Surgical Instrument Force Exerted during Endoscopic Sinus Surgery: Differences within the Ethmoid Sinus Complex

Ross, Peter; Joice, Paul; Nassif, Ramez; White, Paul S.

doi:10.2500/ajra.2010.24.3374

Cited by 10 publications

(12 citation statements)

References 12 publications

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“…The study design used an endoscope to apply and measure mean osteotomy forces. The study results estimated mean osteotomy forces for the bulla ethmoidalis of 8.1 N. These forces are greater than those found in our previous cadaver study, 4 (6.64 N) but they were less that those recorded in the current live patient study (9.49 N) and would support the view that live tissue requires greater osteotomy force than cadaver tissue. The cause of the weaker bone found in the cadaver material is not clear.…”

Section: Discussionsupporting

confidence: 44%

“…The previous cadaver-based study 4 used a modified set of Blakesley forceps to measure axial forces. A detailed description of the design of the modified Blakesley forceps and the method of data collection have been published.…”

Section: Methodsmentioning

confidence: 99%

“…4 However, the validity of extrapolating cadaver-based data to living tissue has not been previously established.…”

mentioning

confidence: 99%

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Measurement of Osteotomy Force during Endoscopic Sinus Surgery

Joice

Ross

Wang

et al. 2012

Allergy�Rhinol (Providence)

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Greater understanding of the surgeon's task and skills are required to improve surgical technique and the effectiveness of training. Currently, neither the objective measurement of osteotomy forces during endoscopic sinus surgery (ESS) nor the validity of the properties of cadaver materials, are well documented. Measurement was performed of peak axial osteotomy force during ESS. A comparison was made of results with previously published cadaver data to validate the force properties of cadaver models. A prospective, consecutive cohort of 25 patients was compared with data from 15 cadaver heads. A modified Storz sinus curette measured osteotomy force from uncinate, bulla ethmoidalis, and ground lamella. Independent variables were osteotomy site, age, gender, indication for surgery, and side. Corresponding cadaver data were analyzed for the independent variables of osteotomy site, side, and gender and then compared with the live patient data. Mean osteotomy force in live patients was 9.6 N (95% CI, 8.9–10.4 N). Mean osteotomy force in the cadaver heads was 6.4 N (95% CI, 5.7–7.0 N). Ethmoid osteotomy of live patients required 3.2 N (95% CI, 2.1–4.3 N) more force than the cadaver heads (p = 0.0001). This relationship was statistically significant at the bulla ethmoidalis (p = 0.002) and the ground lamella (p = 0.0001) but not at the uncinate (p = 0.068). Osteotomy in female live subjects required 1.6 N (95% CI, 0.1–3.1 N) more force than male live subjects (p = 0.03). Cadaver tissue may underestimate the mean osteotomy force required in osteotomy of living ethmoid sinus lamellae by a factor of 1.5 times. Caution may be required in extrapolating force estimates from cadaver tissue to those required in living patients.

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Section: Discussionsupporting

confidence: 44%

Section: Methodsmentioning

confidence: 99%

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Measurement of Osteotomy Force during Endoscopic Sinus Surgery

Joice

Ross

Wang

et al. 2012

Allergy�Rhinol (Providence)

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“…10 This underscores the need for appropriate understanding of the orbital and ethmoid skull-base relationship during surgery. A modern tenet of safe endoscopic sinus surgery is the principle of early identification of key landmarks, such as the lamina papyracea and skull base.…”

Section: Discussionmentioning

confidence: 95%

Ethmoid skull‐base height: a clinically relevant method of evaluation

Ramakrishnan

Suh

Kennedy

2011

Int Forum Allergy Rhinol

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“…We have experience in force measurement in surgery, and have developed systems which measure the required instrument forces to undertake endoscopic sinus surgery, as well as otological procedures [19][20][21][22]. The current version of DEPOST does not have this facility but including it would increase its relevance as a tool.…”

Section: Measurement Limitationsmentioning

confidence: 97%

Computer-assessed performance of psychomotor skills in endoscopic otolaryngology surgery: construct validity of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST)

et al. 2014

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Increasing experience led to significantly improved performance with the DEPOST (p < 0.01). Senior trainees' results were significantly better than those of consultant otolaryngologists in success rate and time (p < 0.05 & p < 0.05). Consultants were the most efficient in their movement (p = 0.051) CONCLUSIONS: The system provides an accurate and customisable assessment of endoscopic skill in otolaryngologists. The DEPOST system has construct validity, with master surgeons and senior trainees completing the tasks more accurately without sacrificing execution time, success rate or efficiency of movement.

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Surgical Instrument Force Exerted during Endoscopic Sinus Surgery: Differences within the Ethmoid Sinus Complex

Cited by 10 publications

References 12 publications

Measurement of Osteotomy Force during Endoscopic Sinus Surgery

Measurement of Osteotomy Force during Endoscopic Sinus Surgery

Ethmoid skull‐base height: a clinically relevant method of evaluation

Computer-assessed performance of psychomotor skills in endoscopic otolaryngology surgery: construct validity of the Dundee Endoscopic Psychomotor Otolaryngology Surgery Trainer (DEPOST)

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