Prospective Study of Resident-Performed Stapedectomy

Cirurgia do estapédio na residência: experiência do Hospital de Clínicas/UFPR

“…We had complications in 11.4% of all the surgeries performed, however with not one case of facial paralysis, perilymphatic fistula or profound sensorineural hearing loss. These data are similar to the ones found in many studies published in the literature 18,10,5 .…”

“…Experienced and properly trained surgeons reach success rates of 90% or more 6,15 . However, recent publications have shown that surgical success carried out in teaching institutions by resident physicians have reduced and the audiologic results have been worse when compared to those from experienced ear surgeons (Table 5) [5][6][7][8]15 . The possible cause for this would be a reduction in the number of patients who required stapes surgery, and thus, as it happens with any surgical procedure, the greater the number of surgeries performed, the greater the training and thus the success rate.…”

“…As to the surgical intervention, the type of anesthesia is an important factor and can depend on the surgeon's preference. Most studies found in the literature 5,6 show that there is no difference in relation to the type of anesthesia used in stapes surgery; however, they advocate the use of general anesthesia in medical residency programs, because it facilitates the performance of this surgery by physicians in training, facilitating the communication with the professor and reducing concerns regarding surgery duration. Burns and Lambert 15 described that local anesthesia and sedation is more advantageous because it reduces the theoretical risk of prosthesis shifting during the time when the patient has the orotracheal tube removed, reduces the episodes of nausea and vomit in the postoperative period and allows the patient to tell the physician about his hearing at the end of the procedure, thus providing the surgeon with facts to discuss surgical results.…”

“…Another important factor is related to the technique employed, especially when complications happen. Backous et al 5 , Burns and Lambert 15 and Lesinski 22 described in their papers a stapedectomy in most of these cases, stressing the fact that it can maximize the performance of resident physicians and, consequently, increase the success rate associated with the procedure. Mathews et al 10 and De Bruijn et al 14 reported that they performed stapedotomies in almost all their cases, showing a very low likelihood of prosthesis migration, which corresponds to the most common cause for failure.…”

“…This can be explained by the technological progress in the area of otology, especially in diagnosis and treatment, when we consider the number of otorhinolaryngologists trained to carry out this procedure, and by the current use of fluorine in the water 4,5 . Recent publications have shown that the surgical success in stapes surgery carried out by resident physicians has dropped and the audiologic results have been worse than those obtained by experienced ear surgeons [5][6][7][8]15 .…”