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Iannella G, Pace A, Mucchino A, Greco A, De Virgilio A, Lechien JR, Maniaci A, Cocuzza S, Perrone T, Messineo D, Magliulo G. A new 3D-printed temporal bone: 'the SAPIENS'-specific anatomical printed-3D-model in education and new surgical simulations. Eur Arch Otorhinolaryngol 2024; 281:4617-4626. [PMID: 38683361 PMCID: PMC11393115 DOI: 10.1007/s00405-024-08645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/26/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE Otology and neuro-otology surgeries pose significant challenges due to the intricate and variable anatomy of the temporal bone (TB), requiring extensive training. In the last years 3D-printed temporal bone models for otological dissection are becoming increasingly popular. In this study, we presented a new 3D-printed temporal bone model named 'SAPIENS', tailored for educational and surgical simulation purposes. METHODS The 'SAPIENS' model was a collaborative effort involving a multidisciplinary team, including radiologists, software engineers, ENT specialists, and 3D-printing experts. The development process spanned from June 2022 to October 2023 at the Department of Sense Organs, Sapienza University of Rome. Acquisition of human temporal bone images; temporal bone rendering; 3D-printing; post-printing phase; 3D-printed temporal bone model dissection and validation. RESULTS The 'SAPIENS' 3D-printed temporal bone model demonstrated a high level of anatomical accuracy, resembling the human temporal bone in both middle and inner ear anatomy. The questionnaire-based assessment by five experienced ENT surgeons yielded an average total score of 49.4 ± 1.8 out of 61, indicating a model highly similar to the human TB for both anatomy and dissection. Specific areas of excellence included external contour, sigmoid sinus contour, cortical mastoidectomy simulation, and its utility as a surgical practice simulator. CONCLUSION We have designed and developed a 3D model of the temporal bone that closely resembles the human temporal bone. This model enables the surgical dissection of the middle ear and mastoid with an excellent degree of similarity to the dissection performed on cadaveric temporal bones.
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Affiliation(s)
- Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Annalisa Pace
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy.
| | - Alessandro Mucchino
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Antonio Greco
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Armando De Virgilio
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Jerome R Lechien
- Faculty of Medicine and Pharmacy, University of Mons (UMons), Mons, Belgium
| | | | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Tiziano Perrone
- Department of Otolaryngology, Civil Hospital of Alghero, Alghero, Italy
| | - Daniela Messineo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
| | - Giuseppe Magliulo
- Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185, Rome, Italy
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Jiang Y, Jiang H, Yang Z, Li Y. The current application of 3D printing simulator in surgical training. Front Med (Lausanne) 2024; 11:1443024. [PMID: 39267979 PMCID: PMC11390463 DOI: 10.3389/fmed.2024.1443024] [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: 06/05/2024] [Accepted: 08/05/2024] [Indexed: 09/15/2024] Open
Abstract
In the rapidly evolving field of medical education, the integration of innovative technologies has become paramount to enhance the training and proficiency of future surgeons. Among these advancements, the application of 3D printing technology stands out as a useful tool in surgical training. The advantages of the 3D printing model include customization, re-usability and low-cost. The average cost of the 3D printing simulators was between $100-1000. However, there were extremely high potential labor cost during the 3D printing that hadn't been calculated into. Additionally, in the current stage, the 3D printing simulator still have specific limitations. The most mentioned limitation was poor haptic feedback of the simulators, which was very important during the surgical training, since it is the key element for junior doctors to master practical procedures. Also, some simulators didn't possess the integrated and elaborate structure as the human tissue, hence not the whole surgical procedures can be practiced by the trainees, and further improvement should be made. Although there are shortages, many studies have proved that 3D printing simulator can effectively reduce learning curves and is useful to enhance the trainees' surgical skills.
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Affiliation(s)
- Yang Jiang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hanyu Jiang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Eight-Year Medical Doctor Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhikun Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Vrzáková H, Tapiala J, Iso-Mustajärvi M, Timonen T, Dietz A. Estimating Cognitive Workload Using Task-Related Pupillary Responses in Simulated Drilling in Cochlear Implantation. Laryngoscope 2024. [PMID: 38989899 DOI: 10.1002/lary.31612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Training of temporal bone drilling requires more than mastering technical skills with the drill. Skills such as visual imagery, bimanual dexterity, and stress management need to be mastered along with precise knowledge of anatomy. In otorhinolaryngology, these psychomotor skills underlie performance in the drilling of the temporal bone for access to the inner ear in cochlear implant surgery. However, little is known about how psychomotor skills and workload management impact the practitioners' continuous and overall performance. METHODS To understand how the practitioner's workload and performance unfolds over time, we examine task-evoked pupillary responses (TEPR) of 22 medical students who performed transmastoid-posterior tympanotomy (TMPT) and removal of the bony overhang of the round window niche in a 3D-printed model of the temporal bone. We investigate how students' TEPR metrics (Average Pupil Size [APS], Index of Pupil Activity [IPA], and Low/High Index of Pupillary Activity [LHIPA]) and time spent in drilling phases correspond to the performance in key drilling phases. RESULTS All TEPR measures revealed significant differences between key drilling phases that corresponded to the anticipated workload. Enlarging the facial recess lasted significantly longer than other phases. IPA captured significant increase of workload in thinning of the posterior canal wall, while APS revealed increased workload during the drilling of the bony overhang. CONCLUSION Our findings contribute to the contemporary competency-based medical residency programs where objective and continuous monitoring of participants' progress allows to track progress in expertise acquisition. Laryngoscope, 2024.
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Affiliation(s)
- Hana Vrzáková
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Jesse Tapiala
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
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Ang AJY, Chee SP, Tang JZE, Chan CY, Tan VYJ, Lee JA, Schrepfer T, Ahamed NMN, Tan MB. Developing a production workflow for 3D-printed temporal bone surgical simulators. 3D Print Med 2024; 10:16. [PMID: 38814431 PMCID: PMC11138071 DOI: 10.1186/s41205-024-00218-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION 3D-printed temporal bone models enable the training and rehearsal of complex otological procedures. To date, there has been no consolidation of the literature regarding the developmental process of 3D-printed temporal bone models. A brief review of the current literature shows that many of the key surgical landmarks of the temporal bone are poorly represented in models. This study aims to propose a novel design and production workflow to produce high-fidelity 3D-printed temporal bone models for surgical simulation. METHODS Developmental phases for data extraction, 3D segmentation and Computer Aided Design (CAD), and fabrication are outlined. The design and fabrication considerations for key anatomical regions, such as the mastoid air cells and course of the facial nerve, are expounded on with the associated strategy and design methods employed. To validate the model, radiological measurements were compared and a senior otolaryngologist performed various surgical procedures on the model. RESULTS Measurements between the original scans and scans of the model demonstrate sub-millimetre accuracy of the model. Assessment by the senior otologist found that the model was satisfactory in simulating multiple surgical procedures. CONCLUSION This study offers a systematic method for creating accurate 3D-printed temporal bone models for surgical training. Results show high accuracy and effectiveness in simulating surgical procedures, promising improved training and patient outcomes.
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Affiliation(s)
| | - Shu Ping Chee
- 3D Printing Centre Singapore General Hospital, Singapore, Singapore
| | - Joyce Zhi En Tang
- Department of Otorhinolaryngology- Head & Neck Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ching Yee Chan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Vanessa Yee Jueen Tan
- Department of Otolaryngology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jordan Adele Lee
- Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia
| | - Thomas Schrepfer
- Department of Otolaryngology, University of Florida, Florida, USA
| | | | - Mark Bangwei Tan
- Department of Neuroradiology & 3D Printing Centre Singapore General Hospital, Singapore, Singapore
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Reisman Y, van Renterghem K, Meijer B, Ricapito A, Fode M, Bettocchi C. Development and validation of 3-dimensional simulators for penile prosthesis surgery. J Sex Med 2024; 21:494-499. [PMID: 38477106 DOI: 10.1093/jsxmed/qdae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The acquisition of skills in penile prosthesis surgery has many limitations mainly due to the absence of simulators and models for training. Three-dimensional (3D) printed models can be utilized for surgical simulations, as they provide an opportunity to practice before entering the operating room and provide better understanding of the surgical approach. AIM This study aimed to evaluate and validate a 3D model of human male genitalia for penile prosthesis surgery. METHODS This study included 3 evaluation and validation stages. The first stage involved verification of the 3D prototype model for anatomic landmarks compared with a cadaveric pelvis. The second stage involved validation of the improved model for anatomic accuracy and teaching purposes with the Rochester evaluation score. The third stage comprised validation of the suitability of the 3D prototype model as a surgical simulator and for skill acquisition. The third stage was performed at 3 centers using a modified version of a pre-existing, validated questionnaire and correlated with the Rochester evaluation score. OUTCOME We sought to determine the suitability of 3D model for training in penile prosthesis surgery in comparison with the available cadaveric model. RESULTS The evaluation revealed a high Pearson correlation coefficient (0.86) between questions of the Rochester evaluation score and modified validated questionnaire. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding replication of the relevant human anatomy for the penile prosthesis surgery procedure. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding its ability to improve technical skills, teach and practice the procedure, and assess a surgeon's ability. Furthermore, the experts stated that compared with the cadaver, the 3D model presented greater ethical suitability, reduced costs, and easier accessibility. CLINICAL IMPLICATIONS A validated 3D model is a suitable alternative for penile prosthesis surgery training. STRENGTHS AND LIMITATIONS This is the first validated 3D hydrogel model for penile prosthesis surgery teaching and training that experts consider suitable for skill acquisition. Because specific validated guidelines and questionnaires for the validation and verifications of 3D simulators for penile surgery are not available, a modified questionnaire was used. CONCLUSION The current 3D model for penile prosthesis surgery shows promising results regarding anatomic properties and suitability to train surgeons to perform penile implant surgery. The possibility of having an ethical, easy-to-use model with lower costs and limited consequences for the environment is encouraging for further development of the models.
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Affiliation(s)
- Yacov Reisman
- Flare-Health, Amsterdam, the Netherlands
- Reuth Rehabilitation Hospital, Tel-Aviv 67062, Israel
| | | | - Boaz Meijer
- Department of Urology, Acibadem Medical Center, 1043, HP Amsterdam, the Netherlands
| | - Anna Ricapito
- Andrology and Male Genitalia Reconstructive Surgery Unit, University of Foggia, 71122, Foggia FG, Italy
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, 13DK-2730, Herlev, Denmark
| | - Carlo Bettocchi
- Andrology and Male Genitalia Reconstructive Surgery Unit, University of Foggia, 71122, Foggia FG, Italy
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Lähde S, Hirsi Y, Salmi M, Mäkitie A, Sinkkonen ST. Integration of 3D-printed middle ear models and middle ear prostheses in otosurgical training. BMC MEDICAL EDUCATION 2024; 24:451. [PMID: 38658934 PMCID: PMC11044351 DOI: 10.1186/s12909-024-05436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND In otosurgical training, cadaveric temporal bones are primarily used to provide a realistic tactile experience. However, using cadaveric temporal bones is challenging due to their limited availability, high cost, and potential for infection. Utilizing current three-dimensional (3D) technologies could overcome the limitations associated with cadaveric bones. This study focused on how a 3D-printed middle ear model can be used in otosurgical training. METHODS A cadaveric temporal bone was imaged using microcomputed tomography (micro-CT) to generate a 3D model of the middle ear. The final model was printed from transparent photopolymers using a laser-based 3D printer (vat photopolymerization), yielding a 3D-printed phantom of the external ear canal and middle ear. The feasibility of this phantom for otosurgical training was evaluated through an ossiculoplasty simulation involving ten otosurgeons and ten otolaryngology-head and neck surgery (ORL-HNS) residents. The participants were tasked with drilling, scooping, and placing a 3D-printed partial ossicular replacement prosthesis (PORP). Following the simulation, a questionnaire was used to collect the participants' opinions and feedback. RESULTS A transparent photopolymer was deemed suitable for both the middle ear phantom and PORP. The printing procedure was precise, and the anatomical landmarks were recognizable. Based on the evaluations, the phantom had realistic maneuverability, although the haptic feedback during drilling and scooping received some criticism from ORL-HNS residents. Both otosurgeons and ORL-HNS residents were optimistic about the application of these 3D-printed models as training tools. CONCLUSIONS The 3D-printed middle ear phantom and PORP used in this study can be used for low-threshold training in the future. The integration of 3D-printed models in conventional otosurgical training holds significant promise.
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Affiliation(s)
- Sini Lähde
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Yasmin Hirsi
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- King's College London, London, UK
| | - Mika Salmi
- Department of Mechanical Engineering, Aalto University, Espoo, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
| | - Saku T Sinkkonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center Tauno Palva Laboratory, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Lee JWY, Susanto J, Lai SH, Cheow PC, Low LXT, Bello F. What Faculty and Students Value When Evaluating Human Digital Anatomy Platforms: A Mixed-Methods Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241256043. [PMID: 38765319 PMCID: PMC11102696 DOI: 10.1177/23821205241256043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES There is an increasing availability of digital technologies for teaching and learning of human anatomy. Studies have shown that such applications allow for better spatial awareness than traditional methods. These digital human anatomy platforms offer users myriad features, such as the ability to manipulate 3D models, conduct prosection, investigate anatomical regions through virtual reality, or perform knowledge tests on themselves. This study examined what faculty members' value when using digital human anatomy platforms for teaching and what students value when using these platforms for learning. METHODS Six anatomy faculty members and 21 students were selected to participate in this study. After using the three digital anatomy platforms for at least 1 week, a survey was conducted to record their feedback in 4 categories: usability, interactive features, level of detail, and learning support. Respondents' Qualitative feedback within each category was also analyzed to strengthen the study's findings. RESULTS The study's findings showed that faculty members and students have different priorities when evaluating digital anatomy platforms. Faculty members valued platforms that provided better accuracy and detailed anatomical structures, while students prioritized usability above the rest of the features. CONCLUSION Given that faculty and students have different preferences when selecting digital anatomy platforms, this article proposed that educators maximize the specific affordances offered by the technology by having a clear pedagogy and strategy on how the technology will be incorporated into the curriculum to help students achieve the desired learning outcomes.
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Affiliation(s)
- Jason Wen Yau Lee
- Technology Enhanced Learning and Innovation, Duke-NUS Medical School, Singapore, Singapore
| | - Johan Susanto
- Technology Enhanced Learning and Innovation, Duke-NUS Medical School, Singapore, Singapore
| | - Siang Hui Lai
- Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Peng Chung Cheow
- Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Division of Surgery & Oncology, National Cancer Centre Singapore, Singapore
| | - Li Xiang Tessa Low
- Department of Psychology, Faculty of Arts & Social Sciences, National University of Singapore, Singapore, Singapore
| | - Fernando Bello
- Technology Enhanced Learning and Innovation, Duke-NUS Medical School, Singapore, Singapore
- Surgical Computing and Simulation Science, Imperial College London, London, UK
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de Souza MA, Bento RF, Lopes PT. A three-dimensionally printed otological model for cholesteatoma mastoidectomy training. Eur Arch Otorhinolaryngol 2023; 280:671-680. [PMID: 35789285 DOI: 10.1007/s00405-022-07536-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: 03/04/2022] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To relate the creation and expert validation (face and content validity) of an affordable three-dimensional (3-D) printed model of temporal bones with chronic otitis media with cholesteatoma (COMC) as a simulator for mastoidectomy. METHODS We performed computed tomography (CT) of the temporal bones of a patient with COMC followed at the University of São Paulo (USP) Hospital with 3-D Slicer to create a 3-D model of the affected bone using light-curing resin and silicone (cholesteatoma). The final 3-D printed images were scored by 10 otologists using a customized version of the Michigan Standard Simulation Scale Experience (MiSSES). Internal consistency and inter-rater reliability were assessed using Cronbach's α and intraclass correlations. RESULTS Otologists consistently scored the model positively for fidelity, educational value, reactions, and the overall model quality. Nine otologists agreed that the model was a good educational device for surgical training of COMC. All experts deemed the model ready-or nearly ready-for use. The final cost of the model, including raw materials and manufacturing, was 120 USD. CONCLUSIONS Using 3-D printing technology, we created the first anatomically accurate, low-cost, disease-reproducing 3-D model of temporal bones for mastoidectomy training for cholesteatoma.
