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Parab SR, Khan MM, Memon RA, Ingale MH, Shinde V. Modified Circular Knife in Two-Handed Endoscopic Ear Surgery: A Technical Note. Indian J Otolaryngol Head Neck Surg 2024; 76:3726-3729. [PMID: 39130331 PMCID: PMC11306827 DOI: 10.1007/s12070-024-04725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/18/2024] [Indexed: 08/13/2024] Open
Abstract
With the introduction of endoscope to middle ear surgery, certain modifications are required in the middle ear instruments to reach the nook and corners of the middle ear without compromising vision and leading to cross-over of instruments. In this manuscript we describe and discuss the modified circular knife and enumerate its advantages and applications during two handed endoscopic ear surgery.
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Affiliation(s)
- Sapna Ramkrishna Parab
- Sushrut ENT Hospital and Dr. Khan?s Research Center, Talegaon Dabhade, India
- Department of ENT, Dr D Y Patil Medical college, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune India
| | - Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan?s Research Center, Talegaon Dabhade, India
- Department of ENT, Dr D Y Patil Medical college, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune India
- Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Rizwan Abduljabbar Memon
- Care ENT Hospital, UL 9 Century Apartments. Besides municipal water tank, behind juhapura bus stand, juhapura cross road, Ahmedabad, 380055 India
| | - Mayur H Ingale
- Department of ENT, Dr D Y Patil Medical college, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune India
| | - Vinod Shinde
- Department of ENT, Dr D Y Patil Medical college, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune India
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Khan MM, Parab SR. Feasibility and Applicability of Portable Goose Neck System as a Third Arm for Holding Endoscope in Two Handed Endoscopic ENT Surgeries. Indian J Otolaryngol Head Neck Surg 2023; 75:1490-1501. [PMID: 37636703 PMCID: PMC10447698 DOI: 10.1007/s12070-023-03604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Endoscopes have revolutionised and have added a new dimension to the surgical domain. Many surgical techniques have reformed from the open surgical approach to a minimal access endoscopic one. In otolaryngology too, the indications and the use of endoscopes have been increasing in the last few decades. Even in otology, slowly and steadily Wulstein's microscopic techniques have been changing to endoscopic techniques. The only disadvantage of endoscopic ear surgery is that it is a single handed technique as the non dominant hand is utilised in holding the endoscope. We have developed portable endoscope holder based on the Goose neck system with rack and pinion mechanism. The goose neck system acts as a third arm to hold the endoscope. The novel portable endoscope holder bears the potential to provide benefits for various endoscopic ear nose and throat surgeries. We present our experience of feasibility and applicability of this endoscope holder. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03604-9.
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Affiliation(s)
- Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s Research Center, Talegaon Dabhade, India
- Dept of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore and Manipal Academy of Higher Education , Manipal, India
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Khan MM, Parab SR. A Perfect Bent Flag Knife- Significance and Relevance During Two Handed Endoscopic Ear Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:514-517. [PMID: 37206724 PMCID: PMC10188716 DOI: 10.1007/s12070-023-03603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
The micro-ear instruments are designed to work with the operating oto-microscope where the principle of working depends on the magnification and the focal length of the objective lens. During the endoscopic ear surgery, the length of instrument interferes with the length of the endoscope making the working under the lens difficult. Hence certain modifications are required in the existing micro ear instruments so as to be used in endoscopic ear surgery to reach the nooks and corners of the middle ear. In this manuscript, we describe the angle rendered to the flag knife.
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Affiliation(s)
- Mubarak Muhamed Khan
- Adjunct faculty, Dept of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Manipal, India
- Sushrut ENT Hospital and Dr. Khan’s Research Center, Talegaon Dabhade, India
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Khan MM, Parab SR, Rana AK, Kumar S. Portable Gas Spring with Rachet and Pinion System as a Third Arm for Holding Endoscope in Two Handed Endoscopic ENT Surgery. Indian J Otolaryngol Head Neck Surg 2023; 75:73-78. [PMID: 37206714 PMCID: PMC10188770 DOI: 10.1007/s12070-022-03246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
The role of endoscope has been changing from that being an adjuvant during microear surgery to the exclusive endoscopic middle ear surgery. However the only disadvantage of endoscopic ear surgery is its single handed technique as the non-dominant hand is used to hold the endoscope. We propose the concept and design of our portable endoscope holder for two handed endoscopic ear surgery. It is based on the gas spring action and rack and pinion system which act as a third arm to hold the endoscope. The novel portable endoscope holder bears the potential to provide benefits for various two handed endoscopic ear nose and throat surgeries. Level of evidence: Level V. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03246-3.
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Affiliation(s)
- Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s Research Center, Talegaon Dabhade, India
- Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | | | - Amit Kumar Rana
- Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, India
| | - Shivesh Kumar
- ENT Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh India
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Khan MM, Parab SR. Does the angle of the intsruments matter during two handed endoscopic ear surgery? Indian J Otolaryngol Head Neck Surg 2023; 75:465-469. [PMID: 37206816 PMCID: PMC10188678 DOI: 10.1007/s12070-023-03563-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
The micro-ear instruments are designed to work with the operating oto-microscope where the principle of working depends on the magnification and the focal length of the objective lens. The focal length of the microscope allows a greater working distance for manipulation of the instruments. During the endoscopic ear surgery, the length of instrument interferes with the length of the endoscope making the working under the lens difficult. Hence reaching to the corners of the middle ear becomes impossible with the straight micro-ear instruments during endoscopic ear surgery. Hence certain modifications are required in the existing micro ear instruments so as to be used in endoscopic ear surgery.
