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Di Bari M, Nucci R, Bernardeschi D, Lepera D, Alciato L, Ferreli F, Colombo G. 3D 4K Exo-Endoscopic Temporal Bone Dissection: A Novel Approach for Sharing the Anatomy. Surg Innov 2024:15533506241273451. [PMID: 39096061 DOI: 10.1177/15533506241273451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Temporal bone dissection is overwide recognized as an ideal training method for otologic surgeons. The knowledge of temporal bone anatomy and especially of the course of infratemporal facial nerve is pivotal in practice. The 3D exoscope is an innovative and promising tool, that was recently introduced in ear surgery. METHODS A high-definition 3D exoscope (3D VITOM®) mounted on the VERSACRANETM holding system (Karl Storz) was used to perform two temporal bone dissection, with the aim to study the anatomy of infratemporal facial nerve. The 3D endoscope (TIPCAM®1 S 3D ORL, Karl Storz) was used in combination to provide a close-up high-quality view and to provide a different angle of view on fine anatomical relationships. RESULTS The high-definition 3D exoscope allowed to conduct the dissection with high quality visualization and to share the same surgical field with trainees. Moreover, it showed a high interchangeability with the 3D endoscope. CONCLUSIONS 3D 4 K Exo-endoscopic temporal bone dissection seems to have benefits in terms of educational purpose, especially concerning anatomy understanding. The superiority in teaching value of this tool should be further investigated in cohort studies.
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Affiliation(s)
- Matteo Di Bari
- Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
- Humanitas University, Milan, Italy
| | - Raul Nucci
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milano, Italy
| | - Daniele Bernardeschi
- Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Davide Lepera
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milano, Italy
| | - Lauranne Alciato
- Service d'Oto-Rhino-Laryngologie, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | | | - Giovanni Colombo
- Humanitas University, Milan, Italy
- Department of Otorhinolaryngology, Ospedale Nuovo di Legnano, Milano, Italy
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Hosoya M, Kurihara S, Koyama H, Komune N. Recent advances in Otology: Current landscape and future direction. Auris Nasus Larynx 2024; 51:605-616. [PMID: 38552424 DOI: 10.1016/j.anl.2024.02.009] [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: 08/22/2023] [Revised: 11/24/2023] [Accepted: 02/21/2024] [Indexed: 05/12/2024]
Abstract
Hearing is an essential sensation, and its deterioration leads to a significant decrease in the quality of life. Thus, great efforts have been made by otologists to preserve and recover hearing. Our knowledge regarding the field of otology has progressed with advances in technology, and otologists have sought to develop novel approaches in the field of otologic surgery to achieve higher hearing recovery or preservation rates. This requires knowledge regarding the anatomy of the temporal bone and the physiology of hearing. Basic research in the field of otology has progressed with advances in molecular biology and genetics. This review summarizes the current views and recent advances in the field of otology and otologic surgery, especially from the viewpoint of young Japanese clinician-scientists, and presents the perspectives and future directions for several topics in the field of otology. This review will aid next-generation researchers in understanding the recent advances and future challenges in the field of otology.
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Affiliation(s)
- Makoto Hosoya
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Sho Kurihara
- Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishishimbashi Minato-ku, Tokyo, 105-8471, Japan
| | - Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, 113-8654, Japan
| | - Noritaka Komune
- Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, 3-1-1Maidashi Higashi-ku, Fukuoka 812-8582, Japan
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Rak K, Kaulitz S, Voelker J, Müller-Graff T, Engert J, Spahn B, Hackenberg S, Grasso P, Hagen R. [Online training for hearing implant surgery : A new approach to otological training. German version]. HNO 2024; 72:317-324. [PMID: 38530381 PMCID: PMC11045577 DOI: 10.1007/s00106-024-01451-w] [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] [Accepted: 01/29/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Education in microsurgery of the ear includes staged training to allow for mastering of the complex microsurgical procedures, particularly in the context of middle ear reconstruction and cochlear implantation. Traditional surgical training includes temporal bone preparations by cadaver dissection and supervised operating room practice. As these on-site trainings are limited, there is a need to broaden education facilities in an on-line format. Therefore, a first basic on-line training for otosurgery was developed. MATERIALS AND METHODS The system consists of an artificial temporal bone model together with a set of basic surgical instruments and implant dummies. As an essential part of the training kit, a high-resolution camera set is included that allows for connection to a video streaming platform and enables remote supervision of the trainees' surgical steps by experienced otological surgeons. In addition, a pre-learning platform covering temporal bone anatomy and instrumentation and pre-recorded lectures and instructional videos has been developed to allow trainees to review and reinforce their understanding before hands-on practice. RESULTS Over the three courses held to date, 28 participants with varying levels of prior surgical experience took part in this otological surgical training program. The immediate feedback of the participants was evaluated by means of a questionnaire. On this basis, the high value of the program became apparent and specific areas could by identified where further refinements could lead to an even more robust training experience. CONCLUSION The presented program of an otosurgical online training allows for basal education in practical exercises on a remote system. In this way, trainees who have no direct access to on-site instruction facilities in ear surgery now have the chance to start their otosurgical training in an educational setting adapted to modern technologies.
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Affiliation(s)
- Kristen Rak
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland.
| | - Stefan Kaulitz
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Johannes Voelker
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Tassilo Müller-Graff
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Jonas Engert
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Björn Spahn
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Stephan Hackenberg
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
| | - Peter Grasso
- MED-EL Elektromedizinische Geräte Gesellschaft m.b.H., Innsbruck, Österreich
| | - Rudolf Hagen
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland
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Wang X, Shujaat S, Shaheen E, Jacobs R. Quality and haptic feedback of three-dimensionally printed models for simulating dental implant surgery. J Prosthet Dent 2024; 131:660-667. [PMID: 35513918 DOI: 10.1016/j.prosdent.2022.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM A model offering anatomic replication and haptic feedback similar to that of real bone is essential for hands-on surgical dental implant training. Patient-specific skeletal models can be produced with 3-dimensional (3D) printing, but whether these models can offer optimal haptic feedback for simulating implant surgery is unknown. PURPOSE The purpose of this trial was to compare the haptic feedback of different 3D printed models for simulating dental implant surgery. MATERIAL AND METHODS A cone beam computed tomography image of a 60-year-old man with a partially edentulous mandible was manipulated to segment the mandible and isolated from the rest of the scan. Three-dimensional models were printed with 6 different printers and materials: material jetting-based printer (MJ, acrylic-based resin); digital light processing-based printer (DLP, acrylic-based resin); fused filament fabrication-based printer (FFF1, polycarbonate filament; FFF2, polylactic acid filament); stereolithography-based printer (SLA, acrylic-based resin); and selective laser sintering-based printer (SLS, polyamide filament). Five experienced maxillofacial surgeons performed a simulated implant surgery on the models. A 5-point Likert scale questionnaire was established to assess the haptic feedback. The Friedman test and cumulative logit models were applied to evaluate differences among the models (α=.05). RESULTS The median score for drilling perception and implant insertion was highest for the MJ-based model and lowest for the SLS-based model. In relation to the drill chips, a median score of ≥3 was observed for all models. The score for corticotrabecular transition was highest for the MJ-based model and lowest for the FFF2-based model. Overall, the MJ-based model offered the highest score compared with the other models. CONCLUSIONS The 3D printed model with MJ technology and acrylic-based resin provided the best haptic feedback for performing implant surgery. However, none of the models were able to completely replicate the haptic perception of real bone.
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Affiliation(s)
- Xiaotong Wang
- Doctoral Candidate, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium; Clinical Surgeon, Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sohaib Shujaat
- Postdoctoral Researcher, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Eman Shaheen
- Clinical Engineer, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- Professor, OMFS-IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven & Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Professor, Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden.
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Gautam I, Shaw A, Brickman D, Mahajan A, Jeyakumar A. Creation of a Prototype Cochlear Training Model. Ann Otol Rhinol Laryngol 2024:34894241238868. [PMID: 38491865 DOI: 10.1177/00034894241238868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Creation of a novel 3D-printed physical cochlear model that demonstrated the feasibility of creating the model, and impact of a Graphical User Interface (GUI) system on training insertion metrics. STUDY DESIGN Feasibility study with a pilot prospective data collection. SETTING Tertiary academic center. METHODS The study was IRB exempt. Five resident trainees (PGY1-PGY5) practiced electrode insertions in cadaveric temporal bones before using the simulator. Nine students were educated on how to hold the electrodes and position them, and then allowed to use the simulator. All trainees were instructed that slower insertions were favorable. One cochlear implant (CI) surgeon used the simulator. The GUI captured the real video feed, but also provided distance, trajectory, and velocity measurements. The program is designed to plot the real-time depth of insertion and speed of insertion of the electrode; the user is also provided real-time occurrence of any kinks and back-outs. RESULTS A total of 14 trainees and 1 CI surgeon inserted the electrode at least 5 times without the use of the GUI (before) and then at least 5 times with the use of the GUI (after). Average Speed before and after (100.84 and 53.23 mm/s); Average minimum speed before and after (59.34 and 9.65 mm/s); and Average maximum speed before and after (416 and 285.81 mm/s). Statistically significant improvements were noted in all the measured speeds of insertion (P < .001). The other variables improved but not to a statistical significance. CONCLUSIONS Real-time training using the 3D-printed model and GUI for cochlear implantation can help improve surgical resident training and comfort levels with electrode insertion for surgical trainees. The advantage of this model is that surgeons/trainees can use it as many times as they like, as the whole set-up is easy, economical, and reusable. The real time graphical user interface enhances training and retention of the practiced skills.
