Acquisition of surgical skills for endoscopic ear and lateral skull base surgery: a staged training programme

Endoscopic ear surgery is radically changing the treatment of several middle and inner ear pathology, but its learning presents well-knownmanual and technical difficulties. The aim of this paper is be to present a training programme based on a modular model of increased difficulties.The experience from 2007 to 2016 at the University Hospital of Modena and University Hospital of Verona was reviewed andanalysed for further considerations and to establish stages of training. The increasing experience of expert surgeons who deal with this kindof surgery represented the main guide to establish the steps and progression of training. In addition, the potential risk of damage of vascularstructures or nerves represents fundamental criteria for progression toward higher levels. Some not-mandatory skills were also suggestedfor stage of difficulty. Five stages of training were deemed appropriate for progressive learning of endoscopic ear and lateral skull basesurgery, ranging from simple middle and external ear procedures to surgery of inner ear and internal auditory canal. Mastering of eachlevel is suggested before attempting procedures at a higher level, in particular for procedures involving lateral skull base. Standardisationand adoption of modular incremental training are expected to facilitate improvement of otolaryngologists and neurosurgeons starting withendoscopic middle ear and lateral skull base surgery. Adherence to such a programme during the growth phase may potentially decrease therate of complications, making the training programme safer.