Program Directors??? Opinions about Surgical Competency in Otolaryngology Residents

Operative Airway Exposure in an Otolaryngology-Head and Neck Surgery Training Program. A Survey of Current Trainees

To survey Otolaryngology residents to evaluate their operative airway exposure during their training and to assess if the exposure was adequate to decide whether to pursue fellowship in pediatric. A modified and validated survey was distributed among otolaryngology trainees in the Western region of Kingdom of Saudi Arabia. It assesses operative airway exposure during training, adequacy of experience to decide on whether to pursue fellowship in pediatric otolaryngology, and plan to perform the following six procedures (diagnostic rigid bronchoscopy, diagnostic flexible bronchoscopy, endoscopic airway foreign body removal, rigid esophagoscopy with or without foreign body removal, suspension microlaryngoscopy procedures, open tracheostomy) in practice. Only 24/60 (60%) of respondents perceived that they had adequate training as to whether or not to make them decide to pursue fellowship in pediatric. In regard to over all assessment of the level of exposure: the vast majority of trainees regarded the training as adequate 30/60 (50%), 3/60 (5%) thought it was excellent, 6/60 (10%) thought it was good, and 21/60 (35%)assessed the training adequacy as poor. 24/33 (72.7%) perceived that the presence of a pediatric fellow with them enhanced their training. In regards to performing surgeries after training, 78% were planning to perform rigid bronchoscopy, flexible bronchoscopy (58%), endoscopic airway FB removal (92%), esophagoscopy (54%), suspension microlaryngoscopy (82%), and open tracheostomy (100%). The presence of a pediatric fellow in service was thought of by most residents as being beneficial, however, the exposure to airway surgeries were not adequate as to inform trainees if they want to pursue fellowship in pediatric, when they were not exposed to a fellow.

[Multimodal training concept for temporal bone surgery]

BACKGROUND

Surgical training is increasingly supported by the use of simulators. For temporal bone surgery, shown here by means of mastoidectomy, there are other training models besides cadaver specimens, such as artificial temporal bones or computer-based simulators.

OBJECTIVES

A structured training concept was created which integrates different training methods of mastoidectomy with regard to effectiveness and current learning theory in education.

METHOD

A selective literature research was conducted to compare learning-theoretical findings and the availability and effectiveness of currently existing training models.

RESULTS

To acquire surgical skills, a stepwise approach is suggested. Depending on the progress with computer-based simulation, plastic or native temporal bones should be used. To achieve a plateau of the learning curve, approximately 25 semi-autonomous preparations are recommended. Different 'Objective Structured Assessments of Technical Skills' (OSATS) are implemented to assess the learning progress at different levels.

DISCUSSION

Simulation-based training is recommended until an adequate learning curve plateau is achieved. This is reasonable for patient safety, based on limited accessibility of human cadaveric temporal bones but also by findings of the learning theory.

CONCLUSION

The curriculum integrates different training models of mastoidectomy and OSATS into an overall concept. The training plan has to be continuously adapted to new findings and technical developments.

Reliable Assessment of Surgical Technical Skills Is Dependent on Context: An Exploration of Different Variables Using Generalizability Theory

PURPOSE

Reliable assessment of surgical skills is vital for competency-based medical training. Several factors influence not only the reliability of judgments but also the number of observations needed for making judgments of competency that are both consistent and reproducible. The aim of this study was to explore the role of various conditions-through the analysis of data from large-scale, simulation-based assessments of surgical technical skills-by examining the effects of those conditions on reliability using generalizability theory.

METHOD

Assessment data from large-scale, simulation-based temporal bone surgical training research studies in 2012-2018 were pooled, yielding collectively 3,574 assessments of 1,723 performances. The authors conducted generalizability analyses using an unbalanced random-effects design, and they performed decision studies to explore the effect of the different variables on projections of reliability.

