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Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity.

Study design

This was a prospective cohort study.

Methods

Eight otolaryngology trainees and three otolaryngology experts were asked to use a microscope to insert a tympanostomy tube into a cadaveric myringotomy in a standardized setting. Microscope movements were tracked in a three-dimensional space, and tracking metrics were applied to the data. The procedure was video-recorded and then analyzed by blinded experts using operational metrics. Results from both groups were compared, and discriminatory metrics were determined.

Results

The following tracking metrics were identified as discriminatory between the trainee and expert groups: total completion time, operation time, still time, and jitter (movement perturbation). Many operational metrics were found to be discriminatory between the two groups, including several positioning metrics, optical metrics, and procedural metrics.

Conclusions

Performance metrics were implemented, and construct validity was established for a subset of the proposed metrics by discriminating between expert and novice participants. These discriminatory metrics could form the basis of an automated system for providing feedback to residents during training while using a myringotomy surgical simulator. Additionally, these metrics may be useful in guiding a standardized teaching and evaluation methodology for training in the use of surgical microscopes.

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Acknowledgement

The authors thank Lauren Siegel for manuscript editing.

Funding

Funding for this work was provided by the Natural Sciences and Engineering Research Council of Canada (RGPIN-2015–03799).

Author information

Authors and Affiliations

  1. Department of Otolaryngology–Head and Neck Surgery, Western University, London, ON, Canada

    Brandon Wickens, Murad Husein, Lorne S. Parnes, Sumit K. Agrawal & Hanif M. Ladak

  2. Department of Electrical & Computer Engineering, Western University, London, ON, Canada

    Arefin Shamsil, Sumit K. Agrawal & Hanif M. Ladak

  3. Department of Medical Biophysics, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada

    Sumit K. Agrawal & Hanif M. Ladak

  4. Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, QC, Canada

    Lily H. P. Nguyen

  5. Department of Pediatric Surgery, McGill University, Montreal, QC, Canada

    Lily H. P. Nguyen

  6. Institute of Health Sciences Education, McGill University, Montreal, QC, Canada

    Lily H. P. Nguyen

  7. Department of Otolaryngology–Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, CA, USA

    Philip C. Doyle

Authors
  1. Brandon Wickens
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  2. Arefin Shamsil
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  3. Murad Husein
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  4. Lily H. P. Nguyen
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  5. Philip C. Doyle
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  6. Lorne S. Parnes
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  7. Sumit K. Agrawal
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  8. Hanif M. Ladak
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Contributions

BW recruited participants, collected data, and wrote the initial draft with AS. In addition to assisting with the first draft, AS implemented the experimental setup, programmed the tracking metrics, and assisted with data collection and analysis. MH, LHPN, and LSP assessed trial videos and developed and applied the operational metrics questionnaire. PCD assisted with data presentation, data analyses, and interpretation. SKA and HML designed and managed the study. All authors edited the manuscript.

Corresponding author

Correspondence to Hanif M. Ladak.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Wickens, B., Shamsil, A., Husein, M. et al. Comprehensive metrics for evaluating surgical microscope use during tympanostomy tube placement. Int J CARS 16, 1587–1594 (2021). https://doi.org/10.1007/s11548-021-02428-8

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  • DOI: https://doi.org/10.1007/s11548-021-02428-8

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