Cracking that Learning Curve - The First Year of Endoscopic Ear Surgery
Dr Alice Stringer, Surgeon, Wellington Regional Hospital, New Zealand
Authors List
Introduction
The endoscope has been used for several decades in the ear for diagnostic purposes but it has only been in the last decade that transcanal endoscopic ear surgery (TEES) has increased in popularity. Initial data on cholesteatoma residivism and success of myringoplasty suggests that TEES is not inferior to open approaches for these conditions and so is unlikely to be detrimental to the patient.
Aims
To determine whether or not a change to TEES has benefits to the ENT service without being detrimental for the patient.
Methods
A retrospective review of a single surgeon practice from 1 Oct 2018 to 30 Sept 2020 (12 months prior to change in practice and 12 months after). Clinic and operation notes were reviewed, TEES operations were compared with previously standard approach which involved post auricular incision and vascular strip elevation.
Results
102 patients underwent 127 surgeries over this time. Those that underwent TEES were more likely to be day stay cases (24% vs 64%) resulting in a reduction in 27 overnight stays. Surgical times of tympanoplasty only (no cholesteatoma) were reduced using TEES compared with standard approach (63 mins vs 90 mins, p <0.001). TEES patients required fewer outpatient follow up appointments postoperatively (1.9 vs 3.2, p<0.001). Subjectively there were fewer wound complications in the TEES group.
Conclusion
The learning curve is real and frustrating but TEES does not increase the time for cholesteatoma surgery and may decrease the time for tympanoplasty. Fewer overnight stays and post-operative outpatient visits are hugely beneficial in the resource constrained public hospital system. Lessons were learned. Fun was had. Beautiful pictures were obtained.
- Dr Alice Stringer, Surgeon, Wellington Regional Hospital, New Zealand
Introduction
The endoscope has been used for several decades in the ear for diagnostic purposes but it has only been in the last decade that transcanal endoscopic ear surgery (TEES) has increased in popularity. Initial data on cholesteatoma residivism and success of myringoplasty suggests that TEES is not inferior to open approaches for these conditions and so is unlikely to be detrimental to the patient.
Aims
To determine whether or not a change to TEES has benefits to the ENT service without being detrimental for the patient.
Methods
A retrospective review of a single surgeon practice from 1 Oct 2018 to 30 Sept 2020 (12 months prior to change in practice and 12 months after). Clinic and operation notes were reviewed, TEES operations were compared with previously standard approach which involved post auricular incision and vascular strip elevation.
Results
102 patients underwent 127 surgeries over this time. Those that underwent TEES were more likely to be day stay cases (24% vs 64%) resulting in a reduction in 27 overnight stays. Surgical times of tympanoplasty only (no cholesteatoma) were reduced using TEES compared with standard approach (63 mins vs 90 mins, p <0.001). TEES patients required fewer outpatient follow up appointments postoperatively (1.9 vs 3.2, p<0.001). Subjectively there were fewer wound complications in the TEES group.
Conclusion
The learning curve is real and frustrating but TEES does not increase the time for cholesteatoma surgery and may decrease the time for tympanoplasty. Fewer overnight stays and post-operative outpatient visits are hugely beneficial in the resource constrained public hospital system. Lessons were learned. Fun was had. Beautiful pictures were obtained.