RESULTS

Overall, 5 observations were needed to achieve a generalizability coefficient > 0.8. Several variables modified the projections of reliability: increased learner experience necessitated more observations (5 for medical students, 7 for residents, and 8 for experienced surgeons), the more complex cadaveric dissection required fewer observations than virtual reality simulation (2 vs 5 observations), and increased fidelity simulation graphics reduced the number of observations needed from 7 to 4. The training structure (either massed or distributed practice) and simulator-integrated tutoring had little effect on reliability. Finally, more observations were needed during initial training when the learning curve was steepest (6 observations) compared with the plateau phase (4 observations).

CONCLUSIONS

Reliability in surgical skills assessment seems less stable than it is often reported to be. Training context and conditions influence reliability. The findings from this study highlight that medical educators should exercise caution when using a specific simulation-based assessment in other contexts.

Assessment of operative competency for thyroidectomy: Comparison of resident self-assessment vs attending surgeon assessment

BACKGROUND

Self-awareness of skill, essential for progression as a surgeon, has direct bearing on postresidency practice; however, studies have supported that residents achieve self-perceived competence later than believed by program directors. This study compares residents' self-perception of operative competency to attending surgeon's evaluation using Computer Enhanced Visual Learning, a validated online hemithyroidectomy-specific assessment tool.

METHODS

Eleven otolaryngology-Head and Neck Surgery (HNS) residents completed a preoperative module and postoperative survey, later reviewed by an attending surgeon. Eighty-three performances were assessed for inter-rater reliabilities of key surgical steps.

RESULTS

Almost perfect agreement (Kappa = 0.81-1.00) was shown in 11 of 18 parameters. Substantial agreement (Kappa = 0.61-0.80) was demonstrated in the remaining seven parameters.

CONCLUSIONS

Otolaryngology-HNS trainees have high self-awareness of their performance at each step in a hemithyroidectomy. Standardized assessment tools can allow for documentation of procedural performance and serve as guides for improvement. This is the only study to examine otolaryngology-HNS trainees' self-perceived skill compared to an attending surgeon's assessment for hemithyroidectomy.

Otologic Skills Training

This article presents a summary of the current simulation training for otologic skills. There is a wide variety of educational approaches, assessment tools, and simulators in use, including simple low-cost task trainers to complex computer-based virtual reality systems. A systematic approach to otologic skills training using adult learning theory concepts, such as repeated and distributed practice, self-directed learning, and mastery learning, is necessary for these educational interventions to be effective. Future directions include development of measures of performance to assess efficacy of simulation training interventions and, for complex procedures, improvement in fidelity based on educational goals.

Evaluation of the training capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an electronic portfolio

BACKGROUND

and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents.

METHODS

A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website.

RESULTS

A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format.

CONCLUSIONS

The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.

Effects of anatomical variation on trainee performance in a virtual reality temporal bone surgery simulator

OBJECTIVE

To investigate the importance of anatomical variation in acquiring skills in virtual reality cochlear implant surgery.

METHODS

Eleven otolaryngology residents participated in this study. They were randomly allocated to practice cochlear implant surgery on the same specimen or on different specimens for four weeks. They were then tested on two new specimens, one standard and one challenging. Videos of their performance were de-identified and reviewed independently, by two blinded consultant otolaryngologists, using a validated assessment scale. The scores were compared between groups.

RESULTS

On the standard specimen, the round window preparation score was 2.7 ± 0.4 for the experimental group and 1.7 ± 0.6 for the control group (p = 0.01). On the challenging specimen, instrument handling and facial nerve preservation scores of the experimental group were 3.0 ± 0.4 and 3.5 ± 0.7 respectively, while the control group received scores of 2.1 ± 0.8 and 2.4 ± 0.9 respectively (p < 0.05).

CONCLUSION

Training on temporal bones with differing anatomies is beneficial in the development of expertise.

Objective Assessment of Temporal Bone Drilling Skills

Objectives:

There is great interest in training surgeons in the technical aspects of their craft through simulation and laboratory-based exercises. However, there are as yet only a few objective tools to assess technical performance in a laboratory setting. This study assesses three potential objective assessment tools for a traditional otolaryngology laboratory exercise, temporal bone drilling.

