Assessing the validity of the endoscopic shunt insertion trial: did surgical experience affect the results?

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Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Kestle, John R. W.
Other Author Klimo Jr.,, Paul.; Thompson, Clinton J.; Drake, James
Title Assessing the validity of the endoscopic shunt insertion trial: did surgical experience affect the results?
Date 2004-01-01
Description Object. Most surgical procedures are associated with a learning curve in which the success rate is lower early in the experience before mistakes have been identified and modifications made to the procedure. Negative results obtained early in a trial's learning curve may be a matter of timing rather than a reflection of the procedure's effectiveness. The recently published results of the Endoscopic Shunt Insertion Trial (ESIT) represent the notion that endoscopically placed shunts were no more likely to survive than conventionally placed shunts. This negative result may be due to inexperience in performing endoscopic surgeries. Methods. Surgical experience was assessed in two ways. Shunt survival rates were compared between cases treated endoscopically in the 1st and last years of the ESIT. The effect of center volume was evaluated using a Cox proportional hazard model in which the following variables were analyzed: age at registration, the diagnosis of myelomeningocele, head size, method of shunt placement (endoscopic compared with conventional), and center volume. There was no difference in survival (endurance) of the shunt between patients enrolled in the 1st and last years (log rank = 0.08, p = 0.77). Likewise, no variable in the Cox multivariate model, including center volume, was a significant factor in predicting shunt survival. Conclusions. The primary result of the ESIT was found to be internally valid. The fact that endoscopic shunt placement did not benefit patients evaluated in the study was not due to early timing of the trial. Any learning curve among the participating surgeons did not adversely affect the results.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
Volume 101
Issue 2 suppl
First Page 130
Last Page 133
Subject Endoscopic shunt insertion; Ventriculoperitoneal shunt; Pediatric neurosurgery; Surgical experience
Subject LCSH Endoscopy; Pediatric neurology; Hydrocephalus in children
Language eng
Bibliographic Citation Klimo, P. Jr., Thompson, C. J., Drake, J., & Kestle, J. R. (2004). Assessing the validity of the endoscopic shunt insertion trial: did surgical experience affect the results?. Journal of Neurosurgery, 101(2 suppl), 130-3.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 161,923 bytes
Identifier ir-main,13198
ARK ark:/87278/s64t72n1
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 704127
Reference URL https://collections.lib.utah.edu/ark:/87278/s64t72n1