{"id":2989,"date":"2016-01-21T12:27:56","date_gmt":"2016-01-21T12:27:56","guid":{"rendered":"http:\/\/www.library.sath.nhs.uk\/intelligence\/?p=2989"},"modified":"2016-10-31T13:26:46","modified_gmt":"2016-10-31T13:26:46","slug":"the-learning-curve-in-endoscopic-dacryocystorhinostomy-outcomes-in-surgery-performed-by-trainee-oculoplastic-surgeons-2015","status":"publish","type":"post","link":"https:\/\/www.library.sath.nhs.uk\/research\/2016\/01\/21\/the-learning-curve-in-endoscopic-dacryocystorhinostomy-outcomes-in-surgery-performed-by-trainee-oculoplastic-surgeons-2015\/","title":{"rendered":"The Learning Curve in Endoscopic Dacryocystorhinostomy: Outcomes in Surgery Performed by Trainee Oculoplastic Surgeons (2015)"},"content":{"rendered":"<p><strong>Type of publication:<\/strong><br \/>\nJournal article<\/p>\n<p><strong>Author(s):<\/strong><br \/>\nMalhotra R., Norris J.H., Sagili S., *Al-Abbadi Z., Avisar I.<\/p>\n<p><strong>Citation:<\/strong><br \/>\nOrbit, November 2015, vol.\/is. 34\/6(314-319)<\/p>\n<p><strong>Abstract:<\/strong><br \/>\nTo report outcomes of endoscopic DCR (En-DCR) performed by oculoplastic trainees and describe factors to improve success rates for trainees. Methods: Retrospective, single-centre audit of En-DCR procedures performed by three consecutive trainee oculoplastic surgeons, over a 3-year period. Trainees also completed a reflective-learning questionnaire highlighting challenging and technically difficult aspects of En-DCR surgery, with relevant tips. Results: Thirty-eight consecutive independently-performed en-DCR procedures on 38 patients (mean age 58.6 +\/- 21.4 years) were studied. Mean time spent in the operating-theatre was 95.7 +\/- 27.3 minutes. Success rate for each year was 15\/17(88%), 8\/8(100%) and 7\/13(54%), respectively, at mean follow-up 12.5 +\/- 12 months. The lowest success rate year coincided with use of silicone stents in 31% cases compared to 94% and 100% i n the previous 2 years. In cases that failed, video-analysis highlighted in adequate superior bony rhinostomy (2 cases), incomplete retroplacement of posterior-nasal mucosal-flaps (3 cases), significant bleeding (1 case). Those who underwent revision surgery (n = 6), were found to have soft-tissue ostium and sac closure requiring flap revision. Two-cases required further bone removal supero-posterior to the lacrimal sac. Trainees-tips that helped improve their surgery related to patient positioning, instrument handling , bone removal and posture. Conclusion: Good surgical outcomes are achievable training in en-DCR surgery. Adequate operating time needs to be planned. Failure was primarily due to closure of the soft-tissue ostium, either secondary to inadequate osteotomy and sac-marsupialisation or postoperative scarring. Intra-operative mucosal trauma is higher amongst trainees and adjuvant silicone stenting during the training period may be of value where mucosal adhesions are anticipated.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Type of publication: Journal article Author(s): Malhotra R., Norris J.H., Sagili S., *Al-Abbadi Z., Avisar I. Citation: Orbit, November 2015, vol.\/is. 34\/6(314-319) Abstract: To report outcomes of endoscopic DCR (En-DCR) performed by oculoplastic trainees and describe factors to improve success<span class=\"ellipsis\">&hellip;<\/span><\/p>\n<div class=\"read-more\"><a href=\"https:\/\/www.library.sath.nhs.uk\/research\/2016\/01\/21\/the-learning-curve-in-endoscopic-dacryocystorhinostomy-outcomes-in-surgery-performed-by-trainee-oculoplastic-surgeons-2015\/\">Read more <span class=\"screen-reader-text\">The Learning Curve in Endoscopic Dacryocystorhinostomy: Outcomes in Surgery Performed by Trainee Oculoplastic Surgeons (2015)<\/span><span class=\"meta-nav\"> &#8250;<\/span><\/a><\/div>\n<p><!-- end of .read-more --><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"content-type":"","footnotes":""},"categories":[200],"tags":[569],"class_list":["post-2989","post","type-post","status-publish","format-standard","hentry","category-staff-publication","tag-569"],"_links":{"self":[{"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/posts\/2989","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/comments?post=2989"}],"version-history":[{"count":3,"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/posts\/2989\/revisions"}],"predecessor-version":[{"id":3013,"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/posts\/2989\/revisions\/3013"}],"wp:attachment":[{"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/media?parent=2989"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/categories?post=2989"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.library.sath.nhs.uk\/research\/wp-json\/wp\/v2\/tags?post=2989"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}