Variability of the mental representation of the cochlear anatomy during cochlear implantation.
The aim of this study was to assess the mental representation of the insertion axis of surgeons with different degrees of experience, and reproducibility of the insertion axis in repeated measures. A mastoidectomy and a posterior tympanotomy were prepared in five different artificial temporal bones. A cone-beam CT was performed for each temporal bone and the data were registered on a magnetic navigation system. In these five temporal bones, 16 surgeons (3 experts; >50 cochlear implant surgery/year; 7 fellows with few cochlear implant experience, and 6 residents) were asked to determine the optimal insertion axis according to their mental representation. Compared to a planned ideal axis, the insertion axis was better determined by the experts with higher accuracy (axial: 7° ± 1.5°, coronal: 6° ± 1.5°) than fellows (axial: 14° ± 1.7°, coronal: 13° ± 1.7°; p < 0.05), or residents (axial: 15° ± 1.5°; p < 0.001, coronal: 17° ± 1.9°; p < 0.001). This study suggests that mental representation of the cochlea is experience-dependent. A high variation of the insertion axis to the scala tympani can be observed due to the complexity of the temporal bone anatomy and lack of landmarks to determine scala tympani orientation. Navigation systems can be used to evaluate and improve mental representation of the insertion axis to the scala tympani for cochlear implant surgery.
Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Bâtiment Castaigne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|UPMC Univ. Paris 06, Sorbonne University, Paris, France.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.
Renato
R
Torres
UPMC Univ. Paris 06, Sorbonne University, Paris, France.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.|Shacra Inria, Lille Nord-Europe, Université Lille-1, Lille, France.
Guillaume
G
Kazmitcheff
Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Bâtiment Castaigne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|UPMC Univ. Paris 06, Sorbonne University, Paris, France.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.
Daniele
D
Bernardeschi
Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Bâtiment Castaigne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|UPMC Univ. Paris 06, Sorbonne University, Paris, France.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.|Department of Sense Organs, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
Daniele
D
De Seta
"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.|Cabinet de Radiologie, 106 bis Rue de Lourmel, 75015, Paris, France.
Jean Loup
JL
Bensimon
Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Bâtiment Castaigne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|UPMC Univ. Paris 06, Sorbonne University, Paris, France.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.
Evelyne
E
Ferrary
Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Bâtiment Castaigne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.|UPMC Univ. Paris 06, Sorbonne University, Paris, France.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France.
Olivier
O
Sterkers
Unit of Otology, Auditory Implants and Skull Base Surgery, Otorhinolaryngology Department, Pitié-Salpêtrière Hospital, AP-HP, Bâtiment Castaigne, 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France. yann.nguyen@inserm.fr.|UPMC Univ. Paris 06, Sorbonne University, Paris, France. yann.nguyen@inserm.fr.|"Minimally Invasive Robot-based Hearing Rehabilitation", UMR-S 1159, Paris 6 UMPC Univ, Inserm, Paris, France. yann.nguyen@inserm.fr.
Yann
Y
Nguyen
D002983:Clinical Competence / Q000592:standards*; D003051:Cochlea / Q000000981:diagnostic imaging / Q000601:surgery; D019929:Cochlear Implantation / Q000379:methods / Q000523:psychology; D054893:Cone-Beam Computed Tomography / Q000379:methods; D061827:Dimensional Measurement Accuracy; D006801:Humans; D008416:Mastoid / Q000000981:diagnostic imaging / Q000601:surgery; D000070587:Mental Navigation Tests; D015203:Reproducibility of Results; D066231:Surgeons / Q000523:psychology / Q000592:standards; D025321:Surgery, Computer-Assisted / Q000379:methods / Q000592:standards; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery
Cochleostomy; Computer assisted surgery; Insertion axis; Learning curve; Navigation; Round window