An Integrated (Microscopic/Endoscopic) Dissection Ear Surgery Course

Abstract

Traditionally, otologic surgical training consisted of microscopic cadaveric dissections. However, during the last decades the endoscope has significantly changed the surgical perspective in the otologic field. Thus, the modern ear and lateral skull base surgeon should master the entire spectrum of endoscopic and microscopic approaches, with the aim of tailoring the procedure and guaranteeing the best possible functional outcome. This work proposes a step-by-step guided and illustrated dissection course, including indications for the setup of the cadaver lab and the integration of the microscope and endoscope to enhance the use of both instruments. The alternation of the endoscope and microscope allows the novice to train the correct handling of the instruments in the surgical field under both optical views. This aspect is of utmost importance since it is not advisable to start off a technique without practicing the other one, as both are important and complementary in the modern otologic surgery setting.

Introduction

Traditionally, otologic surgical training consisted of microscopic cadaveric dissection in order to develop both transcanal and transmastoid procedures. However, during the last decades the endoscope has significantly changed the surgical perspective. Nowadays, a consistent number of patients can benefit from minimally invasive endoscopic ear surgeries^1,2,3,4,5,6. Thus, the modern otologic surgeon should master the entire spectrum of both endoscopic and microscopic approac....

Protocol

The following protocol follows the guidelines of our institution's human research ethics committee. The ethics committee approved the protocol.

1. Preparation of the specimen

1. Position a vacuum mattress on the dissection table and cover it with a sterile and resorbable blanket. Lay the anatomical specimen in a surgical position on the mattress with the head rotated to the contralateral side.
2. Cover the specimen with a blanket sparing the external ear an.......

Discussion

The proposed integrated microscopic and endoscopic dissection course manual is thought to maximize the capability to perform different otologic approaches on a single anatomic specimen. By alternating the two instruments, the trainee can perform a stepwise dissection that preserves the anatomical landmarks needed for the further surgical steps, enhancing the use of the microscope and the endoscope. In fact, the modern ear and lateral skull base surgeon should master the entire spectrum of these approaches to tailor the i.......

Materials

Name	Company	Catalog Number	Comments
Antifog solution	-		Consumables
Aspirator (power 40 L/min)	-
Cadaveric Specimen	-
Cold light source with cable	STORZ
Cotton pads	-		Consumables
Cottonoid pledges	-		Consumables
Endoscope 3mm diameter, 15cm length, 0° and 45°	STORZ	Instrument Set for Endoscopic Middle Ear Surgery Karl Storz 7220AA
Endoscope 3mm diameter, 15cm length, 45°	STORZ	Instrument Set for Endoscopic Middle Ear Surgery Karl Storz 7220FA
Gloves	-		Consumables
Gown	-		Consumables
High definition camera head	STORZ	TH110	Video equipment
High-speed drill (micromotor, handpieces, set of burrs)	MEDTRONIC	1898001; 1898430; 1845000; 1845010; 1845020; 1845030
Mask	-		Consumables
Microscope	LEICA	M320 F12 for ENT
Otologic dissectors, round knifes, hooks, curette, microscissors (Bellucci) and microforceps (Hartmann)	STORZ	Instrument Set for Otologic Surgery Karl Storz 224003; 224004; 226211; 221100; 226810; 226815; 226820; 222602; 222605L; 222604R; 153800; 154800; 161000; 192206; 222800;
Piezosurgery	MECTRON	5170003;
Scalpel n° 11	-
Scissors	-
Straight and curved suction tubes	-
Telepack	STORZ	TP101	Video equipment
USB for recording	STORZ	20040282	Video equipment
Vacuum matress or temporal bone holder	-
Water to rinse	-		Consumables