Surgical injuries and underlying factors in novice’s mastoidectomy and posterior tympanotomy training

BACKGROUND: Achieving surgical expertise requires repetition and continuous practice. As clinical demands increase and opportunities for safe learning decline, enhancing surgical training methods is essential. PURPOSE: In this study, we investigate what kind of errors beginners make during mastoidectomy and posterior tympanotomy and what factors precede those injuries. MATERIALS AND METHODS: We analyzed video recordings of 30 medical students performing mastoidectomy and posterior tympanotomy on 3D-printed temporal bone models. The participants were trained using either traditional methods or VR. We assessed surgical injuries and their possible underlying causes by analyzing the end result and video recordings. RESULTS: The most common surgical errors were injuries to the posterior ligament of the incus, posterior ear canal wall, and incus body in 64%, 27%, and 13% of the models, respectively. Common factors included insufficient anatomical knowledge, inadequate exposure, poor spatial orientation, and inattention to nearby anatomical features during targeted work. CONCLUSIONS AND SIGNIFICANCE: Novice surgeons commonly make errors which differ from previously reported error-rates for experienced surgeons. These data could be useful to better understand what novices are struggling with when developing surgical training methods in the future.