A basic model for training of microscopic and endoscopic transsphenoidal pituitary surgery: the Egghead

Engel, Doortje C.; Ferrari, Andrea; Tasman, Abel‐Jan; Schmid, Raphael; Schindel, Ralf; Haile, Sarah R.; Mariani, Luigi; Fournier, Jean–Yves

doi:10.1007/s00701-015-2544-z

Cited by 14 publications

(9 citation statements)

References 23 publications

(38 reference statements)

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“…Comparisons between the two endoscopes (Table I) found no evidence of significant differences between the time (P = .153) or the adjustment time (P = .067), although the trend was for the latter to be longer in the 3D endoscopes irrespective of whether using this endoscope first or second. However, past pointing was found to be significantly lower when using 3D endoscopes (median 0 vs. 2, P = .025), and depth perception (8 vs. 4, P < .001) Adjustment Time (seconds) 9 (5-13) 10 (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) .067…”

Section: Resultsmentioning

confidence: 99%

“…Other specialities, however, including neurosurgery and ophthalmology, as well as junior doctors with little to no endoscopic experience, are required to acquire a new skill set using an unfamiliar tool while operating in delicate surgical fields. 8,9 In 2012, a new 4-mm three-dimensional (3D) endoscope was introduced primarily to overcome the lack of stereopsis. 3D endoscopes have encountered an evolution of their own through improvements in image clarity and endoscopic quality.…”

Section: Introductionmentioning

confidence: 99%

“…In essence, surgeons are capable of creating three‐dimensionality through experience, commonly through years of training in otolaryngology. Other specialities, however, including neurosurgery and ophthalmology, as well as junior doctors with little to no endoscopic experience, are required to acquire a new skill set using an unfamiliar tool while operating in delicate surgical fields …”

Section: Introductionmentioning

confidence: 99%

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Endoscopic training—is the future three‐dimensional?

Nassimizadeh

Zaidi

Nassimizadeh³

et al. 2018

Laryngoscope Investig Oto

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Background/ObjectivesEndoscopic surgery has a distinct disadvantage compared to direct vision: loss of binocular vision. Three‐dimensional endoscopy has been welcomed due to the promise of improving stereopsis.MethodsProspective randomized study of junior doctors with minimal endoscopic experience, using both two‐dimensional and three‐dimensional, zero‐degree, 4‐mm Storz endoscopes. Data was collected using validated, standardized training models, both objectively and subjectively. Paired comparisons between variables relating to the endoscopes were performed using Wilcoxon's tests. Operators were then split into groups based on their endoscope preference, with comparisons made using Mann‐Whitney tests for Likert scale responses, Kendall's tau for ordinal variables, and Fisher's exact tests for nominal variables.ResultsReduction of field of vision of three‐dimensional endoscopy by 2%. Significant findings included decreased past‐pointing, improved depth and perception and image quality.ConclusionThe use of an endoscopic endonasal approach with three‐dimensional technology has measurable advantages for novice users, and highlights potential tailoring of future surgical trainingLevel of Evidence1b

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic training—is the future three‐dimensional?

Nassimizadeh

Zaidi

Nassimizadeh³

et al. 2018

Laryngoscope Investig Oto

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“…Cadaveric models represent invaluable training aids; however, merely manipulating orbital fat and anatomy identification does not adequately prepare the surgeon for the technical challenges of dissecting orbital pathology away from sensitive neurovascular structures within the intraconal space. Although numerous training models in endoscopic skull base surgery have been described, [20][21][22] to date no known orbital models have been reported that successfully simulate orbital pathology.…”

