Endoscopic endonasal dacryocystorhinostomy learning curve

Abstract

To compare the learning curves of the specialists in two different fields without previous endoscopic endonasal dacryocystorhinostomy experience as well as to reveal the related complications with surgical success rates. Methods: We retrospectively investigated 90 patients who received consecutive endoscopic endonasal dacryocystorhinostomy with mucosa preservation by an ophthalmologist (Group 1, n=45) and an otorhinolaryngologist (Group 2, n=45) between October 2017 and October 2019. Patients who were admitted with epiphora complaints and diagnosed with primary acquired nasolacrimal duct obstruction through lacrimal irrigation test and aged >18 years with at least 6 months of follow-up were included in the study. In all cases, additional pathologies such as septum deviation were evaluated by performing maxillofacial imaging. Patients' medical records were evaluated in terms of surgery duration, complications, and functional achievements. Results: The mean surgical duration of the patients in Group-2 was 36.27 ± 11.61 min, while it was 43.62 ± 16.89 min in Group-1; the difference was statistically significant (p=0.018). Functional achievements in Group 1 was 84.4% (73.3% in the first set of 15 cases, 93.3% in the last set of 15 cases) in Group 2; this rate was 88.9% (80% in the first set of 15 cases, 93.3% in the last set of 15 cases), and the difference was not statistically significant (p=0.53). Septum intervention in addition to endoscopic surgery in both the groups (p=0.03, p=0.005, respectively) and intense bleeding during surgery (for both the groups, p<0.0001) significantly decreased the functional success. Conclusion: Endoscopic endonasal dacryocystorhinostomy, performed after the necessary training, can provide high success and low complication rates when even conducted by ophthalmologists who are unfamiliar with endoscopic surgery after an experience of 30 cases.

DCR preferences among oculoplastic surgeons: Barriers and facilitators to adoption of endoscopic DCR

“…Although surgeons with lower surgical volumes and limited technical proctorship might have concerns about being able to overcome the learning curve of endoscopic DCR, previous research shows that the initial learning curve may be overcome relatively easily after 30 cases of experience of endoscopic surgeries 3,23 . This is consistent with our study which showed that those who performed 40 cases of EE-DCR during fellowship were more likely to perform this procedure after training.…”

Endoscopic Dacryocystorhinostomy With Modified Mucosal Flap Technique

“…1 Despite all these advantages, the biggest disadvantage of E-DCR is that the learning curve is steeper and the main reason for this is that it is difficult to master the intranasal anatomy and requires a certain amount of time. 2 The most important cause of surgical failure in E-DCR is postoperative granulation and synechiae, which causes closure of the bony window. 1 Different techniques such as silicone tube intubation and intraoperative mitomycin-C application have been tried to reduce failure rates, and the effectiveness of these methods on surgical success is controversial.…”

“…Among these advantages are the absence of skin scarring, no damage to the lacrimal pump system and canthus anatomy, less intraoperative bleeding, shorter operative time, and less postoperative morbidity 1. Despite all these advantages, the biggest disadvantage of E-DCR is that the learning curve is steeper and the main reason for this is that it is difficult to master the intranasal anatomy and requires a certain amount of time 2…”