Ovine Endoscopic Ear Surgery - Accessible Smartphone-Based Training Model

Background: Understanding middle ear anatomy, in addition to endoscopic surgical skill acquisition, is an arduous task. Mastering 3-dimensional conceptualization and surgical dexterity may take many years. The coronavirus pandemic has made training difficult and complicated due to social distancing and risk of aerosolized viral spread in cadaver dissection. In this study we suggest a smartphone-based endoscope ovine head cadaveric dissection which is a simple, safe, and affordable training model for residents as an initial step in otologic endoscopic surgery training.Methods: A stepwise depiction of endoscopic ovine middle ear surgery; from cadaver and equipment acquisition, setting preparation, to surgical explanation and procedural steps. Results: The smartphone-based endoscopic otological ovine dissection model provides a low-cost, easily accessible and easily deployable training model for the novice surgeon world-wide. This model permits the novice surgeon a comprehensive anatomical understanding, middle ear proprioception, as well as a "safe" practicing model for diverse middle ear procedures. Conclusions: The ovine cadaver otological smartphone-based endoscopic surgery training model is an affordable, easy, reproducible, and transportable model, which makes it an ideal model from implementation in both low-middle and high-income countries.

Tips, Tricks, and Guides in Descemet Membrane Endothelial Keratoplasty Learning Curve

Lamellar keratoplasty is fast becoming the most popular form of corneal transplantation. The adoption of Descemet membrane endothelial keratoplasty (DMEK) in the management of Fuchs endothelial dystrophy and pseudophakic bullous keratopathy is partly responsible for this shift in the paradigm of management of corneal pathology. The learning curve of DMEK, however, has been proven to be much steeper than previous endothelial keratoplasty procedures. To ease the procedure, experts have proposed multiple innovative techniques from tissue preparation to graft unfolding to aid the more novice surgeon. Here, we collate and share tips and tricks from our collective experiences to support the learning curve and outcomes in DMEK for both the novice and more experienced corneal transplant surgeons.

Experience level as a predictor of entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy

Objectives The study hypotheses were as follows: (1) owing to the unique anatomy of the feline middle ear, the hypotympanum would be entered in less than 100% of cats during total ear canal ablation and lateral bulla osteotomies (TECA-LBOs); and (2) incomplete penetration of the septum and subsequent failure to enter the hypotympanum is more likely to occur in surgeries performed by a novice surgeon when compared with an experienced surgeon and may be under-recognized. Methods Head CT was performed in 12 feline cadavers to confirm absence of gross ear disease. A novice surgeon and an experienced surgeon were randomly assigned to perform TECA-LBO on the left or right ear. Surgeons were blinded to each other’s surgical technique. CT of cadavers was performed after the procedure. Successful penetration of the septum, entry into the hypotympanic cavity and amount of bone removed in bulla osteotomy, quantified via CT, were compared between the novice surgeon and experienced surgeon. Results The novice surgeon entered the hypotympanum in 3/12 (25%) procedures, compared with 9/12 (75%) procedures performed by the experienced surgeon. The experienced surgeon performed a larger osteotomy than the novice surgeon (3301 mm vs 1376 mm, P<0.0023). Regardless of surgeon experience, more bone was removed in surgeries in which the hypotympanum was entered. Conclusions and relevance Our results underscore the need for familiarity with feline middle ear anatomy when performing TECA-LBOs. Postoperative CT is recommended for novice surgeons to confirm entry into the hypotympanum.

Suturing large therapeutic corneal grafts based on donor size: A simplified technique for the novice corneal surgeon

Purpose: We describe a simple technique for achieving radial and equally spaced sutures by novice corneal surgeon in cases of large penetrating keratoplasties. Method: A simple mathematical equation was derived for precise calculation of spacing between interrupted sutures in large grafts ( n = 50). The ubiquitous and easily available Castroviejo calipers were used to mark the donor cornea according to the derived formula. Interrupted sutures were passed over the pre-marked points and tied. Radiality was assessed in the post-operative period. Results: A total of 50 eyes undergoing therapeutic keratoplasty with graft size between 9 and 12 mm were enrolled. Equally spaced and radially aligned sutures were achieved in all cases postoperatively with watertight apposition of the graft host junction using our simple technique. Conclusion: The Castroviejo caliper can be effectively used for equidistant spacing of interrupted sutures in large therapeutic grafts by a novice surgeon thereby simplifying the procedure and reducing the surgical time.