Teaching Middle Ear Anatomy and Basic Ear Surgery Skills: A Qualitative Study Comparing Endoscopic and Microscopic Techniques

Abstract

Objective Endoscopic ear surgery is gaining popularity as a minimally invasive surgical technique for middle ear diseases. Its ongoing implementation into clinical routine has consequences regarding teaching of middle ear anatomy and surgery. To improve undergraduate and postgraduate training, we investigated the perception of and preference for endoscopy as compared with microscopy at different educational levels. Study Design Qualitative study based on a thematic analysis approach. Setting Tertiary academic medical center. Methods After a standardized curriculum was run on endoscopic and microscopic anatomy and surgical skills education, 5 focus groups were held. The interviews were conducted, video recorded, transcribed, and analyzed. Analysis of the data gave rise to 11 themes showing the participants’ perceptions and preferences. Results Five medical students, 11 otorhinolaryngology residents, and 3 staff members participated in this qualitative study. For anatomy teaching, there was a clear preference for the endoscopic technique. The main advantages were the enhanced overview and perception of the anatomic details provided through endoscopy. For skills acquisition, the perceived advantages of the techniques were the same view of the surgical field for endoscopy and the 2-handed surgical technique for microscopy. However, there was no clear preference between the techniques for skills acquisition. Conclusion The endoscopic technique was generally judged more beneficial for teaching anatomy, especially due to the greater visualization of the complex middle ear anatomy. Given that both techniques will remain important to future surgeons, the relative unique benefits of each must be considered when designing and optimizing curricula for otologic education.

Microscopic versus endoscopic stapes surgery: systematic review and meta-analysis

“…31 Moreover, the improved visualisation of the surgical field provided by the endoscope enables less bony auditory canal drilling, and, consequently, limited manipulation or injury of the chorda tympani, leading to better rates regarding postoperative dysgeusia. 32 This is in compliance with the outcomes of recent meta-analyses, as their results are relevant to those of the current study. [29][30][31] Furthermore, less or no scutum curetting, alongside minimal incisions, offers the advantage of minimal post-operative pain.…”

“…15 However, as the microscopic technique is of great importance and cannot be entirely substituted, ENT trainees should be enrolled in augmented learning curricula, combining microscopic and endoscopic ear surgery teaching, allowing optimal performance in otological surgery. 32…”

“…With the endoscopic technique, both the surgeon and their assistants have an unimpeded view of the surgical field and the procedure through the uniformly used monitor, resulting in better education for the observers of the operation. 32,33 Nevertheless, like any other newly introduced technology, this innovative approach has a learning curve for every surgeon not acquainted with endoscopic otology. 16,[18][19][20]23,34 In line with this view, Iannella and Magliulo reported that operative duration seemed to decrease with greater experience.…”

“…15 The Journal of Laryngology & Otology However, as the microscopic technique is of great importance and cannot be entirely substituted, ENT trainees should be enrolled in augmented learning curricula, combining microscopic and endoscopic ear surgery teaching, allowing optimal performance in otological surgery. 32 As health professionals aim to achieve the highest possible satisfaction and comfort with their services, endoscopic stapes procedures undoubtedly belong in the everyday clinical practice of otological surgery. Given its proven predominance so far in terms of two-dimensional vision, cosmetic result, post-operative pain and safety, combined with a comparable success rate, endoscopic surgery seems to be the frontrunner, and may replace microscopes in most common otological cases in the near future.…”

Video Learning of Surgical Procedures: A Randomized Comparison of Microscopic, 2- and 3-Dimensional Endoscopic Ear Surgery Techniques

“…This is most probably due to their larger display and comprehensible visualization of the middle ear anatomy. They provide a better overview to participants, which reduces the cognitive load and improves the learning effect (27). In a laparoscopic study, Sakata et al (28) reported that 3D video imaging significantly reduces mental workload in comparison with a 2D system.…”