The Learning Curve in Endoscopic Dacryocystorhinostomy: Outcomes in Surgery Performed by Trainee Oculoplastic Surgeons

Malhotra, Raman; Norris, Jonathan H.; Sagili, Suresh; Al-Abbadi, Z; Avisar, Inbal

doi:10.3109/01676830.2015.1078378

Cited by 27 publications

(22 citation statements)

References 23 publications

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“…[4] To the best of our knowledge, there are five previous reports on experiences of trainees with DCR, two studies that have focused on external DCR and three on En-DCR. [1011121314] Two studies with endoscopic DCR involved otolaryngology fellows and consultants and only one study involved ophthalmology trainees. This study documents the clinical profile, intraoperative details, postoperative ostium findings, and surgical outcomes after endoscopic En-DCR operated by ophthalmic plastic surgery fellow during the training period with good success rates.…”

Section: Discussionmentioning

confidence: 99%

“…appears to be comparable. [14] In their study, three different trainees operated on 17, 8, and 13 cases each, and the mean surgical time in the operating room was 95.7 ± 27.3 min. While in principle, the surgical technique is by and large similar to our technique, it is worth noting that in their cohort, five cases required septoplasty, which was done simultaneously by the preceptor.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

Kamal

Ali

Nair

2016

Indian J Ophthalmol

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Aim:The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR).Settings and Design:This study was a retrospective, interventional case series.Subjects and Methods:Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora.Results:Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4–75) years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD) obstruction in 72% (39/54), acute dacryocystitis in 15% (8/54), failed DCR in 7% (4/54), and persistent congenital NLD obstruction in 5% (3/54). The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05). Anatomical and functional success rate was 94% (48/51) at 6 months follow-up period.Conclusions:Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn and perform En-DCR with acceptable success rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

Kamal

Ali

Nair

2016

Indian J Ophthalmol

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“…Thus, the separation of their groups into cases done by consultants and trainees was artificial and did not reflect the reality of surgical practice. Malhotra et al (2015) reported the results of 38 cases of endonasal DCR independently performed by 3 trainee (all post -residency) oculoplasty surgeons, where all trainees underwent a supervised training and were allowed to operate independently only after a minimum of 6 months of fellowship training. They excluded the cases prior to being independent, thus excluding the learning curve.…”

Section: Discussionmentioning

confidence: 99%

“…Mirza et al (2002) found an improved outcome in the last 38 cases of endonasal DCR out of a total of 76 cases but did not explicitly mention data documenting the learning curve. Surprisingly, no study till date has evaluated the learning curve in detail (Mirza et al, 2002;Pandya et al, 2010;Malhotra, 2015;Kashkouli et al, 2003). Ours was a unique study in which we compared the results of external DCR surgery by a trainee ophthalmologist over time.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve in External DCR – A Trainee’s Perspective

2018

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Purpose: The aim of this study is to determine the success rate over time in patients undergoing External Dacryocystorhinostomy (DCR) with acquired naso-lacrimal duct obstruction (NLDO), when done by a trainee ophthalmologist. Methods:The study was Prospective Observational study and was conducted in Tertiary Eye Hospital, Uttar Pradesh, India. One hundred and fourteen consecutive adult patients underwent external DCR for acquired complete NLDO by a trainee with less than 3 years of experience in ophthalmology between November 2011 and March 2013. Postoperative anatomic success rate was determined at 6 months on the basis of the patency of lacrimal sac syringing and patients were asked to subjectively evaluate improvement of their epiphora using a questionnaire. Results: Anatomical success rate across the entire study period was 93.7% and this improved from 87% in the first tertile of 38 patients to 94% in the second tertile and 100% in the final tertile of cases (p<0.05). Overall complication rate was 16.67% and reduced from 29% in the first tertile to 8% in the final tertile (p<0.05). Loss of anterior nasal flap was the commonest complication (10 cases) during the training period. Conclusion: External DCR, as a primary procedure for acquired NLDO, even when operated by trainee ophthalmologists, has a relatively high success rate that improves over time. As the learning curve improves, complication rates reduce significantly. Financial Disclosure: No author has any financial or proprietary interest in the material or method mentioned.

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“…Some studies have reported success rates as low as 57%, while others have reported success rates of 100%. [4][5][6] A recent retrospective review of 1083 END-DCRs performed by a single surgeon reported a success rate of 92.7%. 7 The reasons for this variation are unclear but probably include differences in patient selection, exact surgical approach, surgeon experience, time to follow-up, and definition of 'success'.…”

Section: Introductionmentioning

confidence: 99%

Anatomical and subjective success rates of endonasal dacryocystorhinostomy over a seven-year period

Beshay

Ghabrial

2016

Eye

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Purpose Endonasal dacryocystorhinostomy (END-DCR) is a relatively novel approach that has recently been shown in some studies to provide similar success rates to the more traditional external approach for the treatment of nasolacrimal duct obstruction (NLDO). However, a range of success rates using this approach are reported within the literature and the majority of oculoplastic surgeons are still favouring the external approach. The purpose of this study was to review the anatomical and subjective success rates of END-DCRs performed over a 7-year period. Patients and methods We provide a review of the success rates of 288 END-DCRs for the treatment of acquired NLDO performed over a 7-year period by a single oculoplastic surgeon in Sydney, Australia. We describe the operative technique used and define anatomical success as demonstrated patency of the nasolacrimal drainage system at 10 weeks postoperatively while subjective success is defined as complete resolution or significant improvement of symptoms as reported by patients at the same time point. Results In our study, we were able to demonstrate that out of 288 END-DCRs, an average anatomical success rate of 89.6% and an average subjective success rate of 81.3% were achievable. Conclusions We conclude that the success rates using our endonasal approach remain similar to those obtained using the external approach, as reported within the literature, and may be considered as a primary treatment option for acquired NLDO.

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The Learning Curve in Endoscopic Dacryocystorhinostomy: Outcomes in Surgery Performed by Trainee Oculoplastic Surgeons

Cited by 27 publications

References 23 publications

Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

Learning Curve in External DCR – A Trainee’s Perspective

Anatomical and subjective success rates of endonasal dacryocystorhinostomy over a seven-year period

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