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Affiliation(s)
- Ishwor Gautam
- Biomedical Engineering, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
| | - Avi Shaw
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, OH, USA
| | - Dhiren Brickman
- Department of Computer Science, Ashland University, Ashland, OH, USA
| | - Ajay Mahajan
- Biomedical Engineering, Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
| | - Anita Jeyakumar
- Department of Otolaryngology, Mercy Bon Secours, Youngstown, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
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Yao A, Richards E, Dalton CL. Trainee-perceived benefits of a virtual temporal bone competition. J Laryngol Otol 2024:1-5. [PMID: 38351567 DOI: 10.1017/s0022215124000070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To assess the perceived benefits of a novel educational approach for otolaryngology trainees: a virtual reality temporal bone simulator drilling competition. METHODS Regional otolaryngology trainees participated in the competition. Drilling activities using the Voxel-Man TempoSurg simulator were scored by experts. Questionnaires that contained questions covering motivators for attending, perceived learning and enjoyment were sent to participants. Agreement with statements was measured on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). RESULTS Eighteen trainees participated. The most cited reason for attending was for learning and/or education (61 per cent), with most attendees (72 per cent) believing that competition encourages more reading and/or practice. Seventeen attendees (94 per cent) believed Voxel-Man TempoSurg-based simulation would help to improve intra-operative performance in mastoidectomy (mean 7.83 ± 1.47, p < 0.001) and understanding of anatomy (mean 8.72 ± 1.13, p < 0.001). All participants rated the competition as 'fun' and 83 per cent believed the competitive element added to this. CONCLUSION The virtual reality temporal bone competition is a novel educational approach within otolaryngology that was positively received by otolaryngology trainees.
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Affiliation(s)
- Alexander Yao
- ENT Department, Worcester Royal Hospital, Worcester, UK
| | - Emma Richards
- ENT Department, Princess Royal Hospital, Telford, UK
| | - C Lucy Dalton
- ENT Department, Queen Elizabeth Hospital, Birmingham, UK
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Tapiala J, Iso-Mustajärvi M, Timonen T, Vrzáková H, Dietz A. Impact of virtual reality training on mastoidectomy performance: a prospective randomised study. Eur Arch Otorhinolaryngol 2024; 281:701-710. [PMID: 37505263 PMCID: PMC10796652 DOI: 10.1007/s00405-023-08143-1] [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: 02/26/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE The opportunities for surgical training and practice in the operating room are in decline due to limited resources, increased efficiency demands, growing complexity of the cases, and concerns for patient safety. Virtual reality (VR) offers a novel opportunity to enhance surgical training and provide complementary three-dimensional experience that has been usually available in the operating room. Since VR allows viewing and manipulation of realistic 3D models, the VR environment could enhance anatomical and topographical knowledge, in particular. In this study, we explored whether incorporating VR anatomy training improves novices' performance during mastoidectomy over traditional methods. METHODS Thirty medical students were randomized into two groups and taught mastoidectomy in a structured manner. One group utilized a VR temporal bone model during the training while the other group used more traditional materials such as anatomy books. After the training, all participants completed a mastoidectomy on a 3D-printed temporal bone model under expert supervision. Performance during the mastoidectomy was evaluated with multiple metrics and feedback regarding the two training methods was gathered from the participants. RESULTS The VR training method was rated better by the participants, and they also needed less guidance during the mastoidectomy. There were no significant differences in operational time, the occurrence of injuries, self-assessment scores, and the surgical outcome between the two groups. CONCLUSION Our results support the utilization of VR training in complete novices as it has higher trainee satisfaction and leads to at least as good results as the more traditional methods.
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Affiliation(s)
- Jesse Tapiala
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland.
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland
| | - Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland
| | - Hana Vrzáková
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Aarno Dietz
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, PL 100, 70029, Kuopio, Finland
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Munawar A, Li Z, Nagururu N, Trakimas D, Kazanzides P, Taylor RH, Creighton FX. Fully immersive virtual reality for skull-base surgery: surgical training and beyond. Int J Comput Assist Radiol Surg 2024; 19:51-59. [PMID: 37347346 PMCID: PMC11163985 DOI: 10.1007/s11548-023-02956-5] [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: 03/09/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE A virtual reality (VR) system, where surgeons can practice procedures on virtual anatomies, is a scalable and cost-effective alternative to cadaveric training. The fully digitized virtual surgeries can also be used to assess the surgeon's skills using measurements that are otherwise hard to collect in reality. Thus, we present the Fully Immersive Virtual Reality System (FIVRS) for skull-base surgery, which combines surgical simulation software with a high-fidelity hardware setup. METHODS FIVRS allows surgeons to follow normal clinical workflows inside the VR environment. FIVRS uses advanced rendering designs and drilling algorithms for realistic bone ablation. A head-mounted display with ergonomics similar to that of surgical microscopes is used to improve immersiveness. Extensive multi-modal data are recorded for post-analysis, including eye gaze, motion, force, and video of the surgery. A user-friendly interface is also designed to ease the learning curve of using FIVRS. RESULTS We present results from a user study involving surgeons with various levels of expertise. The preliminary data recorded by FIVRS differentiate between participants with different levels of expertise, promising future research on automatic skill assessment. Furthermore, informal feedback from the study participants about the system's intuitiveness and immersiveness was positive. CONCLUSION We present FIVRS, a fully immersive VR system for skull-base surgery. FIVRS features a realistic software simulation coupled with modern hardware for improved realism. The system is completely open source and provides feature-rich data in an industry-standard format.
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Affiliation(s)
- Adnan Munawar
- Johns Hopkins University, Baltimore, MD, 21218, USA.
| | - Zhaoshuo Li
- Johns Hopkins University, Baltimore, MD, 21218, USA
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Cafino R, Soliven MMT, Velasco LC, Lopez KH. Evaluation of polyethylene terephthalate glycol (PETG), Simubone™, and photopolymer resin as 3D printed temporal bone models for surgical simulation. Asian J Surg 2024; 47:237-244. [PMID: 37633781 DOI: 10.1016/j.asjsur.2023.08.095] [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: 03/15/2023] [Revised: 07/29/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVES Among types of 3D printing, fused deposition modeling (FDM) and digital light processing (DLP) are the most accessible, making them attractive, low-cost options for simulating surgical procedures. This study characterized and compared inexpensive, synthetic temporal bone models printed using Resin, PETG, and Simubone™. MATERIALS AND METHODS This study compared models made of polyethylene terephthalate glycol (PETG), Simubone™ produced from a FDM printer, and photopolymer resin from a DLP printer. These temporal bone models were processed by: (1) DICOM files from a patient's CT scan were segmented to define critical parts expected in a temporal bone surgery. (2) The model was appended with a base that articulates with a 3D-printed temporal bone holder. (3) The refined, patient-specific model was manufactured using FDM and DLP printing technologies. (4) The models were sent to evaluators, who assessed the models based on anatomic accuracy, dissection experience, and its applicability as a surgical simulation tool for temporal bone dissection. RESULTS The photopolymer resin outperformed PETG and Simubone™ in terms of anatomical accuracy and dissection experience. Additionally, resin and PETG were evaluated to be appropriate for simple mastoidectomy and canal wall down mastoidectomy while Simubone™ was only suitable for simple mastoidectomy. All models were unsuitable for posterior tympanotomy and labyrinthectomy. CONCLUSIONS Photopolymer resin and PETG have shown to be suitable materials for dissection models with 3D-printed resin models showing more accuracy in replicating anatomical structures and dissection experience. Hence, the use of 3D-printed temporal bones may be a suitable low-cost alternative to cadaveric dissection.
