Simulated Cadaveric Practice of Curved Instruments and Angled Endoscopy was Essential for EES Training Program

By June 10, 2019

David Chang-Wei Huang1
1 Department of Otolaryngology – Head and Neck Surgery, Kuang-Tien General Hospital, Taiwan.

Middle ear eas a small space for operation. There are two critical organ of stapes and facial canal in it. Furthermore, it was not intuitive to use curved instrument and angled endoscopy at the same time. For young sinus surgeon, you may begin to practice curved power instrument and angled endoscopy in maxillary sinus on real patients owing to its safe and adequate space. But for the beginner of ear surgeon, it was very dangerous to practice it on real patients.

-Study design: Cadaveric study
-Setting: Temporal bone laboratory
-Patients: 9 Temporal bone specimens
-Intervention: We arranged a consecutive 3-weekend temporal bone cadaveric practice program. Three degree ear surgeons were enrolled including 2nd-year resident, 5th-year resident(chief resident), and 7th-year attending physician. The Spiggle and Theis curved instrument and Karl Storz 30/45-degree endoscopy were applied to cadaveric practice on simulated cholesteatoma condition, especially to inspect and manage at sinus tympani, sinus epitympanum, antrum, and stapes.

-Main outcome measure: We applied Likert scale to evaluate practice outcome for 3-degree doctors and 4 anatomy landmarks.
-Results: The point of Likert scale for before practice, after 1st week practice, after 2nd week practice, and after 3rd week practice were 1,2.25,3.5,4.5 for 2nd-year resident, and 1.5,3,4,4.75 for 5th-year resident, and 3,4,4.5,5 for 7th-year attending physician. The most difficult landmarks for young surgeon are sinus tympani and stapes.
-Conclusion: Simulated cadaveric practice of curved instruments and angled endoscopy was essential for EES training program