Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty
To characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency....
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| Veröffentlicht in: | Journal of International Advanced Otology 2021-07, Vol.17 (4), p.288-293 |
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| creator | Swarup, Arushri Chayaopas, Nichtima W Eastwood, Kyle James, Adrian |
| description | To characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency.
Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer.
Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P < .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P < .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood.
As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration. |
| doi_str_mv | 10.5152/iao.2021.9232 |
| format | Article |
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Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer.
Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P < .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P < .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood.
As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.</description><identifier>ISSN: 2148-3817</identifier><identifier>ISSN: 1308-7649</identifier><identifier>EISSN: 2148-3817</identifier><identifier>DOI: 10.5152/iao.2021.9232</identifier><identifier>PMID: 34309547</identifier><language>eng</language><publisher>Turkey: AVES</publisher><subject>Adolescent ; Age ; Cartilage ; Child ; Child, Preschool ; Ears & hearing ; Efficiency ; Endoscopy ; Hearing loss ; Humans ; Local anesthesia ; Morbidity ; Original ; Physical instruments ; Retrospective Studies ; Statistical analysis ; Surgeons ; Surgery ; Surgical Flaps ; Surgical techniques ; Treatment Outcome ; Tympanic Membrane Perforation - surgery ; Tympanoplasty</subject><ispartof>Journal of International Advanced Otology, 2021-07, Vol.17 (4), p.288-293</ispartof><rights>COPYRIGHT 2021 AVES</rights><rights>Copyright Mediterranean Society for Otology and Audiology Jul 2021</rights><rights>2021 authors 2021 authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c615t-fa86047ebb0d2ad7791d9366ea79746ca5bd6dbf136295fc78b9e55e618be1033</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975406/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8975406/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34309547$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Swarup, Arushri</creatorcontrib><creatorcontrib>Chayaopas, Nichtima</creatorcontrib><creatorcontrib>W Eastwood, Kyle</creatorcontrib><creatorcontrib>James, Adrian</creatorcontrib><creatorcontrib>Khon Kaen Ear, Hearing and Balance Research Group, Department of Otorhinolaryngology, Khon Kaen University, Khon Kaen, Thailand</creatorcontrib><creatorcontrib>Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Canada</creatorcontrib><creatorcontrib>Faculty of Medicine, University of Toronto, Toronto, Canada</creatorcontrib><creatorcontrib>Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand</creatorcontrib><creatorcontrib>Centre for Image-Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Canada</creatorcontrib><creatorcontrib>Institute of Biomedical Engineering, University of Toronto, Toronto, Canada</creatorcontrib><title>Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty</title><title>Journal of International Advanced Otology</title><addtitle>J Int Adv Otol</addtitle><description>To characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency.
Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer.
Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P < .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P < .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood.
As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.</description><subject>Adolescent</subject><subject>Age</subject><subject>Cartilage</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Ears & hearing</subject><subject>Efficiency</subject><subject>Endoscopy</subject><subject>Hearing loss</subject><subject>Humans</subject><subject>Local anesthesia</subject><subject>Morbidity</subject><subject>Original</subject><subject>Physical instruments</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Surgical Flaps</subject><subject>Surgical techniques</subject><subject>Treatment Outcome</subject><subject>Tympanic Membrane Perforation - surgery</subject><subject>Tympanoplasty</subject><issn>2148-3817</issn><issn>1308-7649</issn><issn>2148-3817</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>KPI</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DOA</sourceid><recordid>eNqNks9v0zAUxyMEYtPYkSuK4LIdWvzbzgWpmjqomBjSyoGT5dhO8ZTEme0M-t_PoWNqEQf0DraeP-_75K--RfEagjmFFL13ys8RQHBeIYyeFccIEjHDAvLne_ej4jRGVwPCGAFUoJfFESYYVJTw4-L72nW2vGz9z_ImjWZbJl8uYrQxltfD4EMae5ecjVN_1Q3B39ty2TROO9vrben6ctkbH7UfnC7X225QvR9aFdP2VfGiUW20p4_nSfHtcrm--DS7uv64ulhczTSDNM0aJRgg3NY1MEgZzitoKsyYVbzihGlFa8NM3UDMUEUbzUVdWUotg6K2EGB8Uqx2usarWzkE16mwlV45-bvhw0aqkJxurcQUas045AQYYoxQhGuCiLC64pwJmrU-7LSGse6s0bZPQbUHoocvvfshN_5eiopTAlgWOHsUCP5utDHJzkVt21b11o9RIkopJqwCMKPv_kJv_Rj6bNVECUgBwjxTb3fURuUPuL7xea_Wg7uTjAORi0zQ_B9QLmM7p31vG5f7i_2B84OBzCT7K23UGKP8_HX13-zq5sshO9uxOvgYg22erINATomVObFySqycEpv5N_t-P9F_8okfAMYA45M</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Swarup, Arushri</creator><creator>Chayaopas, Nichtima</creator><creator>W Eastwood, Kyle</creator><creator>James, Adrian</creator><general>AVES</general><general>Mediterranean Society for Otology and Audiology</general><general>European Academy of Otology and Neurotology and the Politzer Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISN</scope><scope>KPI</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>EDSIH</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20210701</creationdate><title>Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty</title><author>Swarup, Arushri ; Chayaopas, Nichtima ; W Eastwood, Kyle ; James, Adrian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c615t-fa86047ebb0d2ad7791d9366ea79746ca5bd6dbf136295fc78b9e55e618be1033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Cartilage</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Ears & hearing</topic><topic>Efficiency</topic><topic>Endoscopy</topic><topic>Hearing loss</topic><topic>Humans</topic><topic>Local anesthesia</topic><topic>Morbidity</topic><topic>Original</topic><topic>Physical instruments</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Surgical Flaps</topic><topic>Surgical techniques</topic><topic>Treatment Outcome</topic><topic>Tympanic Membrane Perforation - surgery</topic><topic>Tympanoplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Swarup, Arushri</creatorcontrib><creatorcontrib>Chayaopas, Nichtima</creatorcontrib><creatorcontrib>W Eastwood, Kyle</creatorcontrib><creatorcontrib>James, Adrian</creatorcontrib><creatorcontrib>Khon Kaen Ear, Hearing and Balance Research Group, Department of Otorhinolaryngology, Khon Kaen University, Khon Kaen, Thailand</creatorcontrib><creatorcontrib>Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Canada</creatorcontrib><creatorcontrib>Faculty of Medicine, University of Toronto, Toronto, Canada</creatorcontrib><creatorcontrib>Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University, Thailand</creatorcontrib><creatorcontrib>Centre for Image-Guided Innovation and Therapeutic Intervention (CIGITI), The Hospital for Sick Children, Toronto, Canada</creatorcontrib><creatorcontrib>Institute of Biomedical Engineering, University of Toronto, Toronto, Canada</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Global Issues</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Turkey Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - 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This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency.
Thirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer.
Raising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P < .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P < .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood.
As elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.</abstract><cop>Turkey</cop><pub>AVES</pub><pmid>34309547</pmid><doi>10.5152/iao.2021.9232</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adolescent Age Cartilage Child Child, Preschool Ears & hearing Efficiency Endoscopy Hearing loss Humans Local anesthesia Morbidity Original Physical instruments Retrospective Studies Statistical analysis Surgeons Surgery Surgical Flaps Surgical techniques Treatment Outcome Tympanic Membrane Perforation - surgery Tympanoplasty |
| title | Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty |
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