Methods:

We performed a validation study in an academic training program. Nineteen otolaryngology residents performed a cortical mastoidectomy on a cadaveric temporal bone. The participants were divided into two groups, experienced and novice, based on previous temporal bone drilling experience. Performance was rated by two independent, blinded experts using four different assessments, the Global Rating Scale (GRS), the Task-Based Checklist (TBC), the final product analysis (FPA), and expert opinion (EO).

Results:

The interrater reliability for all four assessments was good. Two potential objective assessments, the GRS and the TBC, and the traditional assessment tool of EO, correlated with trainee experience. The FPA, however, did not correlate with trainee experience. A logistic regression analysis of all assessments showed that the TBC correlates with EO.

Conclusions:

This study validates EO, the GRS, and the TBC as measures of temporal bone drilling performance. Of these measures, the TBC correlates best with EO according to logistic regression and can be reliably used as an objective assessment of temporal bone drilling.

The construct validity and reliability of an assessment tool for competency in cochlear implant surgery

Introduction. We introduce a rating tool that objectively evaluates the skills of surgical trainees performing cochlear implant surgery. Methods. Seven residents and seven experts performed cochlear implant surgery sessions from mastoidectomy to cochleostomy on a standardized virtual reality temporal bone. A total of twenty-eight assessment videos were recorded and two consultant otolaryngologists evaluated the performance of each participant using these videos. Results. Interrater reliability was calculated using the intraclass correlation coefficient for both the global and checklist components of the assessment instrument. The overall agreement was high. The construct validity of this instrument was strongly supported by the significantly higher scores in the expert group for both components. Conclusion. Our results indicate that the proposed assessment tool for cochlear implant surgery is reliable, accurate, and easy to use. This instrument can thus be used to provide objective feedback on overall and task-specific competency in cochlear implantation.

Otolaryngology-specific emergency room as a model for resident training

OBJECTIVES/HYPOTHESIS

There is a paucity of data on junior resident training in common otolaryngology procedures such as ear debridement, nasal and laryngeal endoscopy, epistaxis management, and peritonsillar abscess drainage. These common procedures represent a critical aspect of training and are necessary skills in general otolaryngology practice. We sought to determine how a dedicated otolaryngology emergency room (ER) staffed by junior residents and a supervising attending provides exposure to common otolaryngologic procedures.

STUDY DESIGN

Retrospective review.

METHODS

Diagnostic and procedural data for all patients examined in the Massachusetts Eye and Ear Infirmary ER between January 2011 and September 2013 were evaluated.

RESULTS

A total of 12,234 patients were evaluated. A total of 5,673 patients (46.4%) underwent a procedure. Each second-year resident performed over 450 procedures, with the majority seen Monday through Friday (75%). The most common procedures in our study included diagnostic nasolaryngoscopy (52.0%), ear debridement (34.4%), and epistaxis control (7.0%)

CONCLUSIONS

An otolaryngology-specific ER provides junior residents with significant diagnostic and procedural volume in a concentrated period of time. This study demonstrates utility of a unique surgical education model and provides insight into new avenues of investigation for otolaryngology training.

Identifying areas of weakness in thoracic surgery residency training: a comparison of the perceptions of residents and program directors

OBJECTIVE

To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard.

METHODS

A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion.

RESULTS

The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures.

CONCLUSION

This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a reconsideration of what the scope of practice of a general thoracic surgeon should entail.

Achievement of competency in endoscopic sinus surgery of otolaryngology residents

OBJECTIVES/HYPOTHESIS

The goal of our study is to identify the number of Endoscopic Sinus Surgery (ESS) cases required to obtain competency in ESS, using a previously validated assessment tool.

STUDY DESIGN

Prospective observational study.

METHODS

Seventeen residents from Johns Hopkins Otolaryngology-Head & Neck Surgery residency program were evaluated as they performed endoscopic sinus surgery in the operating room. Global and checklist parts of the ESS instrument were used for assessment purposes. Items on the tool were grouped into three different milestones for analysis of data (Milestone 1 = Maxillary Antrostomy + Anterior Ethmoidectomy, Milestone 2 = Posterior Ethmoidectomy + Sphenoidostomy, Milestone 3 = Frontal Sinusotomy). Residents were deemed competent if they achieved a minimum score of 3 on a 5-point Likert scale on each step of the surgery.

