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Journal Watch : Vol8, No9

Development of surgical skill with singular neurectomy using human cadaveric temporal bones.

Department
of Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz,
Austria; Division of Anatomy, CMU, Geneva, Switzerland.

BACKGROUND:
Profound anatomical knowledge and surgical experience are essential for
safe otological surgery. The surgeon’s learning curve is evaluated in
performing Gacek’s singular neurectomy on cadaveric specimens.
MATERIALS AND METHOD: One otological surgeon performed Gacek’s approach
on 96 halves of human heads embalmed according to Thiel’s method,
divided into four groups (24 halves per group) and evaluated them
concurrent to the evaluation of an anatomist after a first surgical
attempt. Successful operations were subdivided into “direct hits” of
the osseous canal of the posterior ampullary nerve also known as the
singular nerve and “indirect hits” with access to the posterior
ampullary recess. Unsuccessful operations showed “no hit” of the nerve
without lesion of the membranous labyrinth. “Indirect” or “no hits”
were reinvestigated in a second attempt to evaluate possible
reclassifications due to a learning process of the surgeon. The order
of dissection, the rate of success and the changes of results in
correlation with the numbers of dissected specimens were documented.
RESULTS: The success rate significantly increased from 54.2% direct
hits after the first group to 87.36% in the fourth group after the
first attempt. Successful operations were performed in 86.5% after
completion of the first attempt and 97.9% after the second attempt. The
number of new allocations decreased from 11 cases in the first group of
dissected specimens to zero in the fourth group. CONCLUSIONS: This
paper strengthens the value of cadaveric training for surgeons and the
crucial role of dissection of a large number of specimens in
improvement of the surgeon’s experience and success rate.

Source: Ann Anat. 2008;190(4):316-23