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Affiliation(s)
- Rentor Cafino
- Zamboanga City Medical Center, Department of Otorhinolaryngology - Head and Neck Surgery, Zamboanga City, Republic of the Philippines; ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines.
| | - Maria Monique Theresita Soliven
- Zamboanga City Medical Center, Department of Otorhinolaryngology - Head and Neck Surgery, Zamboanga City, Republic of the Philippines; ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines
| | - Lemuel Clark Velasco
- ENT HNS Medical Makerspace, Zamboanga City, Republic of the Philippines; Mindanao State University-Iligan Institute of Technology, Department of Information Technology, Iligan City, Republic of the Philippines; Premiere Research Institute of Science and Mathematics - Center for Computational Analytics and Modelling, Iligan City, Republic of the Philippines
| | - Kim Harold Lopez
- University of the Philippines Diliman, Department of Mechanical Engineering, Quezon City, Republic of the Philippines
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Frithioff A, Frendø M, Weiss K, Foghsgaard S, Mikkelsen PT, Frederiksen TW, Pedersen DB, Sørensen MS, Andersen SAW. 3-D-Printed Models for Temporal Bone Training: A Validity Study. Otol Neurotol 2023; 44:e497-e503. [PMID: 37442608 DOI: 10.1097/mao.0000000000003936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
OBJECTIVE 3-D printing offers convenient and low-cost mastoidectomy training; nonetheless, training benefits using 3-D-printed temporal bones remain largely unexplored. In this study, we have collected validity evidence for a low-cost, 3-D-printed temporal bone for mastoidectomy training and established a credible pass/fail score for performance on the model. STUDY DESIGN A prospective educational study gathering validity evidence using Messick's validity framework. SETTING Seven Danish otorhinolaryngology training institutions. PARTICIPANTS Eighteen otorhinolaryngology residents (novices) and 11 experienced otosurgeons (experts). INTERVENTION Residents and experienced otosurgeons each performed two to three anatomical mastoidectomies on a low-cost, 3-D-printed temporal bone model produced in-house. After drilling, mastoidectomy performances were rated by three blinded experts using a 25-item modified Welling scale (WS). MAIN OUTCOME MEASURE Validity evidence using Messick's framework including reliability assessment applying both classical test theory and Generalizability theory. RESULTS Novices achieved a mean score of 13.9 points; experienced otosurgeons achieved 23.2 points. Using the contrasting groups method, we established a 21/25-point pass/fail level. The Generalizability coefficient was 0.91, and 75% of the score variance was attributable to participant performance, indicating a high level of assessment reliability. Subsequent D studies revealed that two raters rating one performance or one rater rating two performances were sufficiently reliable for high-stakes assessment. CONCLUSION Validity evidence supports using a low-cost, 3-D-printed model for mastoidectomy training. The model can be printed in-house using consumer-grade 3-D printers and serves as an additional training tool in the temporal bone curriculum. For competency-based training, we established a cut-off score of 21 of 25 WS points using the contrasting groups method.
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Affiliation(s)
| | | | - Kenneth Weiss
- Department of Civil and Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Trier Mikkelsen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | | | - David Bue Pedersen
- Department of Civil and Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Dept. of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
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Abstract
BACKGROUND Computed Tomography (CT) scanning offers an accurate structural definition of bones, blood vessels, and soft tissues; however, mental integration of cross-sectional 2D CT images for a 3D understanding of complex anatomical structures becomes difficult when the field of view is confined to the temporal bone. This project tried to provide a feasible solution to this problem by creating a navigable 3D virtual model which may aid in better comprehension of the temporal bone anatomy. METHODS A helical-CT scan was used to obtain high-resolution cross-sectional slices of a cadaveric human temporal bone. Using the volume-rendering capabilities of 3D Slicer®, which involves volume data management, cropping of the data set, and threshold painting, detailed anatomical structures were segmented based on the intensity captured from different regions. This volumetric data was converted to an interactive virtual model using Blender®. RESULTS The final product is a web page that allows interaction and navigation with a 3D annotated model of the temporal bone, which can be accessed from any device with a web browser. CONCLUSION This model can function as a training tool for students, teachers, and practitioners to understand and review the complex anatomy of the temporal bone.
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Affiliation(s)
- Kunal Sareen
- Medical Doctor, Sant Parmanand Hospital, New Delhi, India
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James J, Irace AL, A Drusin M, Kim AH, Gudis DA, Overdevest JB. Thinking Beyond the Temporal Bone Lab: A Systematic Process for Expanding Surgical Simulation in Otolaryngology Training. Ann Otol Rhinol Laryngol 2022:34894221115753. [PMID: 35915918 DOI: 10.1177/00034894221115753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The COVID-19 pandemic led to a temporary lapse in the development of otolaryngology trainee operative skills due to the cancellation of elective procedures and redeployment of trainees and attendings to COVID-19 units. Although transient, this disruption provided an opportunity for otolaryngology programs to develop contingency plans and formalize nascent simulation training curricula. Integration of formal simulation training alongside current didactic and surgical education may offset lost exposure during surgically lean times while providing the framework and resources for enhanced baseline training. Here, we provide an up-to-date overview of surgical simulation models in otolaryngology and identify easily implementable, low-cost, low fidelity models for junior trainees. By taking advantage of rapid advancements in technology and a paradigm shift to a more hands-on approach in medical education, formal simulation training may prove to be a beneficial tool at all stages of residency training, allowing for expanded peer-mentored skill development and providing a safe haven during unforeseen disruptions in surgical case volume.
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Affiliation(s)
- Joel James
- City University of New York School of Medicine, New York, NY, USA
| | - Alexandria L Irace
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Madeleine A Drusin
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Ana H Kim
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Jonathan B Overdevest
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
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Frithioff A, Frendø M, Weiss K, Foghsgaard S, Pedersen DB, Sørensen MS, Wuyts Andersen SA. Effect of 3D-Printed Models on Cadaveric Dissection in Temporal Bone Training. OTO Open 2021; 5:2473974X211065012. [PMID: 34926973 PMCID: PMC8671684 DOI: 10.1177/2473974x211065012] [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: 09/18/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Mastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation. Study Design Prospective cohort study of an educational intervention. Setting Tertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark. Methods Eighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection. Results The intervention cohort outperformed the controls during cadaver dissection by 29% (P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score). Conclusion Mastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.
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Affiliation(s)
- Andreas Frithioff
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark.,Department of Plastic and Reconstructive Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Kenneth Weiss
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Søren Foghsgaard
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Copenhagen Hearing and Balance Center, Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation, Center for Human Resources and Education, Region H, Copenhagen, Denmark
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14
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Hochman JB, Pisa J, Kazmerik K, Unger B. Hand Motion Analysis Illustrates Differences When Drilling Cadaveric and Printed Temporal Bone. Ann Otol Rhinol Laryngol 2021; 131:1224-1230. [PMID: 34872376 PMCID: PMC9452853 DOI: 10.1177/00034894211059310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Temporal bone simulation is now commonly used to augment cadaveric education. Assessment of these tools is ongoing, with haptic modeling illustrating dissimilar motion patterns compared to cadaveric opportunities. This has the potential to result in maladaptive skill development. It is hypothesized that trainee drill motion patterns during printed model dissection may likewise demonstrate dissimilar hand motion patterns. METHODS Resident surgeons dissected 3D-printed temporal bones generated from microCT data and cadaveric simulations. A magnetic position tracking system (TrakSTAR Ascension, Yarraville, Australia) captured drill position and orientation. Skill assessment included cortical mastoidectomy, thinning procedures (sigmoid sinus, dural plate, posterior canal wall) and facial recess development. Dissection was performed by 8 trainees (n = 5 < PGY3 > n = 3) using k-cos metrics to analyze drill strokes within position recordings. K-cos metrics define strokes by change in direction, providing metrics for stroke duration, curvature, and length. RESULTS T-tests between models showed no significant difference in drill stroke frequency (cadaveric = 1.36/s, printed = 1.50/s, P < .40) but demonstrate significantly shorter duration (cadaveric = 0.37 s, printed = 0.16 s, P < .01) and a higher percentage of curved strokes (cadaveric = 31, printed = 67, P < .01) employed in printed bone dissection. Junior staff used a higher number of short strokes (junior = 0.54, senior = 0.38, P < .01) and higher percentage of curved strokes (junior = 35%, senior = 21%, P < .01). CONCLUSIONS Significant differences in hand motions were present between simulations, however the significance is unclear. This may indicate that printed bone is not best positioned to be the principal training schema.
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Affiliation(s)
- Jordan B Hochman
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Justyn Pisa
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Otolaryngology - Head and Neck Surgery, Health Sciences Centre, Winnipeg, MB, Canada
| | - Katrice Kazmerik
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Family Medicine, Pure Lifestyle, Winnipeg, MB, Canada
| | - Bertram Unger
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Medical Education, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Colombo G, Di Bari M, Canzano F, De Virgilio A, Cugini G, Mercante G, Spriano G, Ferreli F. 3D-4K exoscope-assisted temporal bone dissection: a new frontier in surgical training. Eur Arch Otorhinolaryngol 2021; 279:3875-3880. [PMID: 34719728 DOI: 10.1007/s00405-021-07137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess if 3D-4K exoscope is a valuable tool for temporal bone dissection and to evaluate its teaching potential. METHODS Six consecutive 3D-4K-exoscope-assisted cortical mastoidectomies were performed by a novice, an intermediate and an expert surgeon (two dissections each). All dissections were entirely recorded and later evaluated independently by three other experienced surgeons. The dissection end-product was evaluated according to the Melbourne Mastoidectomy Scale (MMS). Paired t test was used to assess whether novice and intermediate surgeons have a score improvement in the second dissection compared to the first one. Surgeons' interactions, depth effect, and 3D impression were also assessed to perform a subjective analysis. RESULTS Mean MMS scores for the novice, intermediate and expert surgeon were 11.3 ± 2.8, 13.8 ± 3.9 and 19 ± 1.3, respectively. Paired t test demonstrated a statically significant improvement between the first and the second dissection both for the novice and the intermediate surgeon (+ 4.7 and + 7 points; p = 0.0002). A high-quality magnification of the temporal bone was obtained, allowing the expert surgeon to identify all the anatomical structures without injuring them. The exoscope was capable of providing a high involvement in the dissections with very effective interactions between the expert surgeon and the trainees, that had access to the same surgical field view. CONCLUSION 3D-4K-exoscope resulted adequate for a safe and effective mastoidectomy and showed a high potential for training and educational purposes. It can represent a valid option for surgical training of temporal bone dissection and a new interactive tool to understand the complex temporal bone anatomy.
