Jorge N. Buxton, MD, Microsurgical Education Center
One of the most unique medical training facilities in the Tri State area, the Jorge N. Buxton, MD, Microsurgical Education Center is open and available for use by all interested professionals at New York Eye and Ear Infirmary of Mount Sinai (NYEE).
The Center provides ophthalmologists, otolaryngologists and plastic surgeons with opportunities for hands-on experience in a variety of surgical procedures before actually treating patients in the operation room. It is equipped with 16 workstations, each with state-of-the-art operating microscopes and microsurgical instruments. One station is equipped with a chip camera for live demonstrations of surgical techniques. The Center is also equipped with plasma monitors and the latest video technology.
The modern microsurgical laboratory is central to the educational mission of NYEE. Nothing can replace the development of tactile skills and familiarity with three-dimensional anatomical structures.
In ophthalmology, "hands-on" courses include cataract removal, reconstructive plastic surgery, corneal transplantation, non-laser glaucoma surgery, strabismus surgery (muscle surgery to correct crossed eyes), and suturing and incision techniques. Phacoemulsification (used in removal of a cataract) and vitrectomy (removal of the jelly-like matter in the eye to improve vision lost from bleeding in the eye) are practiced on both a simulator and specimens.
In otolaryngology, intensive specialized training is necessitated by the very structure of the human temporal bone, which is one of the most complex in the body; it includes the outer portions of the skull and houses sensitive bones and tissue responsible for hearing and balance. Otologic surgery takes place within an extremely small operative area, and the more important structures are located deep in the head so as to always require delicate microsurgery.
The techniques learned here are used in cases of conductive hearing loss, or loss attributable to non-nerve related problems, such as malfunctioning bones of the middle ear, perforated eardrum from trauma or other causes, or chronic ear disease. Surgical procedures to remedy dizziness and facial paralysis, as well as leading-edge ossicular reconstruction (repair of the hearing bones) are also studied.
Techniques for reconstructive and aesthetic facial surgery have multiplied over the past decade and include endoscopic (performed through small incisions using surgical telescopes) and laser-assisted methods. Over the past several years, the Division of Facial Plastic Surgery within Department of Otolaryngology has become increasingly active in the research, development, and teaching of these new modalities.
The new Center replaced the traditional Temporal Bone Laboratory, which trained more than 2,000 physicians from around the world. Because extensive practice with this part of the anatomy is crucial in developing the expertise necessary to perform delicate surgery in the inner ear and around the facial nerves, NYEE first had a temporal bone laboratory before the turn of the last century.
The Center is named in memory of the world-famous corneal surgeon Jorge N. Buxton, MD, who practiced and taught at New York Eye and Ear for more than four decades.
Formerly The Temporal Bone Laboratory, the Jorge N. Buxton, MD, Microsurgical Education Center located on the 5th Floor of the South Building, officially opened in September 2004.
The Laboratory's Early Stages
Hands-on study of specimens prior to entering the operating room has a long history at NYEE. For many years, starting early in the 20th century, Dr. Edgar Burchell created a world-famous teaching collection of anatomy and pathology of the eyes and ears. He left a library of hundreds of temporal bones, and his study of the seventh, or facial, nerve taught generations of surgeons the means to minimize operative danger of disfigurement.
In 1958, NYEE established its first official Temporal Bone Laboratory, which consisted of one teaching station equipped with hammers and chisels and plaster molds to anchor the temporal bone. Several years later, a second station was installed with a microscope and a drill system. This facility was used until 1972.
A Larger Lab, A Leader In The Field
In the early 70's, illustrious otolaryngologist and NYEE alumnus Young Bin Choo, MD, successfully acquired a $100,000 grant from the Guggenheim Foundation to construct an 11-station, state-of-the-art Temporal Bone Laboratory. The designer was Jack Urban, who designed the only other laboratory of its kind in the world for the House Otology Group.
