Unilateral biportal endoscopic spine surgery: a meta-analysis unveiling the learning curve and clinical benefits

Shu-Xin Liu; Rui-Song Chen; Chien-Min Chen; Li-Ru He; Shang-Wun Jhang; Guang-Xun Lin

doi:10.3389/fsurg.2024.1405519

Unilateral biportal endoscopic spine surgery: a meta-analysis unveiling the learning curve and clinical benefits

Front Surg. 2024 Nov 7:11:1405519. doi: 10.3389/fsurg.2024.1405519. eCollection 2024.

Authors

Shu-Xin Liu^#¹, Rui-Song Chen^#², Chien-Min Chen^#^{3

4

5}, Li-Ru He⁶, Shang-Wun Jhang³, Guang-Xun Lin^{7

8}

Affiliations

¹ Department of Orthopedics, Panjin Central Hospital, Panjin, Liaoning, China.
² Department of Orthopedics and Traumatology of Traditional Chinese Medicine, The Third Hospital of Xiamen, Xiamen, China.
³ Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
⁴ Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan.
⁵ Department of Biomedical Sciences, National Chung Cheng University, Chiayi, Taiwan.
⁶ Department of Anesthesia and Surgery, The First Affiliated Hospital of Xiamen University, Xiamen University, Xiamen, Fujian, China.
⁷ Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
⁸ The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China.

^# Contributed equally.

Abstract

Objective: To provide insights into the learning curve of unilateral biportal endoscopic (UBE) spine surgery by synthesizing available evidence on critical points and associated clinical outcomes.

Methods: A comprehensive literature search was conducted across multiple databases, yielding a pool of relevant studies. Inclusion criteria encompassed studies reporting on UBE learning curves and quantitative data related to clinical outcomes (operative time, hospital stay, and complications).

Results: A total of five studies were included in the analysis, providing six datasets to elucidate the UBE learning curve. Three of the five studies analyzed learning curves using the Cumulative Sum method and identified cutoff points. One study plotted learning curves and determined cutoff points based on surgical time analysis, while the remaining one study (providing two datasets) plotted learning curves using the phased analysis method. The mean value of the cutoff point in terms of the number of cases required to reach proficiency in time to surgery was calculated at 37.5 cases, with a range spanning from 14 to 58 cases. Notably, there was a statistically significant difference in time to surgery between the late group and the early group, with the late group demonstrating a significantly reduced time to surgery (P < 0.0001). Additionally, the determined cutoff points exhibited significant variations when applied to patient outcome parameters, including postoperative hospitalization, postoperative drainage, and surgical complications (P < 0.05).

Conclusion: While the analysis indicates that UBE surgery's learning curve is associated with surgical time, the limited focus on this metric and potential discrepancies in cutoff point determination highlight the need for a more comprehensive understanding.

Keywords: BESS; UBE; learning curve; lumbar degenerative disease; unilateral biportal endoscopic.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the “Xiamen Health System Discipline Leaders and their Backup Candi-dates, Senior Management Talent Training Candidates Training Program (2021)”; funded by Xiamen Municipal Bureau of Science and Technology (3502Z20224033). The funder had no role in the design of the study or collection, analysis, or interpretation of data or in writing the manuscript.