Efficiency of two-surgeon tympanomeatal flap elevation in endoscopic tympanoplasty

This study aims to evaluate the efficiency of the two-surgeon assisted technique (one surgeon performs the dissection while an assistant holds the endoscope) for tympanomeatal (TM) flap elevation during endoscopic tympanoplasty. We retrospectively reviewed 97 video recordings of endoscopic tympanoplasty performed in 97 patients from July 2016 to February 2023. Operative times of TM flap elevation for 38 one-surgeon and 59 two-surgeon techniques were compared. We also evaluated the result of the two-surgeon assisted technique in different diameters and shapes of the external auditory canal (EAC) of the operative ear, as determined by temporal high-resolution computed tomography. The two-surgeon technique significantly shortened the operative time for complete TM flap elevation (16.6 ± 5.8 vs. 22.7 ± 5.8 min, P < 0.001) and from the first incision to exposure of the chorda tympani nerve (7 ± 2 vs. 11.1 ± 3.4 min, P < 0.001). Operative times were not associated with EAC diameter, but were longer in cylindrical EACs (18.34 ± 6.27 min) compared to non-cylindrical EACs (14.85 ± 4.65 min, P = 0.019). Within our controlled study setting, the two-surgeon technique served as an adjunctive strategy, reducing the operative time specifically for the TM flap elevation phase in endoscopic tympanoplasty compared to the conventional one-handed approach, without compromising the perforation closure rate. While this approach is not a prerequisite for efficient endoscopic tympanoplasty, our study suggests that it may serve as a valuable situational adjunct to enhance procedural efficiency during TM flap elevation. • Two-surgeon technique reduces TM flap elevation time. • Time savings occur primarily during the early phase of TM flap elevation. • Two-surgeon technique does not compromise perforation closure rates. • Cylindrical external auditory canals are linked to longer TM flap elevation times.