RESULTS

A total of 73 evaluations were completed for 17 residents (Postgraduate Level 2-5) by eight evaluators between 2009 and 2011. A 60% probability of achieving competency in performance of all milestones of ESS is obtained with performing 42 ESS procedures and the probability is increased to a 100% with performance of 55 endoscopic sinus surgery procedures. On average it took residents 23 cases to become competent in performance of maxillary antrostomy and anterior ethmoidectomy.

CONCLUSIONS

Our results suggest that it requires 42 ESS procedures to attain a 60% probability of competency in ESS. These results have implications for otolaryngology residency programs when developing curriculum and benchmarks for the training residents.

Program director opinions of core competencies in hand surgery training: analysis of differences between plastic and orthopedic surgery accredited programs

BACKGROUND

The authors' aim was to conduct a national survey of hand surgery fellowship program directors to determine differences of opinions of essential components of hand surgery training between program directors from plastic and orthopedic surgery programs.

METHODS

The authors performed a Web-based survey of 74 program directors from all Accreditation Council for Graduate Medical Education-accredited hand surgery fellowship programs to determine components that are essential for hand surgery training. The survey included assessment of nine general areas of practice, 97 knowledge topics, and 172 procedures. Twenty-seven scales of related survey items were created to determine differences between specialty groups based on clinical themes.

RESULTS

An 84 percent response rate was achieved, including 49 orthopedic and 12 plastic surgery program directors. There were significant differences in mean responses between the specialty groups in 11 of 27 scales. Only one scale, forearm fractures, contained items with a significantly stronger preference for essential rating among orthopedic surgeons. The other 10 scales contained items with a significantly higher preference for essential rating among plastic surgeons, most of which related to soft-tissue injury and reconstruction. The burn scale had the greatest discrepancy in opinion of essential ratings between the groups, followed by pedicled and free tissue transfer, and amputation and fingertip injuries.

CONCLUSIONS

Despite being united under the subspecialty of hand surgery, program directors tend to emphasize clinical areas that are stressed in their respective primary disciplines. These differences promote the advantage of programs that provide exposure to both plastic surgery-trained and orthopedic surgery-trained hand surgeons.

Gaps in exposure to essential competencies in hand surgery fellowship training: a national survey of program directors

BACKGROUND

Graduate medical education has moved towards competency-based training. The aim of this study was to assess hand surgery program directors' opinions of exposure gaps in core competencies rated as essential for hand surgery training.

METHODS

We surveyed the 74 ACGME hand surgery fellowship program directors. Respondents rated their opinion of 9 general areas of practice, 97 knowledge topics, and 172 procedures into one of three categories: essential, exposure needed, or unnecessary. Program directors also rated trainee exposure of each component at their respective program. Moderate and large exposure gaps were respectively defined as presence of at least 25 and 50 % of programs rating trainees as not having proficiency in the component at the end of training.

RESULTS

Sixty-two of 74 program directors (84 %) responded to the survey. For the 76 knowledge topics and 98 procedures rated as essential, a majority of the knowledge topics (61 %; n = 46) and procedures (72 %; n = 71) had at least a moderate exposure gap. In addition, 22 % (n = 17) of the essential knowledge topics and 26 % (n = 25) of the essential procedures had a large exposure gap.

CONCLUSION

This study illuminates the discrepancies between what is believed to be important for practicing hand surgeons and graduates' proficiency as perceived by program directors. The field of hand surgery must work to determine if program directors have unrealistic expectations for what is essential for practicing hand surgeons or if reforms are needed to improve exposure to essential skills in hand surgery training.

General surgery and otolaryngology resident perspectives on obtaining competency in thyroid surgery

OBJECTIVE

General surgery (GS) and otolaryngology (OTO) do not require a minimum number of thyroidectomies to qualify for board certification. No standardized criteria exist for declaring competence in this procedure. A survey was created to assess GS and OTO resident perspectives on becoming competent in thyroid surgery.

