Docencia en la cirugía de la Otosclerosis: Entrenamiento quirúrgico en modelos experimentales exvivo de oído medio

Surgical Training in Ex Vivo Experimental Models of the Middle Ear

Abstract

Introduction and objective: Research and teaching in Surgery is fundamentally based on three sources of knowledge: the sick man, the cadaver (human temporal bone) and physical or virtual surgical simulators. Legislation and ethics limit access to temporary bones in our Departments. We propose two cost-effective models for training, teaching and research in ossicular chain surgery, focusing on otosclerosis surgery.Method: After reviewing the literature, we have trained in two experimental models of surgical simulation of the ossicular chain: a) ex vivo experimental model of rabbit middle ear b) ex vivo sheep middle ear experimental model.Results: The exvivo animal models of the middle ear of lamb and rabbit (less than 4 euros per piece) are very low-cost surgical models, with a middle ear anatomy very similar to that of the human. In the rabbit, the ossicular chain is very small, which makes surgery complex. The ossicular chain of the ovine model is approximately 2/3 the size of the human chain, which makes the simulation of the surgical technique more realistic. Technically, stapedectomy is more difficult in these animal models than in humans. Access to the middle ear cavity through the bulla is complicated and requires drilling in the first exercises. In the ovine model, the retroauricular approach achieves adequate access to the tympanic membrane and chain.Discussion and Conclusions: Ex vivo rabbit and ovine models offer a cost-effective alternative to otologic residents and junior surgeons as an alternative to human cadaver temporal bones for middle ear surgery training.