title: Complications of endoscopic microdiscectomy using the EASYGO! system: is there any difference with conventional discectomy during the learning-curve period?
abstract: BACKGROUND
  Microendoscopic discectomy (MED) is emerging as a minimally invasive alternative to conventional microsurgical discectomy (MSD). EASYGO! is a new system for spinal endoscopy that claims smooth transition from MSD to MED, with a reduced learning curve period. The aims of this study were to describe the complications that appeared during the learning curve period of MED and to compare their incidence with the rate and type of complications that occurred during a simultaneous non-randomised series of standard MSDs.
  
  
  METHODS
  Between July 2009 and December 2010, 138 patients underwent scheduled first-time discectomy in our institution, 37 using an MED approach and 101 by a conventional MSD. A MED learning curve was obtained by plotting every case with its respective operative time. Complications, length of hospital stay, need of further surgery and outcome were prospectively recorded in both groups.
  
  
  RESULTS
  The mean operative time was 66 min for the MSD group and 100 min for the MED group, although for the last 14 cases of the latter group the time was reduced. Curve-fitting techniques showed that the inverse equation, ƒ(x) = 122.12/x + 73.05, had the best correlation between case number and operative time. The learning curve was overcome after the 30th case. Complications occurred in 9.8 % of the MSD group and 8.1 % of the MED group (P = 0.49). Average length of hospital stay was 2.36 days for the MED group and 3.36 days for the MSD group (P = 0.01). The procedure successfully relieved patient symptoms in 68.63 % of the MSD group and 89.92 % of the MED group. No revision surgery was required in the MED group, but it was necessary in ten patients of the MSD group.
  
  
  CONCLUSIONS
  Between 25 and 30 cases are needed to reach the learning curve's asymptote of MED. Even during this initial learning period MED is a safe procedure, with comparable results to those obtained with conventional MSD and with a similar complication rate. The key points for reducing intraoperative complications are an adequate expertise in MSD, a precise selection of initial cases, a proper surgical planning and a careful technique, which are mandatory to avoid unnecessary neurological injury in an otherwise secure surgical approach.
authors.affiliation: Department of Neurosurgery and Spine Unit, University Hospital "Marqués de Valdecilla", Santander, Spain. rmlaez@yahoo.es
authors.forename: Rubén
authors.initials: R
authors.lastname: Martín-Láez
authors.forename: José Angel
authors.initials: JA
authors.lastname: Martínez-Agüeros
authors.forename: David
authors.initials: D
authors.lastname: Suárez-Fernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Montiaga-Núñez
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vázquez-Barquero
mesh_terms: D000328:Adult; D017587:Diskectomy, Percutaneous / Q000009:adverse effects* / Q000193:education / Q000379:methods; D004503:Education, Medical, Graduate / Q000379:methods; D004724:Endoscopy / Q000009:adverse effects* / Q000193:education / Q000379:methods; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008866:Microsurgery / Q000009:adverse effects* / Q000193:education / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D011787:Quality of Health Care / Q000639:trends; D012189:Retrospective Studies; D013663:Teaching / Q000379:methods; D013997:Time Factors