Theodoraki M N, Ledderose G J, Becker S, Leunig A, Arpe S, Luz M, Stelter K
Department of Otorhinolaryngology Head and Neck Surgery, University of Ulm, University Clinic of Ulm, Ulm, Germany.
Department of Otorhinolaryngology Head and Neck Surgery, Ludwig Maximilians University, Munich, Germany.
Eur Arch Otorhinolaryngol. 2015 Apr;272(4):905-913. doi: 10.1007/s00405-014-3194-0. Epub 2014 Jul 10.
The use of image-guided navigation systems in the training of FESS is discussed controversy. Many experienced sinus surgeons report a better spatial orientation and an improved situational awareness intraoperatively. But many fear that the navigation system could be a disadvantage in the surgical training because of a higher mental demand and a possible loss of surgical skills. This clinical field study investigates mental and physical demands during transnasal surgery with and without the aid of a navigation system at an early stage in FESS training. Thirty-two endonasal sinus surgeries done by eight different trainee surgeons were included. After randomization, one side of each patient was operated by use of a navigation system, the other side without. During the whole surgery, the surgeons were connected to a biofeedback device measuring the heart rate, the heart rate variability, the respiratory frequency and the masticator EMG. Stress situations could be identified by an increase of the heart rate frequency and a decrease of the heart rate variability. The mental workload during a FESS procedure is high compared to the baseline before and after surgery. The mental workload level when using the navigation did not significantly differ from the side without using the navigation. Residents with more than 30 FESS procedures already done, showed a slightly decreased mental workload when using the navigation. An additional workload shift toward the navigation system could not be observed in any surgeon. Remarkable other stressors could be identified during this study: the behavior of the supervisor or the use of the 45° endoscope, other colleagues or students entering the theatre, poor vision due to bleeding and the preoperative waiting when measuring the baseline. The mental load of young surgeons in FESS surgery is tremendous. The application of a navigation system did not cause a higher mental workload or distress. The device showed a positive effort to engage for the trainees with more than 30 FESS procedures done. In this subgroup it even leads to decreased mental workload.
图像引导导航系统在功能性鼻内镜鼻窦手术（FESS）培训中的应用存在争议。许多经验丰富的鼻窦外科医生报告称，术中空间定向更好，态势感知能力有所提高。但许多人担心，由于精神需求较高且可能导致手术技能丧失，导航系统在外科培训中可能会成为一个劣势。这项临床实地研究调查了在FESS培训早期，使用和不使用导航系统进行经鼻手术期间的精神和身体需求。纳入了由8名不同实习外科医生进行的32例鼻内鼻窦手术。随机分组后，每位患者的一侧使用导航系统进行手术，另一侧不使用。在整个手术过程中，外科医生连接到一个生物反馈设备，该设备测量心率、心率变异性、呼吸频率和咀嚼肌肌电图。心率频率增加和心率变异性降低可识别应激情况。与手术前后的基线相比，FESS手术过程中的精神工作量较高。使用导航时的精神工作量水平与不使用导航的一侧没有显著差异。已经完成30多例FESS手术的住院医生在使用导航时精神工作量略有下降。在任何外科医生中都未观察到额外的工作量转移到导航系统上。在这项研究中还可以识别出其他显著的应激源：上级的行为或45°内窥镜的使用、其他同事或学生进入手术室、因出血导致的视力不佳以及测量基线时的术前等待。FESS手术中年轻外科医生的精神负担巨大。导航系统的应用并未导致更高的精神工作量或困扰。对于已经完成30多例FESS手术的实习生，该设备显示出积极的作用。在这个亚组中，它甚至导致精神工作量下降。
