title: [Evaluation of a training system for middle ear surgery with optoelectric detection].
abstract: OBJECTIVE
  This work presents a new training concept for surgery of the temporal bone. It is based on a model of gypsum plastic with optoelectric detection of risk structures. A prototypical evaluation is given.
  
  
  METHODS
  The training models are based on high-resolution computed tomographic data of a human skull. The resulting data set was printed by a three-dimensional (3D) printer. A 3D phantom is created from gypsum powder and a bonding agent. Risks structures are the facial nerve, semicircular canal, cochlea, ossicular chain, sigmoid sinus, dura, and internal carotid artery. An electrically conductive metal (Wood's metal) and a fiber-optic cable were used as detection materials for the risk structures. For evaluating the training system, a study was done with eight inexperienced and eight experienced ear surgeons. They were asked to perform temporal bone surgery using two identical training models (group A). In group B, the same surgeons underwent surgical training with human cadavers. In the case of injuries, the number, point in time, degree (facial nerve), and injured structure were documented during the training on the model. In addition, the total time needed was noted.
  
  
  RESULTS
  The training systems could be used in all cases. Evaluation of the anatomic accuracy of the models showed results that were between 49.5% and 90% agreement with the anatomic origin. Error detection was evaluated with values between 79% and 100% agreement with the perception of an experienced surgeon. The operating setting was estimated to be better than the previous"gold standard." The possibility of completely replacing the previous training method, which uses cadavers, with the examined training model was affirmed.
  
  
  CONCLUSIONS
  This study shows that the examined system fulfills the conditions for a new training concept for temporal bone surgery. The system connects the preliminary work with printed and sintered models with the possibilities of microsystem engineering. In addition, the model's digital database permits a complete virtual representation of the model with appropriate further applications ("look behind the wall," virtual endoscopy).
authors.affiliation: Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Innovation Center Computer Assisted Surgery (ICCAS) der Universität, Liebigstrasse 10-14, 04103, Leipzig. Gero.Strauss@medizin.uni-leipzig.de
authors.forename: G
authors.initials: G
authors.lastname: Strauss
authors.forename: N
authors.initials: N
authors.lastname: Bahrami
authors.forename: A
authors.initials: A
authors.lastname: Pössneck
authors.forename: M
authors.initials: M
authors.lastname: Strauss
authors.forename: A
authors.initials: A
authors.lastname: Dietz
authors.forename: W
authors.initials: W
authors.lastname: Korb
authors.forename: T
authors.initials: T
authors.lastname: Lüth
authors.forename: R
authors.initials: R
authors.lastname: Haase
authors.forename: H
authors.initials: H
authors.lastname: Moeckel
authors.forename: R
authors.initials: R
authors.lastname: Grunert
mesh_terms: D003194:Computer-Assisted Instruction / Q000379:methods*; D004432:Ear, Middle / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005858:Germany; D006801:Humans; D008348:Manikins; D010027:Osteotomy / Q000193:education* / Q000379:methods; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education* / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*
references.citation: Otol Neurotol. 2002 Nov;23(6):832-5
references.pmid: 12438841
references.citation: HNO. 1998 Mar;46(3):246-51
references.pmid: 9583030
references.citation: HNO. 2006 Dec;54(12):947-57
references.pmid: 16625370
references.citation: J Am Coll Surg. 2004 Jan;198(1):105-10
references.pmid: 14698317
references.citation: Ergonomics. 2002 Apr 15;45(5):362-79
references.pmid: 12028721
references.citation: Laryngorhinootologie. 2003 Oct;82(10):683-6
references.pmid: 14593565
references.citation: Otol Neurotol. 2001 Jul;22(4):451-6
references.pmid: 11449098
references.citation: Acta Otolaryngol. 2004 May;124(4):400-2
references.pmid: 15224862
references.citation: Clin Otolaryngol Allied Sci. 1997 Aug;22(4):355-7
references.pmid: 9298612
references.citation: Laryngorhinootologie. 2004 Jun;83(6):363-6
references.pmid: 15197675
references.citation: ORL J Otorhinolaryngol Relat Spec. 2006;68(2):115-7
references.pmid: 16446558
references.citation: Laryngorhinootologie. 2005 May;84(5):335-44
references.pmid: 15909245
references.citation: Laryngoscope. 2007 Mar;117(3):434-41
references.pmid: 17334303
references.citation: Stud Health Technol Inform. 2003;94:4-10
references.pmid: 15455854
references.citation: Laryngoscope. 1994 Aug;104(8 Pt 1):922-6
references.pmid: 8052074
references.citation: Conf Proc IEEE Eng Med Biol Soc. 2006;2006:4408-11
references.pmid: 17945837
references.citation: Eur Arch Otorhinolaryngol. 2007 Jun;264(6):595-9
references.pmid: 17235531
references.citation: Am J Surg. 2002 Sep;184(3):291-5
references.pmid: 12354602
references.citation: J Am Coll Surg. 2001 Dec;193(6):660-5
references.pmid: 11768683
references.citation: Surgery. 2002 Mar;131(3):318-23
references.pmid: 11894037
references.citation: ORL J Otorhinolaryngol Relat Spec. 2002 Nov-Dec;64(6):378-81
references.pmid: 12499759
references.citation: Otolaryngol Head Neck Surg. 2005 Dec;133(6):911-5
references.pmid: 16360513
references.citation: J Laryngol Otol. 1997 Feb;111(2):113-6
references.pmid: 9102433
references.citation: Laryngoscope. 2007 Feb;117(2):258-63
references.pmid: 17204992