Demonstration surgeries

Window Approach Workshop (WAW)

Window Approach Workshop (WAW) is a cyclically organised surgical and scientific workshop addressed at otosurgeons, heads of hospital wards and heads of clinics specialising in treating deafness using hearing implants, among others. It is one of the programmes of the International Academy of Otosurgery. Window Approach Workshops are attended by specialists from all over the world. This year marks 12 years since the first WAW. 

The first workshops were held in April 2007 as part of the inauguration of a new series of meetings dedicated to the latest achievements in surgical treatment of hearing disorders.  The meeting 12 years ago also aimed to promote the pioneer otosurgical solutions. Prof. Henryk Skarżyński presented 6 demonstration operations at that time – 3 implantation operations conducted on patients with partial deafness and 3 operations involving Vibrant middle ear implant. The participants were trainees from Austria, Belarus, Finland, Spain, Sweden, Ukraine, Great Britain and Italy.

– I perfectly remember the first group of a dozen or so doctors, who were very interested in our achievements – recalls Prof. Henryk Skarżyński, the initiator and originator of the workshops. – We started the trainings in modest conditions, having at out disposal a small laboratory equipped with only 8 workstations where we could practice using specimen.   Today, Kajetany houses the world’s best and largest facility for practising surgical techniques. We managed to build the Education Centre, which has a unique laboratory equipped with 30 otosurgery and rhinosurgery workstations, state-of-art equipment for trainings using anatomical specimens and computer simulators – adds Prof.  Skarżyński.

The programme of every edition of the workshops includes lectures prepared by specialists from the Institute of Physiology and Pathology of Hearing, demonstration surgeries transmitted from the operating theatre to a conference hall, accompanied by a presentation of each case and discussion, and laboratory practices using fresh specimen. One of the most important items in the scientific programme of the workshops is the use of implants in the treatment of partial deafness, where hearing impediment affects only some (most often high) frequencies. Prof. Henryk Skarżyński developed an atraumatic surgical method, where access to the inner ear is obtained through one of the natural openings in the cochlea bone – round window. Today, after 17 years from the world’s first operation of inserting a cochlea implant into a patient with partial normal hearing, performed by Prof. Henryk Skarżyński, this method is known in science throughout the world as the “Polish school of otosurgery”. The participants of the workshops have a chance to learn this surgical method from Prof.  Skarżyński himself.

A huge emphasis during the Window Approach Workshops is placed on practical training. Kajetany is the only place in the world with such an extensive and comprehensive programme of otosurgery trainings which includes demonstration operations. The participants are given the opportunity to observe hearing implantation surgeries performed by Prof. H. Skarżyński along with the team from the Otorhinolaryngological Surgery Clinic at the Institute of Physiology and pathology of Hearing. Demonstration surgeries are a huge challenge for the person performing the operation and the whole operating theatre team, as each stage of the surgery is closely watched and assessed. For that reason, other surgical teams are unwilling to engage in performing demonstration surgeries. The team from the Otorhinolaryngological Surgery Clinic at the Institute of Physiology and Pathology of Hearing, who has for many years been daily performing the biggest number of hearing improving surgeries, takes advantage of its many years of experience to measure up to this task.  – Demonstration surgeries performed during the workshops document the possibilities and high level of the Polish science and medicine, and let us present ourselves on the international arena. They take huge effort, but it is the best way to reinforce new ideas in every day clinical practice – adds Prof. H. Skarżyński.

During each edition of the workshops, at least a dozen or so demonstration surgeries are performed. On the occasion of the jubilee 30th edition of WAW (27-28 November 2017), as many as 30 demonstration surgeries performed by Prof. Henryk Skarżyński were presented – In the World Hearing Centre, participants of the workshops can encounter very rare clinical cases. In Kajetany, they can watch more surgical procedures during a single day than in other centres throughout several years – stresses Prof. Henryk Skarżyński.

It is worth reminding that Window Approach Workshops were also one of the highlights of international scientific conferences organised by the Institute of Physiology and Pathology of Hearing and an occasion to present for the first time new technological developments in the field of hearing implants. This was the case in 2009 during the 9th European Symposium on Paediatric Cochlear Implantation (ESPCI 2009), when during the edition of WAW a new SRA electrode, developed by Prof. Henryk Skarżyński, was presented and implanted for the first time in the world. Currently, its CI-412 and CI-512 versions are the most sold implants worldwide.

The fifth WAW, which accompanied the 9th European Symposium on Paediatric Cochlear Implantation, brought together a record number of participants – over 1500 people from all over the world. Window Approach Workshops were also an important part of the 10th  Congress of the European Federation of Audiology Societies (EFAS) organised by the Institute of Physiology and Pathology of Hearing.

In 2012, Poland’s first operation of inserting the pioneer BONEBRIDGE hearing implant, performed by Prof. Henryk Skarżyński, took place during WAW in the newly opened, second part of the World Hearing Centre in Kajetany. This operation marked a new era in treating inborn hearing disorders resulting mainly from full or partial agenesis of outer or middle ear.   Other indications can include postinflammatory and post-traumatic injuries.

The 28th edition of Window Approach Workshops in March 2017 was also unique – after a one-day training the participants had an opportunity to attend a scientific meeting held in Kajetany, International BONEBRIDGE & SOUNDBRIDGE Symposium, the highlight of which was the world’s first operation of inserting a new type of cochlea implant, Vibrant Soundbridge with LP-Coupler, performed by H. Skarżyński. The operation was watched in Kajatany by over 250 top otosurgeons from all of the continents.

The last pioneer operation performed as part of WAS took place on 24 October 2017. Prof.  Skarżyński was the first in Central Eastern Europe to insert HiRes Ultra cochlea implants using the new HiFocus SlimJ electrode. Using this electrode and his original, minimally traumatic surgical method, which involves placing it in the cochlea through the round window, it is possible to extend the criteria of qualification for implantation to include other groups of patients with partial deafness, i.e. people with good or slightly impaired hearing in low frequencies and significant hearing loss in high frequencies.

Apart from demonstration operations and otosurgery practices, the programme of Window Approach Workshop also includes lectures by specialists from the Institute on diagnostics and qualification of patients for hearing implantation, other advanced surgical techniques and the latest hearing implantation technologies. 

For 12 years, throughout which time Window Approach Workshops have been held, Kajetany has been visited by almost 5 thousand participants from almost 80 countries all over the world. The next workshops are planned at the end of 2018 and in 2019.

The above-mentioned method was also popularised in modern medicine through “live” demonstration operations performed by Henryk Skarżyński in Manila (Philippines) Saint Petersburg (Russia), Minsk and Grodno (Belarus), Kyiv (Ukraine), Bogota (Columbia), Hanover (Germany).