BMJ Case Reports 2017; doi:10.1136/bcr-2017-222657
  • Learning from errors

Preoperative simulation unveiled undetected surgical difficulties in a case of cochlear implantation

  1. Makoto Hashizume2
  1. 1Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  2. 2Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
  1. Correspondence to Dr Nozomu Matsumoto, matunozo{at}
  • Accepted 20 November 2017
  • Published 2 December 2017


We herein report a case in which extensive preparation changed a difficult-to-treat patient into an easy one. We performed a revision cochlear implantation on a patient whose first procedure had been aborted due to unidentified difficulties. During a series of thorough three-dimensional simulations, we found that the patient in question had a normal cochlea but the cochlea was placed in an unusual position and orientation. This condition is difficult to detect on standard preoperative radiographic images. Through this simulation, we were able to propose a surgical plan to avoid making the same mistakes as the first surgeon. We present this case not as a rare difficult case of an unfortunate patient but instead emphasise the importance of performing surgical simulation and looking for non-obvious difficulties. This case is an example of the success that can be achieved with such extensive preparation.


  • Contributors NM is the surgeon who performed revision surgery on this case and wrote this manuscript. MY and BC are the engineers who performed simulation surgery and proposed multiple surgical plans for this case. MH conducted the simulation surgery process.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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