Experimental Model for Training of Endoscopic Transsphenoidal Pituitary Adenoma Resection

Introduction: Transsphenoidal endoscopic surgery has gained popularity in the last 2 decades and is becoming the standard technique for resection of pituitary adenomas. In contrast to their ENT colleagues, neurosurgical residents have practically no endoscopic experience when they reach the stadium of transsphenoidal procedures. Cadaveric workshops are expensive and cannot be repeated very frequently. Endoscopic software simulators do exist but are very expensive as well and although they allow repetition they lack the tactile feedback needed in surgical training. We have developed an affordable method for repetitive training of endoscopic work in a narrow channel, allowing training of the movements needed for resection of pituitary adenoma.

Methods: In collaboration with ENT and the technical university of Zurich we have developed a model of the nasal cavity made of polystyrene. The model has been patented.

Results: The final model consists of a hard 3D reconstruction of the head with a softer removable part in the region of the nose and sphenoid sinus. The boiled egg is inserted in a dedicated box at the level of the sella. The model allows training of the resection of the egg yolk under sparing of the egg white after careful opening of the shell. It is a realistic simulation of the movements done under the endoscope through a narrow approach at a depth of 12 cm.

Conclusions: Our model achieves the goals mentioned above: it is affordable, offers tactile feedback and allows infinite repetitions. It could be used for training of advanced neurosurgical residents who thus far have very few possibilities of acquiring endoscopic experience.