• Sang-Min Park, Ho-Joong Kim, Gang-Un Kim, Min-Ho Choi, Bong-Soon Chang, Choon-Ki Lee, and Jin S Yeom.
• Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
• World Neurosurg. 2019 Feb 1; 122: e1007-e1013.

ObjectiveThe purpose of the present study was to determine the learning curve for biportal endoscopic spinal surgery (BESS) for decompressive laminectomy in lumbar spinal stenosis using a learning curve cumulative summation test (LC-CUSUM).MethodsThe surgeon was proficient in open and microscopic decompressive laminectomy in lumbar spinal stenosis but did not have any experience with BESS or other endoscopic surgery techniques. The learning curve of BESS was investigated using LC-CUSUM analysis. Procedure success was defined as an operative time <75 minutes, the mean operative time with microscopic decompression laminectomy.ResultsThe present study included the first 60 patients who had undergone single-level decompressive laminectomy using BESS by a single orthopedic surgeon. The mean operative time for decompressive laminectomy by BESS was 83.8 ± 37.9 minutes. The mean operative time in the early learning period (≤30 cases) and late learning period (second 30 cases) was 105.3 ± 39.7 minutes and 62.4 ± 19.9 minutes, respectively. The overall complication rate was ∼10%. The LC-CUSUM signaled competency for surgery at the 58th operation, indicating that sufficient evidence had accumulated to prove that the surgeon was competent. Thus, a trainee with no experience with BESS had reached adequate performance at 58 cases.ConclusionsThe results of the present study have demonstrated that a substantial learning period could be needed before adequate performance can be achieved with lumbar decompressive laminectomy using BESS.Copyright © 2018 Elsevier Inc. All rights reserved.

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