More than 1,800 physicians were trained in this Laboratory under the direction of Emmett E. Campbell, MD, otologist and another graduate of NYEE's otolaryngology program (Class of 1959). Dr. Campbell offered courses to residents and attending physicians, many of whom came from around the world, including Australia, Canada, Egypt, Great Britain, Japan, India, Iran, Ireland, and the Philippines to attend his courses.
In 1995, Christopher J. Linstrom, MD, assumed the role as the Lab's Medical Director and carried on the tradition of offering highly regarded temporal bone dissection courses to residents and attending physicians.
Ribbon Cutting at NYEE Microsurgical Dissection Laboratory
The creation of the new Center was made possible by generous donations from Alcon Laboratories, Inc., the Charles and Mildred Schumacher Foundation, Ambrose Monell Foundation, and many physicians and friends of New York Eye and Ear Infirmary.
Named after one of NYEE's most prestigious ophthalmologists, Jorge N. Buxton, MD, the Center was expanded to 16 work stations, each equipped with state-of-the-art microscopes and dissection equipment for temporal bone surgery, ophthalmologic surgery, head and neck dissection, sinus surgery, and plastic surgery.
This Center bridges the gap between academic medicine and the operating room, providing both residents in training and physicians in practice the opportunity to develop and refine their surgical skills before entering the operating room.
Joseph Arigo, MD, assumed the responsibilities as Medical Director of the Laboratory from 2003-2008. He put together extensive hands-on dissection programs in temporal bone surgery under his direction, head and neck anatomy courses under the direction of Stimson Schantz, MD, sinus surgery under the direction of Steven Schaefer, MD, and skull base surgery under the direction of Drs. George Alexiades and Christopher Linstrom. The Department of Ophthalmology also uses the new facility extensively.
One of the most unique features of resident training is the EyeSi microsurgical simulator, which uses advanced computer technology to give the feel of experiencing intraocular surgery. Manipulating instruments while using foot pedals to focus the microscope helps residents refine the hand, eye, and foot coordination that goes into real minimally invasive eye surgery before utilizing actual equipment in the operating room. A supervising surgeon can watch the operation on a large plasma screen and offer critique. The new technology has rapidly become an important foundation of the training process and unanimously meets with positive feedback.
Bridging the labs old and new, and coordinating activities for all courses, is Arthur Tortorelli, who has been Technical Director of the facilities since 1977.
Because the previous Laboratory was designed for temporal bone dissection, course offerings were limited by the design features. The Jorge N. Buxton, MD, Microsurgical Education Center was designed to enable all disciplines at New York Eye and Ear Infirmary to offer courses that were not previously possible in the old facility.
NYEE recognizes the significance of surgical training before entering the operating room. Therefore, it makes the Jorge N. Buxton, MD, Microsurgical Education Center available for individual use, group use, or use by other residency programs in the tri-state area. Inquiries may be directed to firstname.lastname@example.org.
The following courses are part of the regularly scheduled curriculum of resident education in Ophthalmology and Otolaryngology at New York Eye and Ear Infirmary of Mount Sinai.
Other offerings will be advertised to their respective specialties in professional journals and online.
Ophthalmology Residents Courses
- First Year Residents *
- Pterygium Surgery
- Strabismus Surgery
- Second Year Residents *
- Glaucoma Surgery
- Penetrating Keratoplasy
- Phacoemulsification (Alcon)
- Vitrectomy surgery
- Third Year Residents
- Introduction to Phacoemulsification - Alcon
- Vitrectomy, advanced
- Introduction to phaco - Bausch and Lomb
- Introduction to phaco - AMO course
- Advanced phaco and Healon 5 Certificate training - AMO course
- AMO course - Tecnis Multifocal Certification
- Suturing Sessions- all residents twice monthly
- Other Ophthalmology Courses
- IScience Canaloplasty
- Stryker Plating Course - various residents
*offered as annual spring microsurgery courses for residents
Otolaryngology Residents Courses
- First, Second, and Third Year Residents at increasing levels of complexity
- Temporal Bone Dissection
- Plastic surgery flaps and suturing
- Stryker plating course