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Affiliation(s)
- Giovanni Colombo
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Matteo Di Bari
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy. .,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Federica Canzano
- Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Armando De Virgilio
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giovanni Cugini
- Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giuseppe Mercante
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giuseppe Spriano
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Fabio Ferreli
- Humanitas University, Via Rita Levi Montalcini, 4, 20090, Pieve Emanuele , MI, Italy.,Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
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16
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Automated summative feedback improves performance and retention in simulation training of mastoidectomy: a randomised controlled trial. The Journal of Laryngology & Otology 2021; 136:29-36. [PMID: 34709147 DOI: 10.1017/s0022215121003352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to investigate the effects of automated metrics-based summative feedback on performance, retention and cognitive load in distributed virtual reality simulation training of mastoidectomy. METHOD Twenty-four medical students were randomised in two groups and performed 15 mastoidectomies on a distributed virtual reality simulator as practice. The intervention group received additional summative metrics-based feedback; the control group followed standard instructions. Two to three months after training, participants performed a retention test without learning supports. RESULTS The intervention group had a better final-product score (mean difference = 1.0 points; p = 0.001) and metrics-based score (mean difference = 12.7; p < 0.001). At retention, the metrics-based score for the intervention group remained superior (mean difference = 6.9 per cent; p = 0.02). Also at the retention, cognitive load was higher in the intervention group (mean difference = 10.0 per cent; p < 0.001). CONCLUSION Summative metrics-based feedback improved performance and lead to a safer and faster performance compared with standard instructions and seems a valuable educational tool in the early acquisition of temporal bone skills.
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Razavi C, Galaiya D, Vafaee S, Yin R, Carey JP, Taylor RH, Creighton FX. Three dimensional printing of a low-cost middle-ear training model for surgical management of otosclerosis. Laryngoscope Investig Otolaryngol 2021; 6:1133-1136. [PMID: 34693002 PMCID: PMC8513458 DOI: 10.1002/lio2.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical management of otosclerosis is technically challenging with studies demonstrating that outcomes are commensurate with surgical experience. Moreover, experts apply less force on the ossicular chain during prosthesis placement than their novice counterparts. Given the predicted decreasing patient pool and the rising cost of human temporal bone specimens it has become more challenging for trainees to receive adequate intraoperative or laboratory-based experience in this procedure. As such, there is a need for a low-cost training model for the procedure. Here we describe such a model. METHODS A surgical model of the middle ear was designed using computer aided design (CAD) software. The model consists of four components, the superior three dimensional (3D)-printed component representing the external auditory canal, a 90° torsion spring representing the incus, a 3D-printed base with a stapedotomy underlying the torsion spring, and a 3D-printed phone holder to facilitate video-recording of trials and subsequent calculation of the force applied on the modeled incus. Force applied on the incus is calculated based on Hooke's Law from post-trial computer-vision analysis of recorded video following experimental determination of the spring constant of the modeled incus. RESULTS The described model was manufactured with a total cost of $56.50. The spring constant was experimentally determined to be 97.0 mN mm/deg, resulting in an ability to detect force applied to the modeled incus across a range of 1.2 to 5200 mN. CONCLUSIONS We have created a low-cost middle-ear training model with measurable objective performance outcomes. The range of detectable force exceeds expected values for the task.Level of Evidence: IV.
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Affiliation(s)
- Christopher Razavi
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Deepa Galaiya
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Seena Vafaee
- Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Rui Yin
- Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - John P. Carey
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Russell H. Taylor
- Laboratory for Computational Sensing and RoboticsJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Francis X. Creighton
- Department of Otolaryngology – Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Fendos J. Anatomy Terminology Performance is Improved by Combining Jigsaws, Retrieval Practice, and Cumulative Quizzing. ANATOMICAL SCIENCES EDUCATION 2021; 14:641-657. [PMID: 32966702 DOI: 10.1002/ase.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
Science courses containing English-language terminology are a common implement in "English as a foreign language" (EFL) countries across the globe. In many of these countries, licensing examinations place added significance on terminology competence by requiring health science graduates to demonstrate mastery of English-language anatomy terms. In recent years, a wealth of research has shown active learning can offer many benefits over lecture-based, didactic approaches. Despite this work, very little has been done to test the potential of active learning in improving medical terminology performance. The present study explores this potential in two human gross anatomy lecture courses in South Korea, collecting performance and survey data from 399 undergraduates over a period of four years. Jigsaws, retrieval practice, and regular cumulative quizzing were used to mitigate three learning challenges specific to the study context: high vocabulary volume, low feelings of control over learning, and difficulties with exam preparation. The results show the reforms significantly improved both performance and learning attitudes, with students overwhelmingly favoring the use of new methods over lecture when taught using a mixture of both. Given that science learning often resembles the process of learning a foreign language, this study offers broad potential for improving terminology competence across disciplines, even for non-EFL students.
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Affiliation(s)
- Justin Fendos
- Department of Global Biotechology, Dongseo University, Busan, South Korea
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19
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Guy J, Muzaffar J, Coulson C. Teaching middle ear anatomy using a novel three-dimensional papercraft model. Eur Arch Otorhinolaryngol 2021; 278:2769-2774. [PMID: 32970186 PMCID: PMC8266719 DOI: 10.1007/s00405-020-06350-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The middle ear is a complex anatomical space which is difficult to interpret from two-dimensional imagery. Appropriate surgical knowledge of the area is required to operate, yet current anatomical teaching methods are costly and hard to access for the trainee. METHODS A papercraft 3D design involving anatomical elements added separately to a model was designed, and then peer-validated by medical students and junior doctors. Preliminary quantitative assessment was performed using an anatomical labelling questionnaire, with six students given a lecture to act as a control. Qualitative feedback was also gathered. RESULTS 18 participants were recruited for the study. A total of 12 models were constructed by 6 medical students and 6 junior doctors. 6 medical students received a lecture only. Qualitative feedback was positive and suggested the model improved knowledge and was useful, yet timing and complexity were issues. Students scored, on average, 37% higher after completing the model, with junior doctors also improving anatomical knowledge, though these differences were not significant (p > 0.05). CONCLUSIONS In this initial investigation, the model was shown to be an engaging way to learn anatomy, with the tactile and active nature of the process cited as benefits. Construction of the model improved anatomical knowledge to a greater extent than a classical lecture in this study, though this difference was not significant. Further design iterations are required to improve practical utility in the teaching environment, as well as a larger study.
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Affiliation(s)
- John Guy
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2SG UK
| | - Jameel Muzaffar
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH UK
| | - Christopher Coulson
- Department of Otolaryngology, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, B15 2TH UK
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Abstract
BACKGROUND Surgical training is increasingly supported by the use of simulators. For temporal bone surgery, shown here by means of mastoidectomy, there are other training models besides cadaver specimens, such as artificial temporal bones or computer-based simulators. OBJECTIVES A structured training concept was created which integrates different training methods of mastoidectomy with regard to effectiveness and current learning theory in education. METHOD A selective literature research was conducted to compare learning-theoretical findings and the availability and effectiveness of currently existing training models. RESULTS To acquire surgical skills, a stepwise approach is suggested. Depending on the progress with computer-based simulation, plastic or native temporal bones should be used. To achieve a plateau of the learning curve, approximately 25 semi-autonomous preparations are recommended. Different 'Objective Structured Assessments of Technical Skills' (OSATS) are implemented to assess the learning progress at different levels. DISCUSSION Simulation-based training is recommended until an adequate learning curve plateau is achieved. This is reasonable for patient safety, based on limited accessibility of human cadaveric temporal bones but also by findings of the learning theory. CONCLUSION The curriculum integrates different training models of mastoidectomy and OSATS into an overall concept. The training plan has to be continuously adapted to new findings and technical developments.
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21
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Regenerative medicine in the upper aerodigestive tract, temporal bone dissection, nasal douching and management changes at The Journal of Laryngology & Otology. The Journal of Laryngology & Otology 2021; 135:471-472. [PMID: 34121649 DOI: 10.1017/s0022215121001407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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22
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Frendø M, Frithioff A, Konge L, Sørensen MS, Andersen SAW. Cochlear implant surgery: Learning curve in virtual reality simulation training and transfer of skills to a 3D-printed temporal bone - A prospective trial. Cochlear Implants Int 2021; 22:330-337. [PMID: 34151753 DOI: 10.1080/14670100.2021.1940629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Mastering Cochlear Implant (CI) surgery requires repeated practice, preferably initiated in a safe - i.e. simulated - environment. Mastoidectomy Virtual Reality (VR) simulation-based training (SBT) is effective, but SBT of CI surgery largely uninvestigated. The learning curve is imperative for understanding surgical skills acquisition and developing competency-based training. Here, we explore learning curves in VR SBT of CI surgery and transfer of skills to a 3D-printed model. METHODS Prospective, single-arm trial. Twenty-four novice medical students completed a pre-training CI inserting test on a commercially available pre-drilled 3D-printed temporal bone. A training program of 18 VR simulation CI procedures was completed in the Visual Ear Simulator over four sessions. Finally, a post-training test similar to the pre-training test was completed. Two blinded experts rated performances using the validated Cochlear Implant Surgery Assessment Tool (CISAT). Performance scores were analyzed using linear mixed models. RESULTS Learning curves were highly individual with primary performance improvement initially, and small but steady improvements throughout the 18 procedures. CI VR simulation performance improved 33% (p < 0.001). Insertion performance on a 3D-printed temporal bone improved 21% (p < 0.001), demonstrating skills transfer. DISCUSSION VR SBT of CI surgery improves novices' performance. It is useful for introducing the procedure and acquiring basic skills. CI surgery training should pivot on objective performance assessment for reaching pre-defined competency before cadaver - or real-life surgery. Simulation-based training provides a structured and safe learning environment for initial training. CONCLUSION CI surgery skills improve from VR SBT, which can be used to learn the fundamentals of CI surgery.