DESIGN

A survey was electronically mailed to all GS and OTO residents assessing their competence in thyroid surgery.

SETTING

National survey of general surgery and otolaryngology residents.

PARTICIPANTS

National general surgery and otolaryngology residents.

RESULTS

A convenience sample of 526 residents responded (246/280 = GS/OTO). The mean clinical year of training was 3.3 (3.1/3.5). Most residents (50%/41%) performed between 1 and 10 thyroid operations. Residents believed 13 and 25 (GS/OTO) thyroidectomies were required by their respective Boards. Both groups felt that 30 (27/33) thyroid operations were necessary to obtain competence (p < 0.01). The most important feature was operative volume with graduated responsibility, followed by guidance under an expert mentor. Analysis of residents PGY4 and greater showed no significant differences.

CONCLUSIONS

While residents of both specialties generally agree on learning methods, the perception of readiness to perform thyroid surgery after training is variable. A disconnect is present between the number of cases required for Board certification, the number of cases residents believe are required, and the number of cases residents believe it takes to achieve competency.

Extremes in Otolaryngology Resident Surgical Case Numbers

Objective

Understand (1) significance between minimum, mean, and maximum case numbers for otolaryngology resident surgical procedures; (2) weaknesses of Accreditation Council for Graduate Medical Education (ACGME) resident case log system contributing to inaccurate data/case inflation; and (3) when excessive case load may transform education into service.

Study Design

Cross-sectional survey using a national database.

Setting

Academic otolaryngology residency programs.

Subjects/Methods

Review of otolaryngology resident national data reports from ACGME resident case log system performed from 2004 to 2010. Minimum, mean, standard deviation, and maximum values for total number of resident surgeon cases and for specific surgical procedures were compared. Case unbundling, resident data entry habits, and tracked vs untracked Current Procedural Terminology ( CPT) codes were reviewed.

Results

Mean total number of resident surgeon cases remained constant (1699.5 ± 424.2 to 1772.2 ± 517). Minimum total number of cases ranged from 730 to 811 (approaching 2 standard deviations below the mean). Zero was reported as the minimum case number for some procedures. Maximum for total number of cases increased (3559 to 4857) and surpassed the mean by 4 to 5 standard deviations. Some procedures have maximums greater than 11 standard deviations above the mean. The authors identified untracked CPT codes and variations in resident case log documentation habits.

Conclusions

Large differences between the minimum, mean, and maximum resident surgeon case numbers exist. Establishing minimum case number requirements for otolaryngology residents should be considered. Educational benefit derived from excessive case load is unclear. Critical examination of the ACGME resident case log system and resident documentation habits is needed to improve accuracy of reporting.

Video-Based Assessment of Operative Competency in Endoscopic Sinus Surgery

Background

The Accreditation Council for Graduate Medical Education requires that residency programs have an effective plan for assessing their residents’ competence. Current evaluation tools used for the assessment of operative competency are subjective, recall based, and do not allow providing formative feedback to the resident. The purpose of this study was to evaluate the feasibility and validity of video-based assessment of endoscopic sinus surgery (ESS) skills.

Methods

Five junior (postgraduate year levels 1–3[PGY-1 to -3]) and three senior (PGY-4 and -5) residents were videotaped as they performed ESS on cadavers in the laboratory. Five faculty members watched the recorded videotapes and rated performance using global and checklist assessment tools for ESS. Evaluators were blinded to the identity of the performers. Rating was made feasible by allowing the raters to fast-forward through the tapes when appropriate. Construct validity was calculated by comparing total scores and score on each item of the instrument across the training levels. For all statistical purposes p < 0.05 was considered significant.

Results

Results showed construct validity with senior residents performing better than junior residents. It took an average of 20 minutes (range, 7- 39 minutes) to watch and evaluate a video. Interrater reliability, as measured by interclass correlation coefficient across evaluators, was 0.62.

Conclusion

The use of videotapes combined with the objective assessment tool is a feasible and valid method for evaluating surgical skills. It has implications for residency programs, because it will increase faculty buy-in and reduce the potential for biased assessment.

