Reducing the learning curve of interlaminar full-endoscopic discectomy: mushroom model-simulation training.

Purpose: To describe a cheap simulation model used to reduce the learning curve of the interlaminar full-endoscopic discectomy in a pilot study.

Introduction: The steep and difficult learning curve remain one of the main obstacles against the widespread diffusion of interlaminar full endoscopic lumbar discectomy (ILFED). One solution to overcome this learning curve is training with deliberate practice. As realistic models are relatively expensive and cadaver workshops not readily available, we developed a simple and cheap model to train the key steps of the procedure.

Methods: A simple and cheap model were designed. It consists of a king oyster mushroom stalk, a glove finger, a sponge and cotton wool. In order to fix the model to the table and to simulate the level of the patient's skin whereupon the hand of the surgeon relies, a wooden holding device was also used. As the purpose of this pilot study was to evaluate the model as a stimulator, it was tested during an advanced endoscopic training course.

Results: A step-by-step learning method with key steps was used by participants attending an advanced ILFED training on expensive realistic models. The model was considered as comparable and enough realistic to train key steps in order to reduce the learning curve and training costs.

Conclusion: We present an affordable, simple and reproducible training model, which allows for deliberate practice of the key steps of the ILFED procedure. The model may be used by surgeons starting with spinal endoscopy.