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Affiliation(s)
- Martin Frendø
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen, Denmark
| | - Andreas Frithioff
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen, Denmark
| | | | - Mads Sølvsten Sørensen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven A W Andersen
- Copenhagen Hearing and Balance Centre, Department of Otorhinolaryngology-Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen, Denmark
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Srivatsava S, Charles AS, Paul AP, Rabi S. A quick method to expose the structures and relations of the middle ear and inner ear by cadaveric dissection. Morphologie 2021; 106:107-114. [PMID: 33947629 DOI: 10.1016/j.morpho.2021.04.001] [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: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The temporal bone contains structures related to hearing and balance, and is a valuable learning resource for medical students and trainee surgeons. The middle ear and inner ear are difficult to demonstrate by cadaveric dissection as the structures are closely contained in a small space in the dense temporal bone. Consequently, the teaching and learning of the ear are largely relegated to virtual and theoretical images, and models, which has resulted in a knowledge gap in medical students and prospective surgeons. The present study aimed to elucidate a technique that exposes the structures and relations of the middle and inner ear by cadaveric dissection. MATERIALS AND METHODS Forty-seven adult formalin-fixed cadaveric specimens were dissected by the proposed technique. The method was evaluated based on the extent of the structures exposed and time taken for dissection. RESULTS The method exposed all the contents and relations of the middle and inner ear, including the course of the facial nerve in the petrous temporal bone, in a few minutes, without use of specialized instruments like saw, drill, endoscope, operating microscope or electric trephine. CONCLUSION This dissection method combines maximal exposure of the structures and relations of the middle and inner ear with a short dissection time, sans use of specialized tools. It can be incorporated in the gross anatomy curriculum for medical studentsdue to the short dissection time and completeness of structures exposed. The prosected specimen can also be plastinated for use as a teaching-learning resource for medical students and surgeons.
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Affiliation(s)
- S Srivatsava
- Department of Anatomy, Christian Medical College, Vellore, Tamil Nadu, 632002, India.
| | - A S Charles
- Department of Anatomy, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - A P Paul
- Department of Anatomy, Christian Medical College, Vellore, Tamil Nadu, 632002, India
| | - S Rabi
- Department of Anatomy, Christian Medical College, Vellore, Tamil Nadu, 632002, India
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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Tolisano AM, Littlefield PD. A time-sensitive rubric for assessing mastoidectomy proficiency. Am J Otolaryngol 2020; 41:102457. [PMID: 32247707 DOI: 10.1016/j.amjoto.2020.102457] [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: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To develop a time-sensitive, standardized rubric for cadaveric temporal bone dissection for otolaryngology resident education. METHODS This is a five-year prospective cohort study that evaluated otolaryngology resident performance during sequential cadaveric temporal bone dissection courses at a single otolaryngology residency training program. A canal-wall-up mastoidectomy with a facial recess approach was performed adhering to a 30-minute time limit and graded according to a standardized rubric. Main outcome measures included: (1) correct structure identification and (2) injuries sustained to structures as compared by resident post-graduate year (PGY) level. RESULTS Thirteen residents were evaluated from October 2012 to March 2017. This included 57 individual graded exercises performed over ten dissection courses. The average score for PGY-2 residents was lowest (68.9), and PGY-5 residents achieved the highest average score (87.7). Junior residents correctly identified fewer structures (77.5%) when compared to senior residents (91.3%), p < 0.0001. Correct performance of a facial recess approach was achieved by 100% of senior residents, but only 59.3% of junior residents (p = 0.0003). The percentage of major injuries, which included the facial nerve, tegmen, labyrinth, and ossicular chain, decreased each PGY-level from a maximum of 17% by PGY-2 residents to a minimum of 5% by PGY-5 residents. CONCLUSION Senior residents correctly identify more structures and are able to complete a facial recess approach with higher fidelity when subjected to a time-sensitive graded mastoidectomy rubric.
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Gawęcki W, Węgrzyniak M, Mickiewicz P, Gawłowska MB, Talar M, Wierzbicka M. The Impact of Virtual Reality Training on the Quality of Real Antromastoidectomy Performance. J Clin Med 2020; 9:jcm9103197. [PMID: 33023129 PMCID: PMC7600885 DOI: 10.3390/jcm9103197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this paper is to analyze the results of virtual reality (VR) antromastoidectomy simulation training and the transferability of the obtained skills to real temporal bone surgery. METHODS The study was conducted prospectively on a group of 10 physicians, and was composed of five VR simulation training sessions followed by live temporal bone surgery. The quality of performance was evaluated with a Task-Based Checklist (TBC) prepared by John Hopkins Hospital. Additionally, during every VR session, the number and type of mistakes (complications) were noted. RESULTS The quality of performance measured by the TBC increased significantly during consecutive VR sessions. The mean scores for the first and fifth sessions were 1.84 and 4.27, respectively (p < 0.001). Furthermore, the number of mistakes in consecutive VR sessions was gradually reduced from 11 to 0. During supervised surgery, all the participants were able to perform at least part of an antromastoidectomy, and the mean TBC score was 3.57. There was a significant strong positive correlation between the individual results of the fifth VR session and the individual results of supervised surgery in the operating room (rp = 0.89, p = 0.001). CONCLUSIONS Virtual reality for temporal bone training makes it possible to acquire surgical skills in a safe environment before performing supervised surgery. Furthermore, the individual final score of virtual antromastoidectomy training allows a prediction of the quality of performance in real surgery.
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Affiliation(s)
- Wojciech Gawęcki
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, 60-355 Poznań, Poland; (M.W.); (M.W.)
- Correspondence: ; Tel.: +48-61-8691-387; Fax: +48-61-8691-690
| | - Magdalena Węgrzyniak
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, 60-355 Poznań, Poland; (M.W.); (M.W.)
| | | | - Maria Bratumiła Gawłowska
- Medicus sp. z o.o., 50-224 Wrocław, Poland; (M.B.G.); (M.T.)
- Poznań University of Medical Sciences, 61-701 Poznań, Poland
| | - Marcin Talar
- Medicus sp. z o.o., 50-224 Wrocław, Poland; (M.B.G.); (M.T.)
- Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Małgorzata Wierzbicka
- Department of Otolaryngology and Laryngological Oncology, Poznań University of Medical Sciences, 60-355 Poznań, Poland; (M.W.); (M.W.)
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Sramek M, Shi Y, Quintanilla E, Wu X, Ponukumati A, Pastel D, Halter R, Paydarfar J. Tumor phantom for training and research in transoral surgery. Laryngoscope Investig Otolaryngol 2020; 5:677-682. [PMID: 32864438 PMCID: PMC7444757 DOI: 10.1002/lio2.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE With the paradigm shift towards minimally invasive surgical techniques such as transoral laser microsurgery and transoral robotic surgery for resection of head and neck malignancies, there is a need to enhance the surgical training of these techniques as well as provide a platform for testing new approaches and technologies. The steeper learning curve associated with minimally invasive surgical techniques may be mitigated with the use of tumor phantoms (TP) placed in cadaver models. METHODS An injectable TP was developed using an agar-gelatin base, unsalted chicken stock, deionized water, food coloring for visual mimicry, and iohexol for radiographic mimicry. Four percentage glutaraldehyde was used as a cross-linking agent for solidification of the TP. The TP was then injected in various mucosal anatomic sites in four unfixed cadaver heads. Visual, radiographic, and tactile mimicry was assessed via endoscopy, CT scan, and tumor dissection and palpation, respectively. RESULTS Tumor phantom injection was successfully achieved in all four cadaver heads. Visually and tactilely, the TP demonstrated similar color change, induration, and firmness of a typical squamous cell carcinoma (SCCa). However, ulceration that is often seen with SCCa could not be replicated. CT mimicry was compared with nine patients with known SCCa. Tumor radiodensity in the nine patients was between 77 and 110 HU (mean 86.3 HU) whereas TP radiodensity was 59 and 127 HU (mean 93.7 HU), with no significant difference between groups (P = .21). CONCLUSION This inexpensive, easy to apply, and unique tumor phantom could be used both to train transoral techniques and as a tool to further investigate new approaches and technologies for transoral surgery. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Michael Sramek
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Yuan Shi
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
| | | | - Xiaotian Wu
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
| | | | - David Pastel
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Division of Neuroradiology, Department of RadiologyDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
| | - Ryan Halter
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
| | - Joseph Paydarfar
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
- Thayer School of Engineering at DartmouthHanoverNew HampshireUSA
- Section of Otolaryngology, Department of SurgeryDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
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Lyutenski S, Erfurt P, Ochs M, Lenarz T. Reprint of Corrosion casting of the temporal bone: Review of the technique. Ann Anat 2020; 230:151518. [PMID: 32473900 DOI: 10.1016/j.aanat.2020.151518] [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: 10/03/2019] [Accepted: 12/01/2019] [Indexed: 11/18/2022]
Abstract
The temporal bone has the most sophisticated anatomy of the whole skeleton. Its study is a challenge for students and surgeons. An inverse model of the visually obscured cavities and canals can facilitate better three-dimensional orientation and investigation. This can be made by means of corrosion casting, which is an established technique first documented on the temporal bone at the beginning of the nineteenth century. The prepared specimens are suitable not only for teaching purposes but also for research on the fascinating topography of the osseous labyrinth and the whole temporal bone. Many important studies on temporal bone anatomy are based on this technique. An extensive review of the pertinent literature is provided in relation to each method available.
