Otolaryngology Head and Neck Surgery Department, Modena University, University Hospital of Modena (Policlinico Di Modena, Azienda Ospedaliero-Universitaria Di Modena, Università Di Modena E Reggio Emilia), Via del Pozzo 71, 41124, Modena, Italy.
Department of Otorhinolaryngology-Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Eur Arch Otorhinolaryngol. 2021 Apr;278(4):987-995. doi: 10.1007/s00405-020-06166-6. Epub 2020 Jun 26.
The learning curve in endoscopic stapes surgery, is flat and long. There is limited space during training for advanced and salvage procedures, which could be necessary in unexpected intraoperative scenarios. The aim of the present study is to develop an ex-vivo animal model for training in salvage and advanced procedures in endoscopic stapes surgery METHODS: After defining the difficult intraoperative scenarios requiring a salvage procedure during stapes surgery, we used the ovine model to create those intraoperative situations. After assessing the suitability of the model for that purpose, it was validated by subjective feedback rating (scale from 1 to 10) and by comparing the relevant anatomical structures for stapes surgery with the human. Finally, an optimal sequence of surgical steps was defined.
8 Fresh frozen lamb heads (16 ears) were studied. The selected intraoperative scenarios were: floating footplate, footplate fracture, luxation of the incus or necrosis of the long process, overhanging facial nerve, obliterative otosclerosis. The simulation resulted feasible and close to real. The mean overall rating for surgical scenarios ranged from 7.5 to 8.8 for residents and was consistent with the rating of senior surgeons, ranging from 7.67 and 9.0. Anatomical measures of the oval window area resulted similar between the ovine and the human.
The ex-vivo ovine model is a suitable model for training in salvage and advanced procedures in exclusively endoscopic stapes surgery. The model can be used both for the training and maintenance of the acquired advanced skills in endoscopic stapes surgery.
耳内镜镫骨手术的学习曲线是平坦而漫长的。在培训过程中，高级和挽救性手术的空间有限，而这些手术在意外的手术场景中可能是必要的。本研究的目的是开发一种用于培训耳内镜镫骨手术中挽救性和高级手术的体外动物模型。
在确定需要在镫骨手术中进行挽救性手术的困难手术场景后，我们使用绵羊模型来创建这些手术场景。在评估该模型在该目的下的适用性后，通过主观反馈评分（1 到 10 分）和比较与人类相关的镫骨手术解剖结构进行验证。最后，确定了最佳的手术步骤序列。
研究了 8 个新鲜冷冻的羊头（16 只耳朵）。选择的手术场景包括：浮动镫骨板、镫骨板骨折、砧骨脱位或长突骨坏死、面神经突出、闭塞性耳硬化症。模拟结果可行且接近真实。居民的手术场景总体评分从 7.5 到 8.8 不等，与高级外科医生的评分一致，范围从 7.67 到 9.0。卵圆窗区域的解剖学测量结果在绵羊和人类之间相似。
体外绵羊模型是专门进行耳内镜镫骨手术的挽救性和高级手术培训的合适模型。该模型可用于培训和维持在耳内镜镫骨手术中获得的高级技能。
