Endonazal Dakriyosistorinostomi; öğrenme eğrisi ve tecrübelerimiz

Amaç:Bu araştırma sırasında elde edilen sonuçlar ile bir kulak burun boğaz uzmanının gözetimi altında bir oftalmik cerrah tarafından gerçekleştirilen endonazal dakriyosistorinostomi operasyonunun öğrenme eğrisi hakkında bilgi verilmesi amaçlandı. Hastalar ve Yöntem:Bu retrospektif çalışmada, endonazal dakriyosistorinostomi ameliyatı olan ardışık olgular, tek bir oftalmik cerrah tarafından ikinci bir kulak burun boğaz uzmanı gözetiminde gerçekleştirildi. 23 hastaya toplam 29 ameliyat yapıldı. Tam nazolakrimal kanal tıkanıklığı tanısı konulan hastalar değerlendirildi ve ameliyat edildi. Tüm cerrahi vakalar intraoperatif olarak kaydedildi ve her vaka için kayıt süresi belirlendi. Postoperatif dönemde veya sonrasında meydana gelen komplikasyonların tümü kaydedildi. Bulgular:23 hastanın yaş ortalaması 55.25 ± 18.6 yıl (15 yaş-80 yaş) idi; bunlardan 20\'si (% 87) kadındı. Sol taraf tıkanıklığı vakaların% 69\'unda (20/29) yer aldı. Ortalama 12,4 aylık takip sonunda,% 89 (26/29) olguda anatomik ve fonksiyonel başarı elde edildi. Ameliyathanede harcanan ortalama süre 84 ± 17,2 dakika idi (aralık, 40-110 dakika). Sadece 3 başarısız ameliyatın ilk 5 ameliyat arasında olduğu tespit edildi, geri kalan 24 vakada başarısızlık saptanmadı. Sonuç:Endonazal dakriyosistorinostomi, nazolakrimal kanal tıkanıklığının tedavisi için güvenli, etkili ve kozmetik açıdan kabul edilen bir ameliyattır. Bazı ameliyatlardan biraz daha uzun bir öğrenme eğrisine sahip olmasına rağmen, endoskopun kullanımı ustalaştıktan ve cerrahi alanın aşinalığı geliştirildikten sonra, ameliyat süresi önemli ölçüde azalacaktır. Multidisipliner koordinasyonun potansiyel komplikasyon oranlarının azaltılmasında ve tekniğin mükemmelleştirilmesinde önemli bir rol oynadığına inanıyoruz.

Endonasal Dacryocystorhinostomy; the learning curve and our experience

Purpose:It was aimed to give an insight on the learning curve adopted by an ophthalmic surgeon while performing endonasal dacryocystorhinostomy under supervision of an otolaryngologist with the results experienced during this survey. Patients and Methods:In this retrospective study, consecutive cases with endonasal dacryocystorhinostomy surgery was performed by a single ophthalmic surgeon while a second otolaryngologist overlooking the procedures. A total of 29 surgeries were performed on 23 patients. Patients that were diagnosed with complete nasolacrimal duct obstruction were then evaluated and proceeded to the surgery. Intraoperative video was recorded in all surgical cases and recording time was noted for each case. All of the complication occurred during or at the postoperative stages were noted. Results:The mean age of the 23 patients were 55.25±18.6 years (15 y-80 y), of which 20 cases (87%) were female. The left side was involved in 69% (20/29) of cases. At the final follow‐up of mean 12,4 months, the anatomical and functional success was achieved in 89% (26/29) cases. The mean time spent in the operating theatre was 84±17.2 minutes (range, 40–110 min). It was found that the only 3 failed surgeries were in the first 5 surgeries performed with no surgical failure in the remaining 24 eyes. Conclusion:Endonasal dacryocystorhinostomy is a safe, effective and cosmetically pleasing surgery for the treatment of nasolacrimal duct obstruction. Although it has a somewhat longer learning curve than some surgeries, once handling of the endoscope has been mastered and familiarity of the surgical field is improved, the duration of surgery will decrease significantly. We believe multidisciplinary coordination plays an important role in decreasing potential complication rates and also in perfecting the technique.

Keywords:

Endonasal Dacryocystorhinostomy, Ophthalmologist Surgery Time, Learning Curve,

PDF

___

1. Toti A. Nuovometodoconservatore di cura radicle delle sup‐ purazonicroniche del saccolacrimale (Dacriocistorinostomia). Clin Mod Fir 1904; 10: 385‐7.
2. Caldwell GW: Two new operations for obstruction of the nasolacrimal duct, NYJ Med 1893; 57: 581-2.
3. Stammberger H. Endoscopic endonasal surgery--concepts in treatment of recur-ring rhinosinusitis. Part I. Anatomic and pathophysiologic considerations. Oto-laryngol Head Neck Surg. 1986; 94: 143-7.
4. J McDonogh M, Meiring JH. Endoscopic transnasal dacryocystorhinostomy. Lar-yngol Otol. 1989; 103: 585-7.
5. Hartikainen J, Antila J, Varpula M, Puukka P, Seppa H & Grenman R. Prospective randomized comparison of endonasal endoscopic dacryocystorhinostomy and ex-ternal dacryorhinostomy. Laryngoscope 1998; 108: 1106– 13.
6. Jawaheer L, MacEwen CJ, Anijeet D. Endonasal versus external dacryocystorhi-nostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017;24(2):CD007097.
7. Baek JS, Jeong SH, Lee JH, Choi HS, Kim SJ, Jang JW. Cause and management of patients with failed Endonasal Dacryocystorhinostomy. Clin Exp Otorhinolaryn-gol. 2017; 10: 85-90.
8. Qin ZY, Lu ZM, Liang ZJ. Application of mitomycin C in nasal endoscopic dacryo-cystorhinostomy. Int J Ophthalmol 2010; 10: 1569‐71.
9. Roozitalab MH, Amirahmadi M, Namazi MR. Results of the application of in-traoperative mitomycin C in dacryocystorhinostomy. Eur J Ophthal 2004; 14: 461‐3.
10. Smirnov G, Tuomilehto H, Terasvirta M, Nuutinen J, Seppa J. Silicone tubing after endoscopic dacryocystorhinostomy: is it necessary?. Amer J Rhino 2006; 20: 600‐2.
11. Unlu HH, Gunhan K, Baser EF, Songu M. Long term results in endoscopic dacryo-cystorhinostomy: is intubation really required?. Otolaryngology ‐ Head & Neck Sur-gery 2009; 14: 589‐95.
12. Feng YF, Cai JQ, Zhang JY, Han XH. A meta-analysis of primary dacryocystorhi-nostomy with and without silicone intubation. Can J Ophthalmol. 2011; 46: 521-7.
13. Onerci M, Orhan M, Ogretmenoğlu O, Irkeç M. Long-term results and reasons for failure of intranasal endoscopic dacryocystorhinostomy. Acta Otolaryngol. 2000; 120: 319-22.
14. Kamal S, Ali MJ, Nair AG Outcomes of endoscopic dacryocystorhinostomy: Experi-ence of a fellowship trainee at a tertiary care center.Indian J Ophthalmol. 2016 Sep;64(9):648-653.
15. Lee JJ, Lee HM, Lim HB, Seo SW, Ahn HB, Lee SB. Learning Curve for Endoscop-ic Endonasal Dacryocystorhinostomy. Korean J Ophthalmol. 2017 Aug;31(4):299-305.