CUSUM analysis of learning curves for the head-mounted microscope in phonomicrosurgery.

Objectives/hypothesis: To observe the learning curve of the head-mounted microscope in a phonomicrosurgery simulator using cumulative summation (CUSUM) analysis, which incorporates a magnetic phonomicrosurgery instrument tracking system (MPTS). Study

Design: Retrospective case series.

Methods: Eight subjects (6 medical students and 2 surgeons inexperienced in phonomicrosurgery) operated on phonomicrosurgical simulation cutting tasks while using the head-mounted microscope for 400 minutes total. Two 20-minute sessions occurred each day for 10 total days, with operation quality (Qs ) and completion time (T) being recorded after each session. Cumulative summation analysis of Qs and T was performed by using subjects' performance data from trials completed using a traditional standing microscope as success criteria.

Results: The motion parameters from the head-mounted microscope were significantly better than the standing microscope (P < 0.01), but T was longer than that from the standing microscope (P < 0.01). No subject successfully adapted to the head-mounted microscope, as assessed by CUSUM analysis.

Conclusion: Cumulative summation analysis can objectively monitor the learning process associated with a phonomicrosurgical simulator system, ultimately providing a tool to assess learning status. Also, motion parameters determined by our MPTS showed that, although the head-mounted microscope provides better motion control, worse Qs and longer T resulted. This decrease in Qs is likely a result of the relatively unstable visual environment that it provides. Overall, the inexperienced surgeons participating in this study failed to adapt to the head-mounted microscope in our simulated phonomicrosurgery environment. Level of evidence: 4 Laryngoscope, 126:2295-2300, 2016.