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Affiliation(s)
- Marcos Antonio de Souza
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil.
| | - Ricardo Ferreira Bento
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
| | - Paula Tardim Lopes
- Otolaryngology Department, University of São Paulo School of Medicine, Av Dr. Eneas de Carvalho Aguir 255 6º, Andar sala 6167, São Paulo, 05403-000, Brazil
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Suzuki M, Miyaji K, Matoba K, Abe T, Nakamaru Y, Watanabe R, Suzuki T, Nakazono A, Konno A, Hinder D, Psaltis AJ, Wormald PJ, Homma A. Mental workload during endoscopic sinus surgery is associated with surgeons' skill levels. Front Med (Lausanne) 2023; 10:1090743. [PMID: 37168266 PMCID: PMC10165102 DOI: 10.3389/fmed.2023.1090743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/04/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction Surgeons' mental workload during endoscopic sinus surgery (ESS) has not been fully evaluated. The assessment was challenging due to the great diversity of each patient's anatomy and the consequence variety of surgical difficulties. In this study, we examined the mental workload of surgeons with various surgical skill levels during ESS under the standardized condition provided by novel-designed 3D sinus models. Materials and methods Forty-seven participants performed a high-fidelity ESS simulation with 3D-printed sinus models. Surgeons' mental workload was assessed with the national aeronautics and space administration-task load index (NASA-TLX). Associations between the total and subscales score of NASA-TLX and surgical skill index, including the board certification status, the number of experienced ESS cases, and the objective structured assessment of technical skills (OSATS), were analyzed. In addition, 10 registrars repeated the simulation surgery, and their NASA-TLX score was compared before and after the repetitive training. Results The total NASA-TLX score was significantly associated with OSATS score (p = 0.0001). Primary component analysis classified the surgeons' mental burden into three different categories: (1) the skill-level-dependent factors (temporal demand, effort, and performance), (2) the skill-level-independent factors (mental and physical demand), and (3) frustration. After the repetitive training, the skill-level-dependent factors were alleviated (temporal demand; z = -2.3664, p = 0.0091, effort; z = -2.1704, p = 0.0346, and performance; z = -2.5992, p = 0.0017), the independent factors were increased (mental demand; z = -2.5992, p = 0.0023 and physical demand; z = -2.2509, p = 0.0213), and frustration did not change (p = 0.3625). Conclusion Some of the mental workload during ESS is associated with surgical skill level and alleviated with repetitive training. However, other aspects remain a burden or could worsen even when surgeons have gained surgical experience. Routine assessment of registrars' mental burdens would be necessary during surgical training to sustain their mental health.
