ENT Residents Benefit from a Structured Operation Planning Approach in the Training of Functional Endoscopic Sinus Surgery

Abstract

Background and Objectives: Preoperative planning utilizing computed tomographies (CT) is of utmost importance in functional endoscopic sinus surgery (FESS). Frequently, no uniform documentation and planning structures are available to residents in training. Consequently, overall completeness and quality of operation planning may vary greatly. The objective of the present study was to evaluate the impact of a structured operation planning (SOP) approach on the report quality and user convenience during a 4-day sinus surgery course. Materials and Methods: Fifteen participant were requested to plan a FESS procedure based on a CT scan of the paranasal sinuses that exhibited common pathological features, in a conventional manner, using a free text. Afterwards, the participants reevaluated the same scans by means of a specifically designed structured reporting template. Two experienced ENT surgeons assessed the collected conventional operation planning (COP) and SOP methods independently with regard to time requirements, overall quality, and legibility. User convenience data were collected by utilizing visual analogue scales. Results: A significantly greater time expenditure was associated with SOPs (183 s vs. 297 s, p = 0.0003). Yet, legibility (100% vs. 72%, p < 0.0001) and overall completeness (61.3% vs. 22.7%, p < 0.0001) of SOPs was significantly superior to COPs. Additionally, description of highly relevant variants in anatomy and pathologies were outlined in greater detail. User convenience data delineated a significant preference for SOPs (VAS 7.9 vs. 6.9, p = 0.0185). Conclusions: CT-based planning of FESS procedures by residents in training using a structured approach is more time-consuming while producing a superior report quality in terms of detailedness and readability. Consequently, SOP can be considered as a valuable tool in the process of preoperative evaluations, especially within residency.

Keywords: computed tomography; functional endoscopic sinus surgery; medical education; medical informatics; structured surgical training.

Figure 1

Time needed to plan (A), evaluation of legibility (B), and overall completeness of structured (SOP), as well as conventional operation planning (COP, (B,C)). Analysis of time expenditure for operation planning exhibits a significant difference in favor of conventional operation planning (COP). Using SOP results in significantly better legibility and overall completeness. In detail, all relevant anatomical features are addressed considerably more completely using SOP. *** p < 0.001.

Figure 2

Evaluation of user convenience yields a significant overall preference for structured operation planning (SOP) by participating residents in comparison to conventional operation planning (COP). Detailed analysis showed a tendency in favor of SOP in all investigated items without reaching the level of significance. * p < 0.05.