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Affiliation(s)
- Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s Research Center, Talegaon Dabhade, India
- Department of Otolaryngology and Head and Neck Surgery, Kasturba Medical College, Mangalore, India
- Manipal Academy of Higher Education, Manipal, India
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Rana AK, Kumar S, Kumar A, Khan MM, Parab SR, Upadhyay D. Comparative Evaluation of Hearing in Cartilage Umbrella, Boomerang and Torp in Chronic Otitis Media Cases with Absent Stapes Suprastructure: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:4069-4076. [PMID: 36742804 PMCID: PMC9895258 DOI: 10.1007/s12070-021-02819-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/29/2021] [Indexed: 02/07/2023] Open
Abstract
Ossicular discontinuity is one of the most common causes of conductive hearing loss. Ossicular chain reconstruction improves conductive hearing loss. With no additional cost, cartilage ossiculoplasty is easy to perform, and also the cartilage is well tolerated being an autograft. In this study we compared the audiological outcome in ossiculoplasty done by cartilage umbrella, cartilage boomerang and alloplastic TORP. 75 patients of age group 10-50 years clinically diagnosed with chronic otitis media with conductive hearing loss and an air bone gap (ABG) of at least 20 dB posted for surgery were included. Ossiculoplasty was done in three groups with autologous cartilage boomerang, cartilage umbrella and alloplastic TORP. In mucosal disease hearing gain was better in umbrella technique (17.66 ± 1.1) dB than Boomerang (16.9 ± 0.8) dB and TORP (10.68 ± 0.9) dB. ABG closure was higher in Boomerang and TORP. Hearing improvement in patients with squamosal disease managed by canal wall up surgery was 25.01 ± 1.1 dB, 27.73 ± 3.1 dB and 20.12 ± 1.8 dB in Boomerang, Umbrella and TORP group respectively showing that umbrella method gave maximum improvement. ABG closure was better in TORP group. In canal wall down surgery patient's maximum improvement was seen in Boomerang (29.51 ± 0.9) dB followed by Umbrella (26.67 ± 1.2) dB and TORP (25.27 ± 0.8) dB group. ABG closure was higher in Boomerang group. Cartilage ossiculoplasty is a reliable and effective method of ossicular chain reconstruction for both mucosal and squamosal disease. Cartilage ossiculoplasty has the added advantage of reduced chances of prosthesis extrusion as compared to TORP.
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Affiliation(s)
- Amit Kumar Rana
- Department of Otorhinolaryngology and Head Neck Surgery, SRMS Institute of Medical Sciences, Bareilly, India
| | - Shivesh Kumar
- Department of ENT, Career Institute of Medical Sciences and Hospital, Lucknow, India
| | - Amit Kumar
- Department of ENT, BPS Government Medical College, Khanpur, Sonipat India
| | - Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Centre, Talegaon DabhadeTalegaon, Pune, India
| | - Sapna Ramakrishna Parab
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Centre, Talegaon DabhadeTalegaon, Pune, India
| | - Deepak Upadhyay
- Department of Community Medicine, Rohilkhand Medical College and Hospital, Bareilly, India
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Khan MM, Parab SR. Feasibility of Sheep Auricular Cartilage as a Teaching Tool for Training in Slicing Techniques for Cartilage Tympanoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:4366-4371. [PMID: 36742864 PMCID: PMC9895347 DOI: 10.1007/s12070-021-03017-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/28/2021] [Indexed: 02/07/2023] Open
Abstract
There are temporal bone dissection workshops organised all-over the world, however, there is no dedicated teaching program to train in slicing techniques for cartilage tympanoplasty. The aim of the study is to train the otologists in slicing techniques in cartilage tympanoplasty using sheep auricular cartilage as a teaching model and to evaluate the impact of the training on the participants. A total of 98 otologists have been trained in slicing techniques using cartilage slicer during 7 workshops organised at our centre from January 2016 to January 2020 for a total of 6 days for each trainee. Each trainee performed slicing techniques in cartilage tympanoplasty using 5 sheep pinna. Evaluation of the impact of the training was done in terms of assessment of improvement in performance. The feedback forms evaluated the training technique with sheep cartilage, its feasibility and usability as a model for teaching. The impact of the training on the overall performance of the trainee was assessed in terms of confidence, ability and speed in performing tasks related to slicing and cartilage tympanoplasty. The simulation in slicing techniques using sheep auricular cartilage has a teaching potential to improve the surgical outcomes of tympanoplasty as assessed by the performance of the participants. Level of evidence: 4.
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Affiliation(s)
- Mubarak Muhamed Khan
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, Pune, Maharashtra India
| | - Sapna Ramkrishna Parab
- Sushrut ENT Hospital and Dr. Khan’s ENT Research Center, Talegaon Dabhade, Pune, Maharashtra India
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Parab SR, Khan MM, Rana AK. Novel Drill-burr Protection Sheath with Inbuilt Suction-irrigation for Endoscopic Ear Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:4286-4289. [PMID: 36742532 PMCID: PMC9895756 DOI: 10.1007/s12070-021-02944-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Abstract We have developed a novel instrument which is a drill burr protection sheath with an inbuilt suction-irrigation system for endoscopic ear surgery. It allows simultaneous suction and irrigation. It is a metallic attachment onto the mastoid drill handpiece. It provides protection for the endoscope as well as the external auditory skin during transcanal drilling procedures. It is cost effective. Level of evidence 5. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-021-02944-8.
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Affiliation(s)
| | - Mubarak Muhamed Khan
- Sushrut ENT Hospital, Dr. Khan’s ENT Research Center, Talegaon Dabhade, Pune, India
| | - Amit Kumar Rana
- Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, India
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