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Affiliation(s)
- Masanobu Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- *Correspondence: Masanobu Suzuki,
| | - Kou Miyaji
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Kotaro Matoba
- Department of Forensic Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Ryosuke Watanabe
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takayoshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akira Nakazono
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Konno
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Dominik Hinder
- Department of Surgery–Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - A. J. Psaltis
- Department of Surgery–Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - P. J. Wormald
- Department of Surgery–Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Andersen SAW, Frithioff A, von Buchwald JH, Sørensen MS, Frendø M. Am I doing this right? Structured self-assessment during simulation training of mastoidectomy improves cadaver dissection performance: a prospective educational study. Eur Arch Otorhinolaryngol 2023; 280:97-103. [PMID: 35612611 DOI: 10.1007/s00405-022-07454-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Temporal bone surgery requires excellent surgical skills and simulation-based training can aid novices' skills acquisition. However, simulation-based training is challenged by early stagnation of performance after few performances. Structured self-assessment during practice might enhance learning by inducing reflection and engagement in the learning task. In this study, structured self-assessment was introduced during virtual reality (VR) simulation of mastoidectomy to investigate the effects on subsequent performance during cadaveric dissection. METHODS A prospective educational study with comparison with historical controls (reference cohort). At a temporal bone dissection course, eighteen participants performed structured self-assessment during 3 h of VR simulation mastoidectomy training before proceeding to cadaver dissection (intervention cohort). At a previous course, eighteen participants received identical VR simulation training but without the structured self-assessment (reference cohort). Final products from VR simulation and cadaveric dissection were recorded and assessed by two blinded raters using a 19-point modified Welling Scale. RESULTS The intervention cohort completed fewer procedures (average 4.2) during VR simulation training than the reference cohort (average 5.7). Nevertheless, the intervention cohort achieved a significantly higher average performance score both in VR simulation (11.1 points, 95% CI [10.6-11.5]) and subsequent cadaveric dissection (11.8 points, 95% CI [10.7-12.8]) compared with the reference cohort, who scored 9.1 points (95% CI [8.7-9.5]) during VR simulation and 5.8 points (95% CI [4.8-6.8]) during cadaveric dissection. CONCLUSIONS Structured self-assessment is a valuable learning support during self-directed VR simulation training of mastoidectomy and the positive effect on performance transfers to subsequent cadaveric dissection performance.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. .,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, RegionH, Copenhagen, Denmark. .,Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Andreas Frithioff
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Josefine Hastrup von Buchwald
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, RegionH, Copenhagen, Denmark
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11
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Lee WJ, Kim YH, Hong SD, Rho TH, Kim YH, Dho YS, Hong CK, Kong DS. Development of 3-dimensional printed simulation surgical training models for endoscopic endonasal and transorbital surgery. Front Oncol 2022; 12:966051. [PMID: 35992880 PMCID: PMC9389537 DOI: 10.3389/fonc.2022.966051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEndoscopic skull base surgery (ESBS) is complex, requiring methodical and unremitting surgical training. Herein, we describe the development and evaluation of a novel three-dimensional (3D) printed simulation model for ESBS. We further validate the efficacy of this model as educational support in neurosurgical training.MethodsA patient-specific 3D printed simulation model using living human imaging data was established and evaluated in a task-based hands-on dissection program. Endoscopic endonasal and transorbital procedures were simulated on the model by neurosurgeons and otorhinolaryngology surgeons of varying experience. All procedures were recorded using a high-definition camera coupled with digital video recorder system. The participants were asked to complete a post-procedure questionnaire to validate the efficacy of the model.ResultsFourteen experts and 22 trainees participated in simulations, and the 32 participants completed the post-procedure survey. The anatomical realism was scored as 4.0/5.0. The participants rated the model as helpful in hand-eye coordination training (4.7/5.0) and improving surgical skills (4.6/5.0) for ESBS. All participants believed that the model was useful as educational support for trainees (4.7 [ ± 0.5]). However, the color (3.6/5.0) and soft tissue feedback parameters (2.8/5) scored low.ConclusionThis study shows that high-resolution 3D printed skull base models for ESBS can be generated with high anatomical accuracy and acceptable haptic feedback. The simulation program of ESBS using this model may be supplemental or provide an alternative training platform to cadaveric dissection.
