Learning curve and its effect on the results of transsphenoidal endoscopic surgery of pituitary adenomas

Introduction. Since the beginning of the development of the transsphenoidal approach, many practicing surgeons in their publications have emphasized the steep learning curve of this field, highlighting the difficulties that may arise for novice surgeons. Despite the evidence of the overall effectiveness and safety of endoscopic surgery, a variety of factors, as reported in the modern literature, affect the curves of surgical training in minimally invasive endoscopic methods, including transsphenoidal endoscopic surgery of the pituitary gland, and, accordingly, the results of surgical treatment. The objective of the work was the analysis of the results of treatment of patients diagnosed with pituitary adenoma by transsphenoidal endoscopic method for the period from 2019 to 2022 in experienced and inexperienced surgeons, the determination of the threshold for learning this method and ways to overcome it. Methods and materials. This article describes the statistical analysis of the results of treatment of patients diagnosed with pituitary adenoma by transsphenoidal endoscopy for the period from 2019 to 2022 in experienced and inexperienced surgeons, a review of the literature determining the learning curve of surgeons for this approach. Results. A neurosurgeon performing more than 200 transnasal operations per year had lower rates of endocrinological, ophthalmological and infectious complications, a lower frequency of postoperative liquorrhea, a higher rate of radicality of the operations performed, and shorter surgery time. However, it is important to note that for inexperienced surgeons performing less than 50 operations per year and with a total experience of less than 100 operations, the percentage of complications does not exceed the figures published in modern literature. Conclusion. The learning curve is a crucial factor in acquiring new manual skills. Understanding the relationship between the learning curve and surgical outcomes will allow surgeons to better understand what to expect and what measures to take as these surgical skills develop. It seems that the mastery of endoscopic surgery of the base of the skull must necessarily be carried out in a large specialized neurosurgical center, which has an expert-level neurosurgeon with experience of several thousand operations and performs at least 200 operations annually.