Validation of a clinical practice ability instrument for surgical training

Objective: To develop and validate an instrument to measure the progression of clinical practice ability among surgical trainees.

Study Design: Prospective validation study.

Setting: Three academic training institutions: Massachusetts Eye and Ear Infirmary, Brigham and Women's Hospital, Harvard School of Public Health.

Subjects and Methods: A clinical practice instrument (CPI) was created and prospectively validated in otolaryngology trainees at three institutional sites. The instrument is completed during an oral examination of a trainee who is presented with a patient scenario; the scenario yields one clinical diagnosis, one therapeutic intervention, and one interventional complication. On the basis of the trainee's responses, 21 item scores are calculated focusing on key areas within the diagnostic and management paradigm. Internal consistency, reproducibility, inter-rater reliability, discriminant and criterion validity, and responsiveness to change over time were evaluated.

Results: There were 87 administrations of the instrument over a period of 22 months. The subjects (n = 32) spanned the range of training from medical student to clinical fellow. There was strong internal consistency within each domain (Cronbach's alpha 0.85-0.94, one-sided 95% confidence interval > 0.81). Inter-rater reliability was high (kappa 0.66, absolute agreement 72%). Reproducibility of item scores was excellent (intraclass correlation coefficient [ICC] final summary score 0.78, global item score 0.83). Discriminant validity ( P < 0.0001), criterion validity ( P = 0.03), and responsiveness to change ( P = 0.0055) were also established.

Conclusion: The CPI serves as a reliable, reproducible, and valid means to measure the progression of clinical practice ability in trainees as they transition from “novice” to “attending equivalent” surgeons.

Who should be a stapes surgeon? An otologist or a generalist?

PURPOSE OF REVIEW

The overall experience with stapes surgery has declined, both within residency training programs, as well as in clinical practice. Does this change in the environment suggest that subspecialists rather than generalists manage patients with otosclerosis?

RECENT FINDINGS

A decreasing availability of patients with clinical otosclerosis has encouraged trainees and practitioners to adopt strategies that will enable the maintenance of quality care to these patients.

SUMMARY

Well trained generalists should be prepared to perform stapes surgery. Lack of experience or infrequent exposure to disease suggests that optimal care can be achieved by referring the patient to an experienced otologic surgeon.

Parotidectomy for benign parotid disease at a university teaching hospital: outcome of 963 operations

OBJECTIVE/HYPOTHESIS

The objective of this study was to analyze the perioperative and long-term complications after standardized lateral and total parotidectomy for benign parotid tumors and chronic parotitis with special regard on the training skill of the surgeons at a university teaching center. All teaching operations were performed under strict microscopic control and supervision of experienced surgeons.

STUDY DESIGN

The authors conducted a retrospective unicentric study in a tertiary university center.

METHODS

Medical records of 963 lateral and total parotidectomies treated from 1986 to 2004 were analyzed with regard to perioperative and long-term complications. The surgeons' expertise to perform a parotidectomy was classified as beginner (0-20 parotidectomies performed), advanced (21-50), experienced (51-100), or highly experienced (>100).

RESULTS

Eighty-five percent of the cases were primary operations (85%) and 15% revision operations. A lateral parotidectomy was necessary in 61% and total parotidectomy in 39%. The mean operation time was 192 minutes. The incidence of transient facial nerve dysfunction was 25%, and 6% for permanent weakness, respectively. Treatment for Frey's syndrome was performed in 5%. First recurrence for pleomorphic adenoma was observed in 2% and for Warthin's tumor in 3%. Significantly more complications were seen after total parotidectomy and in revision cases. Beginners and advanced surgeons (operated 41% of the cases) needed a longer operation time than experienced and highly experienced surgeon (59% of the cases). The surgeon's expertise had no influence on the incidence of complications.

CONCLUSIONS

Standardized education in lateral and total parotidectomy for treatment of benign parotid disease under precise microscopic control is safe, demonstrates good results, and has low perioperative and long-term morbidity.