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Abstract
BackgroundEndoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows. Due to the wide-angled views offered, the approach significantly differs from the established microscopic technique. This randomized study compares the acquisition of basic ear-surgery skills using the endoscopic and microscopic technique under standardized conditions. We aim to investigate the required surgical times, attempts and accidental damages to surrounding structures (errors) in surgeons with different training levels.MethodsFinal-year medical students (n = 9), residents (n = 14) and consultants (n = 10) from the Department of Otorhinolaryngology, Head and Neck Surgery at the University Hospital of Bern, Switzerland were enrolled in the present study. After randomization every participant had to complete a standard set of grasping and dissecting surgical tasks in a temporal bone model. After the first session the participants were crossed over to the other technique.ResultsTime required for completion of the surgical tasks was similar for both techniques, but highly dependent on the training status. A significant increase in the number of damages to the ossicular chain was observed with the microscopic as compared to the endoscopic technique (p < 0.001). Moreover, students beginning with the endoscopic technique showed an overall significantly lower amount of time to complete the tasks (p = 0.04). From the subjective feedback a preference towards the endoscopic technique mainly in medical students was observed.ConclusionsThe endoscopic approach is useful and beneficial for teaching basic surgical skills, mainly by providing a reduction of damage to surrounding tissues with similar operating times for both techniques. Moreover, medical students performed significantly faster, when first taught in the endoscopic technique. Especially for young surgeons without previous training in ear surgery, the endoscope should be considered to improve surgical skills in the middle ear.
Highlights
Endoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows
The clinical efficacy of the endoscopic technique compared to the standard microscopic technique has previously been shown in various fields of middle ear surgery like type I tympanoplasties [4], cholesteatoma [5] and stapes surgery, especially in stapesmalformation cases [6]
We aim to investigate the required surgical times, attempts and accidental damages to surrounding structures in surgeons with different training levels
Summary
Endoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows. Due to the wide-angled views offered, the approach significantly differs from the established microscopic technique. This randomized study compares the acquisition of basic ear-surgery skills using the endoscopic and microscopic technique under standardized conditions. Angled scopes reach hidden areas of the middle ear such as the retro- and hypotympanum [1,2,3] These technical refinements allow the surgeon to treat middle-ear pathologies adopting a minimally invasive transcanal approach without skin incision or removal of bone for access purposes. The most important differences regarding the acquisition of surgical skills compared to the microscopic approach are probably the one-handed surgical technique and the two-dimensional view. The surgical learning curve is deemed to be flatter, requiring more training to achieve a certain level compared to the microscopic technique
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