Exclusive Endoscopic Laser-Stapedotomy: Feasibility of an Ovine Training Model

Abstract

Objective: Stapedotomy is an effective treatment for conductive hearing loss associated with otosclerosis. However, the procedure, especially using the endoscopic technique requires extensive training and experience for optimal results. Due to limited training options in endoscopic stapes surgery, we aim to develop an ovine stapedotomy model and assess its feasibility for surgeons at different training levels. Methods: A fully endoscopic ovine laser-stapedotomy model was developed and described. During repetitive dissections, surgical time required for the different steps to assess the training curve and associated intraoperative complications were recorded in three surgeons of different training level. Additionally, subjective feedback was assessed. Results: Successful endoscopic laser-stapedotomy was performed in 25 cases in the ovine model. Assessment of surgical time revealed a stable curve for the experienced surgeon (mean 15:01 min) for the whole training with no intraoperative complications. The fellow showed a gradual reduction of surgical time from 27:21 (first five cases) to 24:10 minutes (last five cases) and the resident a reduction from 42:38 to 21:08 minutes respectively. The assessed learning curve for the trainees revealed a significant association between the operative time and observed intraoperative complications. Discussion: In this study, an ex-vivo model for exclusively endoscopic laser-stapedotomy was developed and tested for feasibility. We suggest the ovine model as a cost-effective, easily available, and realistic training model for future otologic surgeons. The surgeons were able to improve their performance with satisfactory results despite the small number of cases.

Use of a Caprine Model for Simulation and Training of Endoscopic Ear surgery

“…While there are some impressive examples within the literature of assessment tools, they are either unvalidated or were developed for use in microscope-guided ear surgery. 5 , 11 , 12 , 18 Development of expert consensus on key steps or a tool such as an objective structured assessment tool would allow for a more objective assessment of the goat head model and offer a means of tracking learner progression through the course of a surgical skills curriculum. 19 A benefit of endoscopic surgery in a simulation or operating room is the ability to easily record video of the procedure for subsequent analysis.…”

“…An ovine (sheep) model has been developed and used in endoscopic ear surgery education as an economically viable way of offering high-fidelity simulation of tissue similar to that of humans. 9 , 10 , 11 , 12 The favorable comparative anatomy has been described in detail. 13 Currently in our center, due to infection control and animal use practices, we are not able to use the ovine model.…”

Sheep’s Head as an Anatomic Model for Basic Training in Endoscopic Sinus Surgery

“…Subjective ratings were high: tissue quality (8.9/10), overall satisfaction (8.3), and learning experience (8.8). Beckmann et al [14] carried out a study in which, using the ovine model, they evaluated the learning curve of laser stapedotomy for trainees, with considerable improvement of operative times once the maneuver is repeated. The experienced surgeon maintained a steady average time of 15:01 min throughout the training without any intraoperative issues.…”

Exploring the Ovine Anatomy: A Comprehensive Study of the Sheep’s Head for Basic Training in Functional Endoscopic Sinus Surgery

“…The comparison of sheep ear anatomy to that of humans served as a basis for conducting various otological surgical procedures like canaloplasty, myringoplasty, and ossiculoplasty [ 10 ]. Another study utilized the ovine model to assess the learning curve of laser stapedotomy in trainees, revealing notable improvements in operative time with repeated practice [ 11 ].…”