Stapedotomy in a residency training program

Lial, Paulo Igor Luz Nunes; Soares, Vítor Yamashiro Rocha; Viana, Lucas Moura; Sampaio, André Luiz Lopes; Oliveira, Carlos Augusto Costa Pires de; Júnior, Fayez Bahmad

doi:10.5935/0946-5448.20130021

The International Tinnitus Journal

2013

DOI: 10.5935/0946-5448.20130021

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Stapedotomy in a residency training program

Paulo Igor Luz Nunes Lial¹,

Vítor Yamashiro Rocha Soares²,

Lucas Moura Viana³

et al.

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Cited by 4 publications

(2 citation statements)

References 14 publications

(33 reference statements)

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“…1,2 Furthermore, despite the high overall rate of positive outcomes, there remains a risk for complications, including total irreversible sensorineural hearing loss. 3,4 As such, stapes surgery is one of the most litigated procedures within neurotology, with successful claims resulting in the second-highest mean payment per claim within the subspecialty at $2,733,000. 5 Complicating matters further is the decreasing volume of these procedures and the limited availability of high-fidelity, low-cost models to adequately facilitate resident/fellow training.…”

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confidence: 99%

“…Surgeons are required to make fine movements under the guide of microscopy, with expected closure of the air‐bone gap to <10 dB among >90% of patients in experienced hands 1,2 . Furthermore, despite the high overall rate of positive outcomes, there remains a risk for complications, including total irreversible sensorineural hearing loss 3,4 . As such, stapes surgery is one of the most litigated procedures within neurotology, with successful claims resulting in the second‐highest mean payment per claim within the subspecialty at $2,733,000 5 .…”

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confidence: 99%

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Applied Force during Piston Prosthesis Placement in a 3D‐Printed Model: Freehand vs Robot‐Assisted Techniques

Razavi

Wilkening

Yin

et al. 2018

Otolaryngol.--head neck surg.

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Objectives To describe a 3D-printed middle ear model that quantifies the force applied to the modeled incus. To compare the forces applied during placement and crimping of a stapes prosthesis between the Robotic ENT Microsurgery System (REMS) and the freehand technique in this model. Study Design Prospective feasibility study. Setting Robotics laboratory. Subjects and Methods A middle ear model was designed and 3D printed to facilitate placement and crimping of a piston prosthesis. The modeled incus was mounted to a 6–degree of freedom force sensor to measure forces/torques applied on the incus. Six participants—1 fellowship-trained neurotologist, 2 neurotology fellows, and 3 otolaryngology–head and neck surgery residents—placed and crimped a piston prosthesis in this model, 3 times freehand and 3 times REMS assisted. Maximum force applied to the incus was then calculated for prosthesis placement and crimping from force/torque sensor readings for each trial. Robotic and freehand outcomes were compared with a linear regression model. Results Mean maximum magnitude of force during prosthesis placement was 126.4 ± 73.6 mN and 105.0 ± 69.4 mN for the freehand and robotic techniques, respectively (P = .404). For prosthesis crimping, the mean maximum magnitude of force was 469.3 ± 225.2 mN for the freehand technique and 272.7 ± 97.4 mN for the robotic technique (P = .049). Conclusions Preliminary data demonstrate that REMS-assisted stapes prosthesis placement and crimping are feasible with a significant reduction in maximum force applied to the incus during crimping with the REMS in comparison with freehand.

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confidence: 99%

mentioning

confidence: 99%

Applied Force during Piston Prosthesis Placement in a 3D‐Printed Model: Freehand vs Robot‐Assisted Techniques

Razavi

Wilkening

Yin

et al. 2018

Otolaryngol.--head neck surg.

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Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching

Nguyen

Mamelle

Seta

et al. 2017

Eur Arch Otorhinolaryngol

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Functional outcomes and complications in otosclerosis surgery are governed by the surgeon's experience. Thus, teaching the procedure to residents to guide them through the learning process as quickly as possible is challenging. Artificial 3D-printed temporal bones are replacing cadaver specimens in many institutions to learn mastoidectomy, but these are not suitable for middle ear surgery training. The goal of this work was to adapt such an artificial temporal bone to aid the teaching of otosclerosis surgery and to evaluate this tool. We have modified a commercially available 3D-printed temporal bone by replacing the incus and stapes of the model with in-house 3D-printed ossicles. The incus could be attached to a 6-axis force sensor. The stapes footplate was fenestrated and attached to a 1-axis force sensor. Six junior surgeons (residents) and seven senior surgeons (fellows or consultants) were enrolled to perform piston prosthesis placement and crimping as performed during otosclerosis surgery. The time required to perform the tasks and the forces applied to the incus and stapes were collected and analyzed. No statistically significant differences were observed between the junior and senior groups for time taken to perform the tasks and the forces applied to the incus during crimping and placement of the prosthesis. However, significantly lower forces were applied to the stapes by the senior surgeons in comparison with the junior surgeons during prosthesis placement (junior vs senior group, 328 ± 202.9 vs 80 ± 99.6 mN, p = 0.008) and during prosthesis crimping (junior vs senior group, 565 ± 233 vs 66 ± 48.6 mN, p = 0.02). We have described a new teaching tool for otosclerosis surgery based on the modification of a 3D-printed temporal bone to implement force sensors on the incus and stapes. This tool could be used as a training tool to help the residents to self-evaluate their progress with recording of objective measurements.

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Potential of Robot-Based Surgery for Otosclerosis Surgery

Nguyen

Bernardeschi

Sterkers

2018

Otolaryngologic Clinics of North America

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Stapedotomy in a residency training program

Cited by 4 publications

References 14 publications

Applied Force during Piston Prosthesis Placement in a 3D‐Printed Model: Freehand vs Robot‐Assisted Techniques

Applied Force during Piston Prosthesis Placement in a 3D‐Printed Model: Freehand vs Robot‐Assisted Techniques

Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching

Potential of Robot-Based Surgery for Otosclerosis Surgery

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