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Affiliation(s)
- Stefan Lyutenski
- Department for Otorhinolaryngology, Hannover Medical School, Hannover, Germany; Department for Otorhinolaryngology, Helios Hospital Berlin-Buch, Berlin, Germany.
| | - Peter Erfurt
- Department for Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Matthias Ochs
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL) and of the Cluster of Excellence REBIRTH, Hannover, Germany; Institute of Vegetative Anatomy, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Thomas Lenarz
- Department for Otorhinolaryngology, Hannover Medical School, Hannover, Germany
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Abstract
: Patient safety demands enhancements in training. Graduated cadaveric bone exposure is fundamental to otologic training. Printed bone models (PBM) provide a low-cost, anatomically consistent adjunct to cadaveric materials in trainee skill acquisition.The purpose of this study is to determine if resident training level can be distinguished on the basis of performance employing a printed temporal bone model, graded by a previous validated scale. METHODS Nineteen residents (11 male, 8 female) from 9 graduate programs, attending a National Otolaryngology Conference, completed a mastoidectomy with posterior tympanotomy on identic 3D PBMs and a Likert scale (1-7) survey on subjective appreciation of the simulation. Four experts graded participant performance using the previously validated Welling Scale. RESULTS ANOVA revealed significant performance differences between the junior/intermediate and junior/senior PGY cohorts. No difference was observed between intermediate/senior cohorts on the basis of PGY or subjective temporal bone dissection experience. Clustering aspects of the scale with specific focus on thinning tasks found a similar outcome to the composite scale scores.Subjective experience judged printed bone to be similar to cadaveric in drill-bone interaction. Participants believed the simulation would improve surgical performance, comfort with actual patients, and operative speed. CONCLUSION Subjectively, printed bone compared favorably to cadaveric.The simulation demonstrated construct validity but was challenged in differentiating senior from intermediate trainee performance. This may be a function of the PBM inherent character, limitations in grading instrument fidelity or sample size. It is also possible that the dominant period of skill acquisition for mastoidectomy and posterior tympanotomy are primarily acquired during the junior training.
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3D printed temporal bone as a tool for otologic surgery simulation. Am J Otolaryngol 2020; 41:102273. [PMID: 32209234 DOI: 10.1016/j.amjoto.2019.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE In this face validity study, we discuss the fabrication and utility of an affordable, computed tomography (CT)-based, anatomy-accurate, 3-dimensional (3D) printed temporal bone models for junior otolaryngology resident training. MATERIALS AND METHODS After IRB exemption, patient CT scans were anonymized and downloaded as Digital Imaging and Communications in Medicine (DICOM) files to prepare for conversion. These files were converted to stereolithography format for 3D printing. Important soft tissue structures were identified and labeled to be printed in a separate color than bone. Models were printed using a desktop 3D printer (Ultimaker 3 Extended, Ultimaker BV, Netherlands) and polylactic acid (PLA) filament. 10 junior residents with no previous drilling experience participated in the study. Each resident was asked to drill a simple mastoidectomy on both a cadaveric and 3D printed temporal bone. Following their experience, they were asked to complete a Likert questionnaire. RESULTS The final result was an anatomically accurate (XYZ accuracy = 12.5, 12.5, 5 μm) 3D model of a temporal bone that was deemed to be appropriate in tactile feedback using the surgical drill. The total cost of the material required to fabricate the model was approximately $1.50. Participants found the 3D models overall to be similar to cadaveric temporal bones, particularly in overall value and safety. CONCLUSIONS 3D printed temporal bone models can be used as an affordable and inexhaustible alternative, or supplement, to traditional cadaveric surgical simulation.
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Bhalla S, Tolley N, Awad Z. Creating a Validated Simulation Training Curriculum in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status.
Recent Findings
Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves.
Summary
A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.
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Frithioff A, Frendø M, Mikkelsen PT, Sørensen MS, Andersen SAW. Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial. Eur Arch Otorhinolaryngol 2020; 277:1335-1341. [PMID: 32067096 DOI: 10.1007/s00405-020-05858-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Ultra-high-fidelity (UHF) graphics in virtual reality (VR) simulation might improve surgical skill acquisition in temporal bone training. This study aims to compare UHF VR simulation training with conventional, screen-based VR simulation training (cVR) with respect to performance and cognitive load (CL). METHODS In a randomized trial with a cross-over design, 24 students completed a total of four mastoidectomies in a VR temporal bone surgical simulator: two performances under UHF conditions using a digital microscope and two performances under conventional conditions using screen-based VR simulation. Performances were assessed by two blinded raters using an established assessment tool. In addition, CL was estimated as the relative change in secondary-task reaction time during simulation when compared with individual baseline measurements. Data were analyzed using linear mixed model analysis for repeated measurements. RESULTS The mean final-product performance score was significantly lower in UHF VR simulation compared to cVR simulation [mean difference 1.0 points out of 17 points, 95% CI (0.2-1.7), p = 0.02]. The most important factor for performance during UHF simulation was the ability to achieve stereovision (mean difference = 3.4 points, p < 0.001). Under the UHF VR condition, CL was significantly higher than during cVR (28% vs. 18%, respectively, p < 0.001). CONCLUSION UHF graphics in VR simulation training reduced performance and induced a higher CL in novices than conventional, screen-based VR simulation training. Consequently, UHF VR simulation training should be preceded by cVR training and might be better suited for the training of intermediates or experienced surgeons.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Copenhagen, Denmark.
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Copenhagen, Denmark
| | | | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet, HovedOrtoCentret, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR, Copenhagen, Denmark
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Lyutenski S, Erfurt P, Ochs M, Lenarz T. Corrosion casting of the temporal bone: Review of the technique. Ann Anat 2019; 228:151455. [PMID: 31862490 DOI: 10.1016/j.aanat.2019.151455] [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: 10/03/2019] [Accepted: 12/01/2019] [Indexed: 11/17/2022]
Abstract
The temporal bone has the most sophisticated anatomy of the whole skeleton. Its study is a challenge for students and surgeons. An inverse model of the visually obscured cavities and canals can facilitate better three-dimensional orientation and investigation. This can be made by means of corrosion casting, which is an established technique first documented on the temporal bone at the beginning of the nineteenth century. The prepared specimens are suitable not only for teaching purposes but also for research on the fascinating topography of the osseous labyrinth and the whole temporal bone. Many important studies on temporal bone anatomy are based on this technique. An extensive review of the pertinent literature is provided in relation to each method available.
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Affiliation(s)
- Stefan Lyutenski
- Department for Otorhinolaryngology, Hannover Medical School, Hannover, Germany; Department for Otorhinolaryngology, Helios Hospital Berlin-Buch, Berlin, Germany.
| | - Peter Erfurt
- Department for Otorhinolaryngology, Hannover Medical School, Hannover, Germany
| | - Matthias Ochs
- Institute of Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL) and of the Cluster of Excellence REBIRTH, Hannover, Germany; Institute of Vegetative Anatomy, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Thomas Lenarz
- Department for Otorhinolaryngology, Hannover Medical School, Hannover, Germany
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Anschuetz L, Huwendiek S, Stricker D, Yacoub A, Wimmer W, Caversaccio M. Assessment of Middle Ear Anatomy Teaching Methodologies Using Microscopy versus Endoscopy: A Randomized Comparative Study. ANATOMICAL SCIENCES EDUCATION 2019; 12:507-517. [PMID: 30430760 DOI: 10.1002/ase.1837] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 06/09/2023]
Abstract
Teaching methodologies for the anatomy of the middle ear have not been investigated greatly due to the middle ear's highly complex structure and hidden location inside of the temporal bone. The aim of this randomized study was to quantitatively compare the suitability of using microscope- and endoscope-based methods for teaching the anatomy of the middle ear. We hypothesize that the endoscopic approach will be more efficient compared to the microscopic approach. To answer the study questions, 33 sixth-year medical students, residents and otorhinolaryngology specialists were randomized either into the endoscopy or the microscopy group. Their anatomical knowledge was assessed using a structured anatomical knowledge test before and after each session. Each participant received tutoring on a human cadaveric specimen using one of the two methods. They then performed a hands-on dissection. After 2-4 weeks, the same educational curriculum was repeated using the other technique. The mean gains in anatomical knowledge for the specialists, residents, and medical students were +19.0%, +34.6%, and +23.4%, respectively. Multivariate analyses identified a statistically significant increase in performance for the endoscopic method compared to the microscopic technique (P < 0.001). For the recall of anatomical structures during dissection, the endoscopic method outperformed the microscopic technique independently of the randomization or the prior training level of the attendees (P < 0.001). In conclusion, the endoscopic approach to middle ear anatomy education is associated to an improved gain in knowledge as compared to the microscopic approach. The participants subjectively preferred the endoscope for educational purposes.
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MESH Headings
- Adult
- Anatomy/education
- Cadaver
- Curriculum
- Dissection
- Ear, Middle/anatomy & histology
- Ear, Middle/diagnostic imaging
- Education, Medical, Continuing/methods
- Education, Medical, Continuing/statistics & numerical data
- Education, Medical, Undergraduate/methods
- Education, Medical, Undergraduate/statistics & numerical data
- Educational Measurement/statistics & numerical data
- Endoscopy
- Female
- Humans
- Internship and Residency/methods
- Internship and Residency/statistics & numerical data
- Male
- Mental Recall
- Microscopy
- Middle Aged
- Program Evaluation
- Random Allocation
- Students, Medical/statistics & numerical data
- Surgeons/education
- Surgeons/statistics & numerical data
- Teaching
- Young Adult
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Affiliation(s)
- Lukas Anschuetz
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Daniel Stricker
- Institute of Medical Education, University of Bern, Bern, Switzerland
| | - Abraam Yacoub
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Wilhelm Wimmer
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
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Razavi CR, Wilkening PR, Yin R, Lamaison N, Taylor RH, Carey JP, Creighton FX. Applied Force during Piston Prosthesis Placement in a 3D-Printed Model: Freehand vs Robot-Assisted Techniques. Otolaryngol Head Neck Surg 2018; 160:320-325. [PMID: 30509152 DOI: 10.1177/0194599818815144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe a 3D-printed middle ear model that quantifies the force applied to the modeled incus. To compare the forces applied during placement and crimping of a stapes prosthesis between the Robotic ENT Microsurgery System ( REMS) and the freehand technique in this model. STUDY DESIGN Prospective feasibility study. SETTING Robotics laboratory. SUBJECTS AND METHODS A middle ear model was designed and 3D printed to facilitate placement and crimping of a piston prosthesis. The modeled incus was mounted to a 6-degree of freedom force sensor to measure forces/torques applied on the incus. Six participants-1 fellowship-trained neurotologist, 2 neurotology fellows, and 3 otolaryngology-head and neck surgery residents-placed and crimped a piston prosthesis in this model, 3 times freehand and 3 times REMS assisted. Maximum force applied to the incus was then calculated for prosthesis placement and crimping from force/torque sensor readings for each trial. Robotic and freehand outcomes were compared with a linear regression model. RESULTS Mean maximum magnitude of force during prosthesis placement was 126.4 ± 73.6 mN and 105.0 ± 69.4 mN for the freehand and robotic techniques, respectively ( P = .404). For prosthesis crimping, the mean maximum magnitude of force was 469.3 ± 225.2 mN for the freehand technique and 272.7 ± 97.4 mN for the robotic technique ( P = .049). CONCLUSIONS Preliminary data demonstrate that REMS-assisted stapes prosthesis placement and crimping are feasible with a significant reduction in maximum force applied to the incus during crimping with the REMS in comparison with freehand.
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Affiliation(s)
- Christopher R Razavi
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul R Wilkening
- 2 Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rui Yin
- 2 Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nicolas Lamaison
- 2 Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Russell H Taylor
- 2 Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P Carey
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Francis X Creighton
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Guyader E, Savéan J, Clodic C, Letellier P, Meriot P, Marianowski R. Three-dimensional reconstruction of the temporal bone: Comparison of in situ, CT, and CBCT measurements. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:393-398. [DOI: 10.1016/j.anorl.2018.08.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chang J, Wu X, Kahng PW, Halter RJ, Paydarfar JA. Cadaver head holder for transoral surgical simulation. Laryngoscope 2018. [PMID: 29536544 DOI: 10.1002/lary.27161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jiyoo Chang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Xiaotian Wu
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Peter W Kahng
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Ryan J Halter
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire, U.S.A
| | - Joseph A Paydarfar
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.,Section of Otolaryngology, Audiology and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire, U.S.A
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Zhou Y, Wijewickrema S, Ioannou I, Bailey J, Kennedy G, Nestel D, O’Leary S. Do experts practice what they profess? PLoS One 2018; 13:e0190611. [PMID: 29304127 PMCID: PMC5755879 DOI: 10.1371/journal.pone.0190611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/18/2017] [Indexed: 12/03/2022] Open
Abstract
We investigated the variation of drilled regions of expert and trainee surgeons performing virtual temporal bone surgery to identify their compliance with standard drilling procedures. To this end, we recruited seven expert and six trainee ENT surgeons, who were asked to perform the surgical preparations for cochlear implantation on a virtual temporal bone. The temporal bone was divided into six regions using a semi-automated approach. The drilled area in each region was compared between groups using a sign test. Similarity within groups was calculated as a ratio of voxels (3D points) drilled by at least 75% of surgeons and at least 25% of surgeons. We observed a significant difference between groups when performing critical tasks such as exposing the facial nerve, opening the facial recess, and finding the round window. In these regions, experts’ practice is more similar to each other than that between trainees. Consistent with models of skills development, expertise and expert-performance, the outcome of the analysis shows that experts perform similarly in critical parts of the procedure, and do indeed practice what they profess.
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Affiliation(s)
- Yun Zhou
- Department of Surgery (Otolaryngology), University of Melbourne, Melbourne, Australia
| | - Sudanthi Wijewickrema
- Department of Surgery (Otolaryngology), University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Ioanna Ioannou
- Department of Surgery (Otolaryngology), University of Melbourne, Melbourne, Australia
| | - James Bailey
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Gregor Kennedy
- Melbourne Centre for the Study of Higher Education, University of Melbourne, Melbourne, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Melbourne, Australia
| | - Stephen O’Leary
- Department of Surgery (Otolaryngology), University of Melbourne, Melbourne, Australia
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European status on temporal bone training: a questionnaire study. Eur Arch Otorhinolaryngol 2017; 275:357-363. [PMID: 29185029 DOI: 10.1007/s00405-017-4824-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE In otorhinolaryngology training, introduction to temporal bone surgery through hands-on practice on cadaveric human temporal bones is the gold-standard training method before commencing supervised surgery. During the recent decades, the availability of such specimens and the necessary laboratory facilities for training seems to be decreasing. Alternatives to traditional training can consist of drilling artificial models made of plaster or plastic but also virtual reality (VR) simulation. Nevertheless, the integration and availability of these alternatives into specialist training programs remain unknown. METHODS We conducted a questionnaire study mapping current status on temporal bone training and included responses from 113 departments from 23 countries throughout Europe. RESULTS In general, temporal bone training during residency in ORL is organized as in-house training, or as participation in national or international temporal bone courses or some combination hereof. There are considerable differences in the availability of training facilities for temporal bone surgery and the number of drillings each ORL trainee can perform. Cadaveric dissection is still the most commonly used training modality. CONCLUSIONS VR simulation and artificial models are reported to be used at many leading training departments already. Decreasing availability of cadavers, lower costs of VR simulation and artificial models, in addition to established evidence for a positive effect on the trainees' competency, were reported as the main reasons. Most remaining departments expect to implement VR simulation and artificial models for temporal bone training into their residency programs in the near future.
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40
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Transparent model of temporal bone and vestibulocochlear organ made by 3D printing. Anat Sci Int 2017; 93:154-159. [DOI: 10.1007/s12565-017-0417-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/11/2017] [Indexed: 11/25/2022]
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41
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Comparison of Experts and Residents Performing a Complex Procedure in a Temporal Bone Surgery Simulator. Otol Neurotol 2017; 38:e85-e91. [DOI: 10.1097/mao.0000000000001398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Suzuki R, Konno N, Ishizawa A, Kanatsu Y, Funakoshi K, Akashi H, Zhou M, Abe H. Time-saving and fail-safe dissection method for vestibulocochlear organs in gross anatomy classes. Clin Anat 2017; 30:703-710. [PMID: 28459129 DOI: 10.1002/ca.22891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 11/10/2022]
Abstract
Because the vestibulocochlear organs are tiny and complex, and are covered by the petrous part of the temporal bone, they are very difficult for medical students to dissect and visualize during gross anatomy classes. Here, we report a time-saving and fail-safe procedure we have devised, using a hand-held hobby router. Nine en bloc temporal bone samples from donated human cadavers were used as trial materials for devising an appropriate procedure for dissecting the vestibulocochlear organs. A hand-held hobby router was used to cut through the temporal bone. After trials, the most time-saving and fail-safe method was selected. The performance of the selected method was assessed by a survey of 242 sides of 121 cadavers during gross anatomy classes for vestibulocochlear dissection. The assessment was based on the observation ratio. The best procedure appeared to be removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof. The whole procedure was completed within two dissection classes, each lasting 4.5 hr. The ratio of surveillance for the chorda tympani and three semicircular canals by students was significantly improved during 2013 through 2016. In our dissection class, "removal of the external acoustic meatus roof and tympanic cavity roof together with removal of the internal acoustic meatus roof" was the best procedure for students in the limited time available. Clin. Anat. 30:703-710, 2017. © 2017Wiley Periodicals, Inc.
