Learning curve for piezosurgery in well-trained otological surgeons

OBJECTIVE: Piezosurgery is an ultrasound instrument (24.7-29.5 kHz) capable of cutting bone without necrosis and nonmineralizedtissue damage. The aim of this work has been to determinethe time required for a well-trained surgeon to perform otologicalsurgery with the piezoelectric device.STUDY DESIGN: Case series with planned data collection.Sixty-three patients affected by otosclerosis and 63 by chronicotitis media were enrolled. For each disease, patients were dividedinto three numerically equal groups, with each group assigned to awell-trained otological surgeon. Patients underwent stapedotomy(n 63) and intact canal wall tympanoplasty (n 63) with thepiezoelectric device.SETTING: ENT Department, University of Genoa (Italy).SUBJECTS AND METHODS: We recorded “skin-to-skin”operation time, surgical success, surgical complication, and hospitalstay duration. Before and one year after surgery, all patientsunderwent pure-tone audiometry, tympanometry, recording oftransient-evoked otoacoustic emission, recording of distortionproduct otoacoustic emission, auditory brainstem response, andelectronystamographic recording.RESULTS: In each surgical technique, the piezoelectric deviceprovided excellent control without side effects on the adjacentstructures of the middle and inner ear.CONCLUSION: The piezoelectric device is a new bony scalpelthat uses microvibrations at ultrasonic frequency so that soft tissue(nerve, vessel, dura mater, etc) will not be damaged even onaccidental contact with the cutting tip. A feature of the piezoelectricdevice is its good manageability, which makes it easy for awell-trained otological surgeon to create a straight osteotomy linewithout any learning period: this renders the piezoelectric devicesuitable for bone surgery.