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European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 1, pp 63–70 | Cite as

Three-dimensional force analysis of surgical manipulations at the long process of the incus

  • Attila ÓváriEmail author
  • Christoph Heckeler
  • Karsten Ehrt
  • Hans-Edgar Bernd
  • Hans-Wilhelm Pau
  • Albrecht Eiber
Otology
  • 43 Downloads

Abstract

Purpose

Surgical manipulation with application of inappropriate force may damage middle ear structures leading to hearing loss. This work analyzes the forces applied in simulated otosurgical exercises in a laboratory set-up by measuring the spatial components of applied forces with objective assessment criteria. With these criteria, the individual force characteristics applied by the surgeon can be quantified and an objective feedback can be given about their surgical maneuvers.

Methods

A natural size model of the human incus was mounted on a load cell to measure the spatial forces in all three directions during different manipulation tasks performed under the microscope by ten surgeons from our department having different levels of experience in otosurgery. The motions of the incus model and the instrument tip were recorded simultaneously with a video camera.

Results

Independent of surgical experience, a three-dimensional force pattern could be detected with components transverse to the desired force directions. The measured forces applied by trainees showed larger variations in magnitude, in spatial distribution and in temporal course than those applied by experienced surgeons. A better repeatability of identical tasks, constancy of force patterns and low peak force values could be seen in the group of experienced surgeons.

Conclusions

The laboratory system presented in this study using simultaneous video and 3-D force registration allows the objective assessment of surgical manipulations, e.g., at the long process of the incus. Training with video and force feedback provides information about surgical techniques and skill development of surgeons and has the potential to shorten the learning curve and to diminish intra-operative risks to patients.

Keywords

Otosurgery Ear ossicles spatial force measurement Trainees Training Exercises 

Notes

Acknowledgements

We acknowledge Prof. Robert Mlynski, director of the Department of Otorhinolaryngology, Head and Neck Surgery “Otto Koerner”, Rostock University Medical Center, Rostock, Germany for his help in critical reviewing of the manuscript.

Compliance with ethical standards

Ethical standards

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

Supplementary material

405_2018_5194_MOESM1_ESM.mp4 (1.6 mb)
Supplementary material 1 (MP4 1643 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck Surgery “Otto Koerner”Rostock University Medical CenterRostockGermany
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryAsklepios St. GeorgHamburgGermany
  3. 3.Institute of Engineering and Computational MechanicsUniversity of StuttgartStuttgartGermany

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