Section: Discussionmentioning

confidence: 99%

Development of a Modular Cadaveric Endoscopic Orbital Surgery Model

Banks

Husain

Sacks

et al. 2019

Am J Rhinol�Allergy

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Introduction Endoscopic orbital surgery requires the acquisition of unique skill set including endoscopic bimanual dissection of intra/extraconal lesions adherent to orbital fat and neurovascular structures. Our goal was to develop a modular cadaveric model used to train surgeons to resect orbital pathology within any desired orbital compartment. Methods Expansile superabsorbent polymer (SAP) beads (2 mm) were soaked in Omnipaque™ (Iohexol) solution for 15 minutes prior to transcaruncular orbital implantation using 10-gauge angiocath. Insertion depth was designed to implant beads in predetermined intraconal compartments corresponding to established orbital tumor stages. Beads were left to expand in situ over a period of 1 to 5 hours. Computed tomography scans were performed using the FUSION image guidance protocol. Model utility and learning curves were assessed by quantifying resection time over 8 sequential attempts. Results All 24 beads were successfully implanted in 8 orbits corresponding to CHEER stage II to IV lesions (n = 3 per orbit). Beads expanded from 2 mm to an average of 5.2 mm within 1 hour. During expansion, the beads interpolated into the adjacent fascia similar to in vivo tumors. Average insertion time was 5:53 minutes per orbit (range, 3:24–10:33 min) and average time to bead identification was 10:47 minutes. Across all beads, dissection times decreased in a nonsignificant manner over 8 consecutive attempts. Conclusion The directed implantation of expansile SAP beads in this cadaveric model accurately replicates the approach, identification, and resection of isolated orbital lesions. This orbital model can assist the endoscopic surgical team to develop further knowledge and technical skill sets to approach orbital lesions. Further ongoing studies to validate this model are currently underway.

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“…22,23 The use of 3-dimensional models has improved training feasibility; however, these models lack the intricacies of complex human anatomy, especially in relation to vascular injury. 24 Anesthesia models have been developed to control hypotension during simulated training experiences, 25 but until recently, simulated vascular complication models for surgical training have not been readily available. The live sheep model is the most comprehensive model addressing vascular injury repair, but it is difficult to replicate at most training programs and is limited in that human anatomy cannot be fully appreciated.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Management of Cavernous Carotid Surgical Complications: Evaluation of a Simulated Perfusion Model

et al. 2017

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Objective Endoscopic surgical treatment of pituitary tumors, lateral invading tumors, or aneurysms requires surgeons to operate adjacent to the cavernous sinus. During these endoscopic endonasal procedures, the carotid artery is vulnerable to surgical injury at its genu. The objective of this simulation model was to evaluate trainees regarding management of a potentially life-threatening vascular injury. Methods Cadaveric heads were prepared in accordance with the Oregon Health & Science University body donation program. An endoscopic endonasal approach was used, and a perfusion pump with a catheter was placed in the ipsilateral common carotid artery at its origin in the neck. Learners used a muscle graft to establish vascular control and were evaluated over 3 training sessions. Simulation assessment, blood loss during sessions, and performance metric data were collected for learners. Results Vascular control was obtained at a mean arterial pressure of 65 mm Hg using a muscle graft correctly positioned at the arteriotomy site. Learners improved over the course of training, with senior residents (n = 4) performing better across all simulation categories (situation awareness, decision making, communications and teamwork, and leadership); the largest mean difference was in communication and teamwork. Additionally, learner performance concerning blood loss improved between sessions (t = 3.667, P < 0.01). Conclusions In this pilot endoscopic endonasal simulation study, we successfully demonstrate a vascular complication perfusion model. Learners were able to gain direct applicable expertise in endoscopic endonasal techniques, instrumentation use, and teamwork required to optimize the technique. Learners gained skills of vascular complication management that transcend this model.

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A basic model for training of microscopic and endoscopic transsphenoidal pituitary surgery: the Egghead

Abstract: Our model, the Egghead, is affordable, offers tactile feedback and allows infinite repetitions in basic training for pituitary surgery. It can be used for training of advanced neurosurgical residents, who thus far have very few possibilities of acquiring endoscopic experience.

Cited by 14 publications

References 23 publications

Endoscopic training—is the future three‐dimensional?

Endoscopic training—is the future three‐dimensional?

Development of a Modular Cadaveric Endoscopic Orbital Surgery Model

Endoscopic Management of Cavernous Carotid Surgical Complications: Evaluation of a Simulated Perfusion Model

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