Learning Curve for Endoscopic Endonasal Dacryocystorhinostomy

Abstract

Purpose: To elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) basedon the results of EE-DCR performed by three surgeons at three different tertiary hospitals. Methods: A retrospective review of the medical records of 386 eyes of 337 patients who had undergone EEDCRby three surgeons at three tertiary hospitals and who were available for a >6-month postoperativeobservation period was conducted. The success of a given surgery was determined based on the results ofa test performed during the patient’s last outpatient visit to the hospital. The learning curve was identified bydividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing theirsuccess rates. Results: The overall success rate of the entire study population was 86.3%. The success rates for each ofthree surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyeseach, all three surgeons showed a significant increase in surgery success rates after their first group of 30eyes (p < 0.05). The overall success rate excluding the first 30 eyes was 92.9%, and all three surgeons exhibiteda significantly improved success rate of >90% (A, 94.4%; B, 90.8%; C, 95.4%). Conclusions: A surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgicalskill for this procedure.