title: [Individual learning curves with reference to endonasal micro-endoscopic pan-sinus operation].
abstract: BACKGROUND
  We examined how surgeons in training will develop into experienced surgeons in sinus surgery by analysing their individual learning curve.
  
  
  METHODS
  In a retrospective study we evaluated complications in 818 surgical procedures (362 revisions = 44.3%) performed by four different surgeons.
  
  
  RESULTS
  We found a dural lesion in six cases (0.75%), opening of the periosteum of the orbit in 30 cases (3.7%), and control of bleeding from the anterior ethmoidal artery in 36 cases (4.4%). No lesions of the internal carotid artery or lacrimal duct system occurred. The complications were not distributed equally. We observed a three-phase learning process which we describe using the example of a traffic light: red with a high risk of complications, yellow with a minor one, and green for the experienced surgeon. The first phase consists of the first 20 procedures, yellow from the 20th to the 100th, and green for procedures performed thereafter.
  
  
  CONCLUSIONS
  Each inexperienced surgeon has to determine his position on the learning curve. He or she should be supervised accordingly.
authors.affiliation: Klinik für HNO-Krankheiten, Kopf-, Hals- und Plastische Gesichts-chirurgie, Kommunikationsstörungen, Klinikum Fulda.
authors.forename: R
authors.initials: R
authors.lastname: Keerl
authors.forename: R
authors.initials: R
authors.lastname: Weber
authors.forename: G
authors.initials: G
authors.lastname: Drees
authors.forename: W
authors.initials: W
authors.lastname: Draf
mesh_terms: D002983:Clinical Competence; D004388:Dura Mater / Q000293:injuries; D004502:Education, Medical, Continuing; D019723:Endoscopes; D005005:Ethmoid Sinus / Q000601:surgery; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008866:Microsurgery / Q000295:instrumentation*; D010036:Otolaryngology / Q000193:education*; D010256:Paranasal Sinuses / Q000601:surgery; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D012852:Sinusitis / Q000601:surgery*
vernacular_title: Individuelle Lernkurven der endonasalen mikro-endoskopischen Pansinusoperation.