis?

How many surgeries do you think you should do to go from lumbar transforaminal to thoracic transforaminal?

How many surgeries should you do to start performing endoscopic fusion (ENDOLIF)?

Which of the following surgical techniques do you perform that you feel comfortable with or that you consider you have mastered? Several possible options. Υ Lumbar transforaminal (disc) Υ Lumbar transforaminal (foraminoplasty) Υ Lumbar interlaminar (disc) Υ Lumbar interlaminar (lumbar stenosis) Υ Thoracic transforaminal Υ Endoscopic Fusion (ENDOLIF) Υ Posterior cervical Υ Anterior cervical
Do you have someone in your center or practice to help you with endoscopic surgery? Υ Yes Υ No
^*Do you have someone technically proficient to help you? A Proctor, for example. Υ Yes Υ No
^*Do you think mastering endoscopic surgery increases the indication for surgery? Υ Yes Υ No
^*What is your main limitation to perform endoscopic surgery? Υ Lack of financial resources Υ Lack of training in endoscopic surgery Υ I don’t think it is superior to other techniques Υ The learning curve is very long for the benefits it brings.
^* In your experience, do you perceive a difficulty in accessing this technology? Υ yes Υ No

[1] Correspondence:
Jorge Alvaro Gonzalez Ross. 3432, Tarascos Street, Monraz, Guadalajara, Jalisco, Mexico. 44670. dr.gonzalez.ross@gmail.com

Brasil

Brasil

PERCEPTION OF THE LEARNING CURVE FOR ENDOSCOPIC SPINE PROCEDURES, A SURVEY OF SPINAL SURGEONS IN LATAM

PERCEPÇÃO DA CURVA DE APRENDIZADO PARA PROCEDIMENTOS ENDOSCÓPICOS DE COLUNA, UMA PESQUISA COM CIRURGIÕES DE COLUNA DA LATAM

PERCEPCIÓN DE LA CURVA DE APRENDIZAJE PARA PROCEDIMIENTOS ENDOSCÓPICOS DE COLUMNA, UNA ENCUESTA A CIRUJANOS DE COLUMNA DE LATAM

ABSTRACT

Objective:

Methods:

Results:

Conclusions: