title: Intraoperative Image Guidance Improves Outcomes in Complex Orbital Reconstruction by Novice Surgeons.
abstract: OBJECTIVE
  This study aims to describe the utility of surgical navigation in improving operative outcomes in complex orbital reconstruction by novice compared with experienced surgical trainees.
  
  
  METHODS
  A randomized, controlled cadaveric study was conducted at the University of Pittsburgh School of Medicine with otolaryngology and ophthalmology residents and fellows. Participants were divided into novice (postgraduate year 2-4 residents) and experienced (postgraduate year 5 residents and fellows) groups. Ten cadaveric specimens with pre-dissection computed tomography images underwent endoscopic resection of the orbital floor and lamina papyracea bilaterally. Participants performed reconstruction with or without the use of surgical navigation, randomized by laterality and order of the use of navigation. Post-dissection imaging was obtained after reconstruction and compared with pre-dissection imaging. The primary outcome was orbital volume; secondary outcomes included the participant's operative time and National Aeronautics and Space Administration Task Load Index score, a subjective workload assessment measure. Matched-pair t tests and 2-way analysis of variance were used for statistical analysis.
  
  
  RESULTS
  Novice participants (n = 6) had improved outcomes with respect to orbital volume when using surgical navigation compared with experienced participants (n = 4). There were no differences in operative times or National Aeronautics and Space Administration Task Load Index scores when using surgical navigation.
  
  
  CONCLUSIONS
  In a cadaveric setting, use of surgical navigation by novice surgeons improves post-dissection orbital volume in complex orbital reconstruction. Surgical navigation should be considered as an adjunct to surgical training and simulation curricula.
authors.affiliation: Resident Physician, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: davisks@upmc.edu.
authors.forename: Kara S
authors.initials: KS
authors.lastname: Davis
authors.affiliation: Resident Physician, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Vosler
authors.affiliation: Assistant Professor, Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Yu
authors.affiliation: Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Wang
mesh_terms: D002102:Cadaver; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D009915:Orbit / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013515:Surgery, Oral / Q000193:education; D014057:Tomography, X-Ray Computed