Validation of a Chicken Wing Training Model for Endoscopic Microsurgical Dissection
Objective: To determine if prior training with a chicken wing model improves performance of endoscopic endonasal surgery (EES) with microvascular dissection.
Design and Methods: A single-blinded randomized controlled trial of trainees with various levels of endoscopic experience was conducted at the University of Pittsburgh to determine if prior training on a non-human model augments endoscopic skill and efficiency in a surrogate model for live surgery. Medical students, residents, and fellows were randomized to 2 groups: a control group that performed an endoscopic transantral internal maxillary artery dissection on a silicone-injected anatomical specimen, and an interventional group that underwent microvascular dissection training on a chicken wing model prior to performing the anatomic dissection.
For the interventional cohort, training consisted of performing five endoscopic surgical tasks on a previously reported chicken wing model. Medical students had six training sessions, at most one per day. Residents and fellows had five training sessions, also at most one per day. Time to completion of each task as well as overall time was recorded, and non-blinded quality assessments were made using the 35 point Modified Global Rating Scale of Operative Performance rubric.
All subjects performed endoscopic anatomical dissection of the internal maxillary artery in the anatomic specimen, which consisted of four tasks. Again, time to completion for each task as well as overall time was recorded, and single blinded quality assessments were made using the Modified Global Rating Scale of Operative Performance rubric. Following completion of the procedure, participants were asked to complete a NASA-Task Load Index, a validated assessment of perceived workload.
Statistical analysis comparing the control and interventional groups while controlling for prior surgical training was conducted with a Mann-Whitney test.
Results: For the medical students, a Mann-Whitney test rejected the null-hypothesis for both time (p = .032) and quality (p = .008). The control group times had mean 74.40 minutes, standard deviation 25.93min, and median 75.49min (50.29–97.98). The interventional group had mean 41.14 minutes, standard deviation 6.10min and median 38.50min (36.24–47.36). For quality, the control group had mean score 13.60, standard deviation 6.11, and median 15 (7.50–19.00). The interventional group had mean 30.60, standard deviation 5.03, and median 33 (25.50–34.50).
For residents and fellows a Mann-Whitney test rejected the null-hypothesis for both time (p = .016) and quality (p = .032). The control group times had mean 45.3100 minutes, standard deviation 8.00min, and median 44.37min (38.85–52.24). The interventional group times had mean 26.44 minutes, standard deviation 6.57min, and median 26.55min (19.93–32.90). For quality, the control group had mean score 24.00, standard deviation 9.25, median 19.00 (16.50–34.00). The interventional group had quality score mean 34.60, standard deviation 0.548, median 35.00 (34.00–35.00).
Conclusion: Based on current results, this study confirms that the chicken wing model improves surgical performance in a surrogate model for actual EES. The chicken wing model is a cost-effective alternative to expensive silicone-injected human specimen materials and may improve efficiency in the operating room. Individuals with limited to moderate endoscopic experience demonstrate the greatest benefit from training on the chicken wing model.