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Affiliation(s)
- Ryoji Suzuki
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Naoaki Konno
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Akimitsu Ishizawa
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Yoshinori Kanatsu
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Kodai Funakoshi
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Hideo Akashi
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Ming Zhou
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
| | - Hiroshi Abe
- Department of Anatomy, Akita University Graduate School of Medicine, Akita city, Akita prefecture, Japan
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43
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Modifications to a 3D-printed temporal bone model for augmented stapes fixation surgery teaching. Eur Arch Otorhinolaryngol 2017; 274:2733-2739. [DOI: 10.1007/s00405-017-4572-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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44
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Copson B, Wijewickrema S, Zhou Y, Piromchai P, Briggs R, Bailey J, Kennedy G, O'Leary S. Supporting skill acquisition in cochlear implant surgery through virtual reality simulation. Cochlear Implants Int 2017; 18:89-96. [DOI: 10.1080/14670100.2017.1289299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bridget Copson
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
| | | | - Yun Zhou
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
| | - Patorn Piromchai
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
- Department of Otorhinolaryngology, Khon Kaen University, Thailand
| | - Robert Briggs
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
| | - James Bailey
- Department of Computing and Information Systems, University of Melbourne, Australia
| | - Gregor Kennedy
- Melbourne Centre for the Study of Higher Education, University of Melbourne, Australia
| | - Stephen O'Leary
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
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Establishing a Temporal Bone Laboratory in Teaching Institutes to Train Future Otorhinolaryngologists and Fundamentals of Temporal Bone Laboratory: Considerations and Requirements. Indian J Otolaryngol Head Neck Surg 2016; 68:451-455. [PMID: 27833871 DOI: 10.1007/s12070-015-0962-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022] Open
Abstract
Temporal bone dissection has important role in educating, and training the surgeons. Temporal bone has complicated three dimensional anatomy and it is challenging for young surgeons to understand and operate. Not knowing the anatomy may cause serious consequences to patient due to injury to vital structures. It is important to learn temporal bone harvesting techniques, preservation of specimens, fixation and to reduce the health hazards posed by these specimens by taking safety measures. Spending more time in temporal bone laboratory and repeated dissection of temporal bones provides the skills necessary in the operating room for future generation. All training institutes should establish temporal bone laboratory in their department to provide the necessary expertise to future generation while maintaining safe and secure environment.
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Barber SR, Kozin ED, Dedmon M, Lin BM, Lee K, Sinha S, Black N, Remenschneider AK, Lee DJ. 3D-printed pediatric endoscopic ear surgery simulator for surgical training. Int J Pediatr Otorhinolaryngol 2016; 90:113-118. [PMID: 27729115 DOI: 10.1016/j.ijporl.2016.08.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator. METHODS The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service. RESULTS All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant hand (p < 0.05) and average completion time for junior and senior residents (p < 0.05) suggest construct validity. CONCLUSIONS A 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation.
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Affiliation(s)
- Samuel R Barber
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Elliott D Kozin
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
| | - Matthew Dedmon
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Brian M Lin
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Kyuwon Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Sumi Sinha
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Nicole Black
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | - Aaron K Remenschneider
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Daniel J Lee
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Conlin A, Lea J, Bance M, Chadha N, Kilty S, Kozak F, Savage J, Sidhu R, Chen J, Westerberg BD. Mental practice in postgraduate training: a randomized controlled trial in mastoidectomy skills. J Otolaryngol Head Neck Surg 2016; 45:46. [PMID: 27634316 PMCID: PMC5025613 DOI: 10.1186/s40463-016-0162-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/10/2016] [Indexed: 01/22/2023] Open
Abstract
Background Mental practice, the cognitive rehearsal of a task in the absence of overt physical movement, has been successfully used in teaching complex psychomotor tasks including sports and music, and recently, surgical skills. The objectives of this study were, 1) To develop and evaluate a mental practice protocol for mastoidectomy 2) To assess the immediate impact of mental practice on a mastoidectomy surgical task among senior Otolaryngology─Head & Neck Surgery (OHNS) residents. Method Three expert surgeons were interviewed using verbal protocol analysis to develop a mastoidectomy mental practice script. Twelve senior Residents from Canadian training programs were randomized into two groups. All Residents were video-recorded performing a baseline mastoidectomy in a temporal bone lab. The intervention group received mental practice training, while the control group undertook self-directed textbook study. All subjects were then video-recorded performing a second mastoidectomy. Changes in pre- and post-test scores using validated expert ratings, the Task Specific Evaluation of Mastoidectomy and the Global Evaluation of Mastoidectomy, were statistically analyzed. Results A mental practice script was successfully developed based on interviews of three expert surgeon-educators. Task Specific Evaluation and Global Evaluation scores increased in both the mental practice and textbook study groups; there was no significant difference between the two groups in the change in scores post-intervention. There was a high and statistically signficant correlation between evaluators on the outcome measures. Conclusions We were not able to demonstrate a significant difference for the benefits of mental practice in mastoidectomy, possibly due to the sample size. However, mental practice is a surgical education tool which is portable, accessible, inexpensive and safe. Electronic supplementary material The online version of this article (doi:10.1186/s40463-016-0162-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Conlin
- Division of Otolaryngology-Head and Neck Surgery, B. C. Rotary Hearing and Balance Centre at St Paul's Hospital, University of British Columbia, Providence 2 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jane Lea
- Division of Otolaryngology-Head and Neck Surgery, B. C. Rotary Hearing and Balance Centre at St Paul's Hospital, University of British Columbia, Providence 2 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Manohar Bance
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Neil Chadha
- Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Children's Hospital, Vancouver, BC, Canada
| | - Shaun Kilty
- Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Frederick Kozak
- Division of Pediatric Otolaryngology-Head and Neck Surgery, B.C. Children's Hospital, Vancouver, BC, Canada
| | - Julian Savage
- Division of Otolaryngology-Head & Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Ravindar Sidhu
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Joseph Chen
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian D Westerberg
- Division of Otolaryngology-Head and Neck Surgery, B. C. Rotary Hearing and Balance Centre at St Paul's Hospital, University of British Columbia, Providence 2 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Hiraumi H, Sato H, Ito J. Papercraft temporal bone in the first step of anatomy education. Auris Nasus Larynx 2016; 44:277-281. [PMID: 27544628 DOI: 10.1016/j.anl.2016.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE (1) To compare temporal bone anatomy comprehension taught to speech therapy students with or without a papercraft model. (2) To explore the effect of papercraft simulation on the understanding of surgical approaches in first-year residents. METHODS (1) One-hundred and ten speech therapy students were divided into three classes. The first class was taught with a lecture only. The students in the second class were given a lecture and a papercraft modeling task without instruction. The third class modeled a papercraft with instruction after the lecture. The students were tested on their understanding of temporal bone anatomy. (2) A questionnaire on the understanding of surgical approaches was completed by 10 residents before and after the papercraft modeling. The papercraft models were cut with scissors to simulate surgical approaches. RESULTS (1) The average scores were 4.4/8 for the first class, 4.3/8 for the second class, and 6.3/8 for the third class. The third class had significantly better results than the other classes (p<0.01, Kruskal-Wallis test). (2) The average scores before and after the papercraft modeling and cutting were 2.6/7 and 4.9/7, respectively. The numerical rating scale score significantly improved (p<0.01, Wilcoxon signed-rank test). CONCLUSION The instruction of the anatomy using a papercraft temporal bone model is effective in the first step of learning temporal bone anatomy and surgical approaches.
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Affiliation(s)
- Harukazu Hiraumi
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, Morioka, Japan; Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Kyoto College of Medical Health, Kyoto, Japan.
| | - Hiroaki Sato
- Department of Otolaryngology, Head and Neck Surgery, Iwate Medical University, Morioka, Japan
| | - Juichi Ito
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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49
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Andersen SAW, Konge L, Mikkelsen PT, Cayé-Thomasen P, Sørensen MS. Mapping the plateau of novices in virtual reality simulation training of mastoidectomy. Laryngoscope 2016; 127:907-914. [DOI: 10.1002/lary.26000] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation; Centre for HR; the Capital Region of Denmark Copenhagen Denmark
| | | | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head ad Neck Surgery; Rigshospitalet; Denmark
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50
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Senior A, Mitchell-Innes A, Scott A. The novel affordable telford temporal bone holder. Clin Otolaryngol 2016; 42:1438-1439. [PMID: 26945911 DOI: 10.1111/coa.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A Senior
- ENT department, Princess Royal Hospital, Telford, UK
| | | | - A Scott
- Princess Royal Hospital, Telford, UK
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