Spine surgeons are always learning throughout their careers, and adding new surgical techniques can take time to master.
Spine surgeons discuss how they address those learning curves.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Editor's note: Responses were lightly edited for clarity and length.
Question: What can spine surgeons do to address the learning curves with learning any new surgical technique?
Brian Gantwerker, MD. Neurosurgeon at The Craniospinal Center of Los Angeles: The steep curve is usually the rate limiting step to adopting new techniques. Many surgeons who played video games have a distinct advantage over those that did not. That being said, the manual dexterity needed can be significant. Practicing with your rep on new techniques either at a lab, a lunch, a meeting, or a dedicated site visit is best. Try to see the steps that will be hard or unnatural for you. The other thing I like to do is play through the scenario in my head in the order of operations. YouTube and VuMedi are great sights for playing through the steps that you will need to address. For infrequent surgeries, this is a great way to bone up and refresh.
Richard Guyer, MD, and Alexander Satin, MD. Texas Back Institute (Plano): New technology has advanced to the point that we can now train surgeons similarly to how the airlines train pilots on new planes with simulators before they actually fly with passengers. We should be no different in training young residents, fellows and surgeons on new techniques. We are constantly seeking new ways to better (and more safely) treat our patients. At the same time, many new techniques are associated with steep learning curves. These new procedures can be safely introduced, but the learning curve comes with significant time and stress costs. This can be challenging for a busy surgeon. Cadaveric training has been the gold standard for surgical training. However, it has limitations such as high costs, need for a wet lab, advanced scheduling requirements, variability in tissue quality, and lack of surgical pathology. Advances in engineering have led to the development of high fidelity synthetic simulators. These simulators replicate the bone, adjacent soft tissues and neurovascular structures. Furthermore, some include surgical pathology (stenosis, spondylolisthesis, disc herniations, etc.), bleeding, and can simulate an incidental durotomy. In the past, we had a cadaveric wet lab at TBI. For the aforementioned reasons we closed it and are currently building a synthetic simulation lab. The primary goal is to give our fellows constant access and supplement their high volume fellowship experience. This will address some of the inherent limitations of modern surgical training. Our surgeons will also have access and can get additional repetitions with new techniques prior to introducing them into their practices.
Arun Hariharan, MD. Play Orthopedic Institute (West Palm Beach, Fla.): Addressing the learning curve with new surgical techniques requires a proactive approach. Surgeons need to commit to continuous education, staying current by attending courses and workshops where emerging techniques are demonstrated. Before implementing these methods in live surgeries, it’s important to practice using cadaver labs or simulators, which offer a safe environment to refine skills and minimize risks.
Mentorship also plays a key role in overcoming the learning curve. Working with experienced surgeons who have mastered the technique can provide invaluable guidance. Early cases can also benefit from proctorship, where a seasoned expert offers real-time feedback and support.
A gradual approach can be quite helpful — starting with simpler cases and progressively tackling more complex ones ensures a smoother transition to the new method. Additionally, collecting data and reviewing outcomes from these cases helps improve overall results.
By focusing on education, practice, mentorship and collaboration, spine surgeons can adopt new techniques effectively while maintaining patient safety.
Jeffrey Kachmann, MD. Spine surgeon in Frisco, Texas: Every new method is accompanied by a learning curve, some steep, but most just needing some time, patience, and practice. A surgeon must never be in a big hurry when performing a new technique to assure the absolute safety of the patient.
Jason Liauw, MD. Hoag Orthopedic Institute (Laguna Hills, Calif.): The "practice of medicine" is a double-edged sword. While the phrase is a nod to the fact that surgeons are human, and we don't know what we don't know, it's also an acknowledgment of the reality that we are always training through our careers. To learn new techniques, surgeons currently use surgical skills labs with cadaveric specimens, mannequins, or virtual reality training methods. Surgeons can also take advantage of collective wisdom by attending regular spine conferences with colleagues to learn nuances of techniques and indications for newer spine techniques.
John Peloza, MD. St Louis Spine and Orthopedic: 1. Understand the new techniques and why they can improve outcomes or patient experience. You should understand the purpose of your change and the investment in time, costs, and staff that it will incur.
2. Understand the biology, metallurgy, design, etc. of the new tech. First, go to a course and meet the experienced surgeons, practice the surgery and get familiar with the tools. Then practice the surgery in a lab that reproduces actual surgery with your team if possible proctored by an experienced surgeon and industry personnel. Continue to practice on cadavers or high end surgical models until you achieve competence before you perform surgery on a patient. Start with easier cases before you increase complexity. If possible, visit a leader in tech and spend time (weeks if possible) to learn the nuances that meetings or courses do not address.
Timur Urakov, MD. University of Miami (Fla.): There is always a learning curve. Whether it is endoscopy, lateral approach, or large deformity surgery there will be a number of cases that a surgeon needs to get through before becoming comfortable with it. Number one consideration when adding a new technique to the armamentarium is how it may hurt your patients. Anticipate all possible complications and work on preventative strategies. It may involve more hands-on practice in a lab, allowing yourself extra time in the OR, or inviting a mentor for the first few cases. Being open to learning new techniques is essential for the development and growth of spine surgery as a field and patient safety should always take highest priority.