The Learning Curve of Sialendoscopy With Modular Sialendoscopes

OBJECTIVE: To assess the learning curve of sialendoscopy with modular endoscopes based on operative parameters and a postoperative performance rating. DESIGN: Prospective study, case series. SETTING: Tertiary referral hospital. PATIENTS: The study included 50 consecutive patients who underwent sialendoscopy by a single surgeon (J.C.L.) between September 2007 and March 2009 at University Hospital of Cologne, Cologne, Germany. The patients were chronologically arranged into 5 groups of 10 patients. INTERVENTIONS: Diagnostic and interventional sialendoscopy using local anesthesia. MAIN OUTCOME MEASURES: Operative parameters and postoperative performance ratings. RESULTS: The average operative time was 39 minutes, with a ratio of diagnostic to interventional sialendoscopy of 62%:38%. There was a significant improvement in the average operative time (P < .001) and in the average performance rating (P = .007) after the first 10 patients and again after the first 30 patients (P = .003 and P = .01, respectively). A continuous decrease in operation time was measurable up to the last patients. Performance ratings reached a level of excellence within the last group of patients. CONCLUSIONS: The performance of sialendoscopy improves with time and experience. With endoscopes of a modular design, the surgeons have a remarkable learning curve. The surgeons' learning curve in this study required 30 cases to reach satisfactory operation times and performance ratings. Both parameters showed continuous improvement and a leveling off after 50 cases.