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Affiliation(s)
- Won-Jae Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, South Korea
| | - Sang-Duk Hong
- Department of Otorhinolaryngology—Head & Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Hoon Rho
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, South Korea
| | - Young Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Doo-Sik Kong, /
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12
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Suzuki M, Miyaji K, Watanabe R, Suzuki T, Matoba K, Nakazono A, Nakamaru Y, Konno A, Psaltis AJ, Abe T, Homma A, Wormald P. Repetitive simulation training with novel 3D-printed sinus models for functional endoscopic sinus surgeries. Laryngoscope Investig Otolaryngol 2022; 7:943-954. [PMID: 36000044 PMCID: PMC9392405 DOI: 10.1002/lio2.873] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study was to find a utility of a newly developed 3D-printed sinus model and to evaluate the educational benefit of simulation training with the models for functional endoscopic sinus surgery (FESS). Material and methods Forty-seven otolaryngologists were categorized as experts (board-certified physicians with ≥200 experiences of FESS, n = 9), intermediates (board-certified physicians with <200 experiences of FESS, n = 19), and novices (registrars, n = 19). They performed FESS simulation training on 3D-printed models manufactured from DICOM images of computed tomography (CT) scan of real patients. Their surgical performance was assessed with the objective structured assessment of technical skills (OSATS) score and dissection quality evaluated radiologically with a postdissection CT scan. First we evaluated the face, content, and constructive values. Second we evaluated the educational benefit of the training. Ten novices underwent training (training group) and their outcomes were compared to the remaining novices without training (control group). The training group performed cadaveric FESS surgeries before and after the repetitive training. Results The feedback from experts revealed high face and content value of the 3D-printed models. Experts, intermediates, and novices demonstrated statistical differences in their OSATS scores (74.7 ± 3.6, 58.3 ± 10.1, and 43.1 ± 11.1, respectively, p < .001), and dissection quality (81.1 ± 13.1, 93.7 ± 15.1, and 126.4 ± 25.2, respectively, p < .001). The training group improved their OSATS score (41.1 ± 8.0 to 61.1 ± 6.9, p < .001) and dissection quality (122.1 ± 22.2 to 90.9 ± 10.3, p = .013), while the control group not. After training, 80% of novices with no prior FESS experiences completed surgeries on cadaver sinuses. Conclusion Repeated training using the models revealed an initial learning curve in novices, which was confirmed in cadaveric mock FESS surgeries. Level of evidence N/A.
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Affiliation(s)
- Masanobu Suzuki
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Kou Miyaji
- Graduate School of Information Science and TechnologyHokkaido UniversitySapporoJapan
| | - Ryosuke Watanabe
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Takayoshi Suzuki
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Kotaro Matoba
- Department of Forensic Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Akira Nakazono
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Yuji Nakamaru
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Atsushi Konno
- Graduate School of Information Science and TechnologyHokkaido UniversitySapporoJapan
| | - Alkis James Psaltis
- Department of Surgery–Otorhinolaryngology Head and Neck SurgeryCentral Adelaide Local Health Network and the University of AdelaideAdelaideSouth AustraliaAustralia
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Akihiro Homma
- Department of Otolaryngology‐Head and Neck Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoHokkaidoJapan
| | - Peter‐John Wormald
- Department of Surgery–Otorhinolaryngology Head and Neck SurgeryCentral Adelaide Local Health Network and the University of AdelaideAdelaideSouth AustraliaAustralia
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13
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Leung G, Pickett AT, Bartellas M, Milin A, Bromwich M, Shorr R, Caulley L. Systematic review and meta-analysis of 3D-printing in otolaryngology education. Int J Pediatr Otorhinolaryngol 2022; 155:111083. [PMID: 35219038 DOI: 10.1016/j.ijporl.2022.111083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Three-dimensional (3D) printing has received increased attention in recent years and has many applications. In the field of otolaryngology surgery, 3D-printed models have shown potential educational value and a high fidelity to actual tissues. This provides an opportunity for trainees to gain additional exposure, especially as conventional educational tools, such as cadavers, are expensive and in limited supply. The purpose of this study was to perform a meta-analysis of the uses of 3D-printing in otolaryngology education. The primary outcomes of investigation were surgical utility, anatomical similarity, and educational value of 3D-printed models. Secondary outcomes of interest included country of implementation, 3D-printer materials and costs, types of surgical simulators, and the levels of training of participants. METHODS MEDLINE, Embase, Web of Science, Google Scholar and previous reviews were searched from inception until June 2021 for eligible articles. Title, abstract, and data extraction were performed in duplicate. Data were analyzed using random-effects models. The National Institute of Health Quality Assessment Tool was used to rate the quality of the evidence. RESULTS A total of 570 abstracts were identified and screened by 2 independent reviewers. Of the 274 articles reviewed in full text, 46 articles met the study criteria and were included in the meta-analysis. Surgical skill utility was reported in 42 studies (563 participants) and had a high degree of acceptance (84.8%, 95% CI: 81.1%-88.4%). The anatomical similarity was reported in 39 studies (484 participants) and was received positively at 80.6% (95% CI: 77.0%-84.2%). Educational value was described in 36 studies (93 participants) and had the highest approval rating by participants at 90.04% (87.20%-92.88%). A subgroup analysis by year of publication demonstrated that studies published after 2015 had higher ratings across all outcomes compared to those published prior to 2015. CONCLUSION This study found that 3D-printing interventions in otolaryngology demonstrated surgical, anatomical, and educational value. In addition, the approval ratings of 3D-printed models indicate a positive trend over time. Future educational programs may consider implementing 3D-printing on a larger scale within the medical curriculum to enhance exposure to otolaryngology.
