title: Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy.
abstract: Beginners usually need increased punctures and dozens of fluoroscopy in learning transforamimal percutaneous endoscopic lumbar discectomy (tPELD). Navigator-assisted spinal surgery (NASS) is a novel technique that could induce a definite trajectory. The retrospective study aimed to investigate the impact of a definite trajectory on the learning curve of tPELD.
  
  
  
  A total of 120 patients with symptomatic lumbar disc herniation who received tPELD between 2012 and 2014. Patients receiving tPELD with NASS technique by one surgeon were regarded as group A, and those receiving conventional methods by another surgeon were regarded as group B. Each group was divided into three subgroups (case 1-20, case 21-40, case 41-60).
  
  
  
  The fluoroscopy times were 22.62 ± 3.80 in group A and 34.32 ± 4.78 in group B (P < 0.001). The pre-operative location time was 3.56 ± 0.60 minutes in group A and 5.49 ± 1.48 minutes in group B (P < 0.001). The puncture-channel time was 21.85 ± 4.31 minutes in group A and 34.20 ± 8.88 minutes in group B (P < 0.001). The operation time was 84.62 ± 9.20 minutes in group A and 101.97 ± 14.92 minutes in group B (P < 0.001), and the learning curve of tPELD in group A was steeper than that in group B. No significant differences were detected in patient-reported outcomes, hospital stay, patient satisfaction, and complication rate between the two groups (p > 0.05).
  
  
  
  Definite trajectory significantly reduced the operation time, preoperative location time, puncture-channel time, and fluoroscopy times of tPELD by beginners, and thus reshaped the learning curve of tPELD and minimized the radiation exposure.
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Guoxin
authors: G
authors: Fan
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Ruoshuang
authors: R
authors: Han
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Xin
authors: X
authors: Gu
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Hailong
authors: H
authors: Zhang
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Xiaofei
authors: X
authors: Guan
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Yunshan
authors: Y
authors: Fan
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China.
authors: Teng
authors: T
authors: Wang
authors: Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, 200072, China. tjhss7418@foxmail.com.
authors: Shisheng
authors: S
authors: He
mesh_terms: D000328:Adult; D017587:Diskectomy, Percutaneous / Q000379:methods* / Q000706:statistics & numerical data; D004724:Endoscopy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005471:Fluoroscopy / Q000706:statistics & numerical data; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies
keywords: Definite trajectory; Learning curve; Lumbar location system; NASS technique; Radiation exposure; Transforaminal percutaneous endoscopy lumbar discectomy