J C Fernandez-Miranda, J Barges-Coll, D M Prevedello, J Engh, C Snyderman, R Carrau, P A Gardner, A B Kassam
{"title":"Animal model for endoscopic neurosurgical training: technical note.","authors":"J C Fernandez-Miranda, J Barges-Coll, D M Prevedello, J Engh, C Snyderman, R Carrau, P A Gardner, A B Kassam","doi":"10.1055/s-0030-1269927","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>The learning curve for endonasal endoscopic and neuroendoscopic port surgery is long and often associated with an increase in complication rates as surgeons gain experience. We present an animal model for laboratory training aiming to encourage the young generation of neurosurgeons to pursue proficiency in endoscopic neurosurgical techniques.</p><p><strong>Methods: </strong>20 Wistar rats were used as models. The animals were introduced into a physical trainer with multiple ports to carry out fully endoscopic microsurgical procedures. The vertical and horizontal dimensions of the paired ports (simulated nostrils) were: 35×20 mm, 35×15 mm, 25×15 mm, and 25×10 mm. 2 additional single 11.5 mm endoscopic ports were added. Surgical depth varied as desired between 8 and 15 cm. The cervical and abdominal regions were the focus of the endoscopic microsurgical exercises.</p><p><strong>Results: </strong>The different endoscopic neurosurgical techniques were effectively trained at the millimetric dimension. Levels of progressive surgical difficulty depending upon the endoneurosurgical skills set needed for a particular surgical exercise were distinguished. LEVEL 1 is soft-tissue microdissection (exposure of cervical muscular plane and retroperitoneal space); LEVEL 2 is soft-tissue-vascular and vascular-capsule microdissection (aorto-cava exposure, carotid sheath opening, external jugular vein isolation); LEVEL 3 is artery-nerve microdissection (carotid-vagal separation); LEVEL 4 is artery-vein microdissection (aorto-cava separation); LEVEL 5 is vascular repair and microsuturing (aortic rupture), which verified the lack of current proper instrumentation.</p><p><strong>Conclusion: </strong>The animal training model presented here has the potential to shorten the length of the learning curve in endonasal endoscopic and neuroendoscopic port surgery and reduce the incidence of training-related surgical complications.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1269927","citationCount":"15","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minimally Invasive Neurosurgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1055/s-0030-1269927","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2011/2/7 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 15
Abstract
Objective: The learning curve for endonasal endoscopic and neuroendoscopic port surgery is long and often associated with an increase in complication rates as surgeons gain experience. We present an animal model for laboratory training aiming to encourage the young generation of neurosurgeons to pursue proficiency in endoscopic neurosurgical techniques.
Methods: 20 Wistar rats were used as models. The animals were introduced into a physical trainer with multiple ports to carry out fully endoscopic microsurgical procedures. The vertical and horizontal dimensions of the paired ports (simulated nostrils) were: 35×20 mm, 35×15 mm, 25×15 mm, and 25×10 mm. 2 additional single 11.5 mm endoscopic ports were added. Surgical depth varied as desired between 8 and 15 cm. The cervical and abdominal regions were the focus of the endoscopic microsurgical exercises.
Results: The different endoscopic neurosurgical techniques were effectively trained at the millimetric dimension. Levels of progressive surgical difficulty depending upon the endoneurosurgical skills set needed for a particular surgical exercise were distinguished. LEVEL 1 is soft-tissue microdissection (exposure of cervical muscular plane and retroperitoneal space); LEVEL 2 is soft-tissue-vascular and vascular-capsule microdissection (aorto-cava exposure, carotid sheath opening, external jugular vein isolation); LEVEL 3 is artery-nerve microdissection (carotid-vagal separation); LEVEL 4 is artery-vein microdissection (aorto-cava separation); LEVEL 5 is vascular repair and microsuturing (aortic rupture), which verified the lack of current proper instrumentation.
Conclusion: The animal training model presented here has the potential to shorten the length of the learning curve in endonasal endoscopic and neuroendoscopic port surgery and reduce the incidence of training-related surgical complications.
目的:鼻内窥镜和神经内窥镜手术的学习曲线很长,并且随着外科医生经验的增加,并发症的发生率也会增加。我们提出了一个用于实验室训练的动物模型,旨在鼓励年轻一代的神经外科医生熟练掌握内窥镜神经外科技术。方法:以20只Wistar大鼠为模型。这些动物被引入一个有多个端口的体能训练器中,以进行全面的内窥镜显微外科手术。配对端口(模拟鼻孔)的垂直和水平尺寸分别为:35×20 mm, 35×15 mm, 25×15 mm和25×10 mm。另外增加了2个11.5 mm的单内镜端口。手术深度可根据需要在8至15厘米之间变化。颈部和腹部区域是内镜下显微手术练习的重点。结果:不同的内窥镜神经外科技术在毫米尺度上得到了有效的训练。根据特定手术练习所需的内神经外科技能,区分渐进式手术难度水平。一级是软组织显微解剖(暴露颈肌平面和腹膜后间隙);2级是软组织-血管和血管囊显微解剖(主动脉-腔暴露,颈动脉鞘打开,颈外静脉隔离);三级是动脉-神经显微解剖(颈动脉-迷走神经分离);4级为动静脉显微解剖(主动脉腔分离);5级是血管修复和微缝合(主动脉破裂),这证实了目前缺乏适当的器械。结论:本文提出的动物训练模型有可能缩短鼻内窥镜和神经内窥镜端口手术的学习曲线长度,并减少训练相关手术并发症的发生率。