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Affiliation(s)
- Gareth Leung
- University of Ottawa, Faculty of Medicine, Ottawa, Canada.
| | | | | | | | - Matthew Bromwich
- University of Ottawa, Department of Otolaryngology, Ottawa, Canada
| | | | - Lisa Caulley
- University of Ottawa, Department of Otolaryngology, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Canada; Erasmus University Medical Center Rotterdam, Department of Epidemiology, Rotterdam, Netherlands
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14
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Suzuki M, Vyskocil E, Ogi K, Matoba K, Nakamaru Y, Homma A, Wormald PJ, Psaltis AJ. Remote Training of Functional Endoscopic Sinus Surgery With Advanced Manufactured 3D Sinus Models and a Telemedicine System. Front Surg 2021; 8:746837. [PMID: 34660685 PMCID: PMC8517106 DOI: 10.3389/fsurg.2021.746837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Traditionally, cadaveric courses have been an important tool in surgical education for Functional Endoscopic Sinus Surgery (FESS). The recent COVID-19 pandemic, however, has had a significant global impact on such courses due to its travel restrictions, social distancing regulations, and infection risk. Here, we report the world-first remote (Functional Endoscopic Sinus Surgery) FESS training course between Japan and Australia, utilizing novel 3D-printed sinus models. We examined the feasibility and educational effect of the course conducted entirely remotely with encrypted telemedicine software. Methods: Three otolaryngologists in Hokkaido, Japan, were trained to perform frontal sinus dissections on novel 3D sinus models of increasing difficulty, by two rhinologists located in Adelaide, South Australia. The advanced manufactured sinus models were 3D printed from the Computed tomography (CT) scans of patients with chronic rhinosinusitis. Using Zoom and the Quintree telemedicine platform, the surgeons in Adelaide first lectured the Japanese surgeons on the Building Block Concept for a three Dimensional understanding of the frontal recess. They in real time directly supervised the surgeons as they planned and then performed the frontal sinus dissections. The Japanese surgeons were asked to complete a questionnaire pertaining to their experience and the time taken to perform the frontal dissection was recorded. The course was streamed to over 200 otolaryngologists worldwide. Results: All dissectors completed five frontal sinusotomies. The time to identify the frontal sinus drainage pathway (FSDP) significantly reduced from 1,292 ± 672 to 321 ± 267 s (p = 0.02), despite an increase in the difficulty of the frontal recess anatomy. Image analysis revealed the volume of FSDP was improved (2.36 ± 0.00 to 9.70 ± 1.49 ml, p = 0.014). Questionnaires showed the course's general benefit was 95.47 ± 5.13 in dissectors and 89.24 ± 15.75 in audiences. Conclusion: The combination of telemedicine software, web-conferencing technology, standardized 3D sinus models, and expert supervision, provides excellent training outcomes for surgeons in circumstances when classical surgical workshops cannot be realized.
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Affiliation(s)
- Masanobu Suzuki
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia.,Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Erich Vyskocil
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Kazuhiro Ogi
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Kotaro Matoba
- Department of Forensic Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Peter J Wormald
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
| | - Alkis J Psaltis
- Department of Surgery-Otorhinolaryngology Head and Neck Surgery, Central Adelaide Local Health Network and the University of Adelaide, Adelaide, SA, Australia
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