Learning curve of FED for surgeon with no experience of LOVE method

Abstract

Introduction: Many surgeons introduce full endoscopic discectomy (FED) after having experienced LOVE and MED methods. In this study, we examined the learning curve of FED for a surgeon who had no experience with either method.

Methods: The subjects were 90 cases of lumbar disc herniation who underwent FED in one level. The study period was from October 2019 to August 2021. The surgeon had no experience with LOVE or MED methods. Operation time, complications, and JOA score were investigated.

Results: Fifty-two patients (36 males, 16 females) were treated by IL procedure with a mean age of 48.4 years, and 38 patients (26 males, 12 females) were treated by TF procedure with a mean age of 53.1 years. The mean operation time was 80.2 min for IL and 78.7 min for TF. The operation time for both methods decreased with the increase in the number of cases (IL: R=-0.4, p< 0.05, TF: R=-0.4, p< 0. 05). Complications included postoperative muscle weakness in 1 case and nerve root injury in 1 case, for a total of 2 cases (3.8%) in IL, and nerve root injury in 2 cases (7.1%) in TF. Recurrence was observed in 7 cases (13.5%) by IL and 3 cases (7.9%) by TF. The improvement rate of JOA score was 88.2% in IL and 84.1% in TF.

Conclusion: The surgeon who had no experience with LOVE or MED methods may be able to perform FED under the environment of various training and sufficient guidance.