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Positioning Accuracy in Otosurgery Measured with Optical Tracking.

Óvári A, Neményi D, Just T, Schuldt T, Buhr A, Mlynski R, Csókay A, Pau HW, Valálik I - PLoS ONE (2016)

Bottom Line: Instrument marker trajectories were compared within groups of experienced and less experienced surgeons performing uncompensated or compensated exercises.Experienced surgeons have significantly better positioning accuracy than novice ear surgeons in terms of mean displacement values of marker trajectories.The instrument support and the two-handed instrument holding techniques significantly reduce surgeons' tremor.

View Article: PubMed Central - PubMed

Affiliation: Department of Oto-Rhino-Laryngology, Head & Neck Surgery, "Otto Koerner", University Medical Center, Rostock, Germany.

ABSTRACT

Objectives: To assess positioning accuracy in otosurgery and to test the impact of the two-handed instrument holding technique and the instrument support technique on surgical precision. To test an otologic training model with optical tracking.

Study design: In total, 14 ENT surgeons in the same department with different levels of surgical experience performed static and dynamic tasks with otologic microinstruments under simulated otosurgical conditions.

Methods: Tip motion of the microinstrument was registered in three dimensions by optical tracking during 10 different tasks simulating surgical steps such as prosthesis crimping and dissection of the middle ear using formalin-fixed temporal bone. Instrument marker trajectories were compared within groups of experienced and less experienced surgeons performing uncompensated or compensated exercises.

Results: Experienced surgeons have significantly better positioning accuracy than novice ear surgeons in terms of mean displacement values of marker trajectories. The instrument support and the two-handed instrument holding techniques significantly reduce surgeons' tremor. The laboratory set-up presented in this study provides precise feedback for otosurgeons about their surgical skills and proved to be a useful device for otosurgical training.

Conclusions: Simple tremor compensation techniques may offer trainees the potential to improve their positioning accuracy to the level of more experienced surgeons. Training in an experimental otologic environment with optical tracking may aid acquisition of technical skills in middle ear surgery and potentially shorten the learning curve. Thus, simulated exercises of surgical steps should be integrated into the training of otosurgeons.

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Related in: MedlinePlus

3-D marker trajectories.3-D marker trajectories of the instrument tip (test person 4). Purple line: axis of the instrument (forceps). Top: one-handed uncompensated manipulation (task 4); bottom: manipulation with IS (task 6).
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pone.0152623.g008: 3-D marker trajectories.3-D marker trajectories of the instrument tip (test person 4). Purple line: axis of the instrument (forceps). Top: one-handed uncompensated manipulation (task 4); bottom: manipulation with IS (task 6).

Mentions: When using the forceps, comparison of marker trajectories showed a significant regression of trajectory field ranges with both two-handed and IS techniques relative to free one-handed manipulation in the dynamic tasks (tasks 4, 5 and 6) (Table 4). Root mean square (rms) displacement values with the IS technique decreased significantly more than with the two-handed manipulation technique (Table 4). Fig 8 demonstrates the extent of reduction in tremor amplitude measured at the instrument tip (one-handed uncompensated manipulation versus IS) for three axis.


Positioning Accuracy in Otosurgery Measured with Optical Tracking.

Óvári A, Neményi D, Just T, Schuldt T, Buhr A, Mlynski R, Csókay A, Pau HW, Valálik I - PLoS ONE (2016)

3-D marker trajectories.3-D marker trajectories of the instrument tip (test person 4). Purple line: axis of the instrument (forceps). Top: one-handed uncompensated manipulation (task 4); bottom: manipulation with IS (task 6).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4814076&req=5

pone.0152623.g008: 3-D marker trajectories.3-D marker trajectories of the instrument tip (test person 4). Purple line: axis of the instrument (forceps). Top: one-handed uncompensated manipulation (task 4); bottom: manipulation with IS (task 6).
Mentions: When using the forceps, comparison of marker trajectories showed a significant regression of trajectory field ranges with both two-handed and IS techniques relative to free one-handed manipulation in the dynamic tasks (tasks 4, 5 and 6) (Table 4). Root mean square (rms) displacement values with the IS technique decreased significantly more than with the two-handed manipulation technique (Table 4). Fig 8 demonstrates the extent of reduction in tremor amplitude measured at the instrument tip (one-handed uncompensated manipulation versus IS) for three axis.

Bottom Line: Instrument marker trajectories were compared within groups of experienced and less experienced surgeons performing uncompensated or compensated exercises.Experienced surgeons have significantly better positioning accuracy than novice ear surgeons in terms of mean displacement values of marker trajectories.The instrument support and the two-handed instrument holding techniques significantly reduce surgeons' tremor.

View Article: PubMed Central - PubMed

Affiliation: Department of Oto-Rhino-Laryngology, Head & Neck Surgery, "Otto Koerner", University Medical Center, Rostock, Germany.

ABSTRACT

Objectives: To assess positioning accuracy in otosurgery and to test the impact of the two-handed instrument holding technique and the instrument support technique on surgical precision. To test an otologic training model with optical tracking.

Study design: In total, 14 ENT surgeons in the same department with different levels of surgical experience performed static and dynamic tasks with otologic microinstruments under simulated otosurgical conditions.

Methods: Tip motion of the microinstrument was registered in three dimensions by optical tracking during 10 different tasks simulating surgical steps such as prosthesis crimping and dissection of the middle ear using formalin-fixed temporal bone. Instrument marker trajectories were compared within groups of experienced and less experienced surgeons performing uncompensated or compensated exercises.

Results: Experienced surgeons have significantly better positioning accuracy than novice ear surgeons in terms of mean displacement values of marker trajectories. The instrument support and the two-handed instrument holding techniques significantly reduce surgeons' tremor. The laboratory set-up presented in this study provides precise feedback for otosurgeons about their surgical skills and proved to be a useful device for otosurgical training.

Conclusions: Simple tremor compensation techniques may offer trainees the potential to improve their positioning accuracy to the level of more experienced surgeons. Training in an experimental otologic environment with optical tracking may aid acquisition of technical skills in middle ear surgery and potentially shorten the learning curve. Thus, simulated exercises of surgical steps should be integrated into the training of otosurgeons.

Show MeSH
Related in: MedlinePlus