The Role of Bimanual Dissection and Dynamic Endoscopy in Endoscopic Neurosurgical Training: Preliminary Results of a Laboratory Investigation

Objective: Endoscopic endonasal approaches are usually done in conjunction by one neurosurgeon and one ENT surgeon. However one-handed versus two-handed dissection and static versus dynamic endoscopy have all been successfully used. The goal of this study is to evaluate the impact of bimanual dissection and dynamic endoscopy in endoscopic microsurgical training using a validated training model. Study Design: Laboratory investigation. Methods: Overall 15 participants were randomized in three different groups and oriented to complete four tasks in the Chicken Wing Training Model using three different surgical techniques. Two scoring methods were used for objective assessment of the surgical skills: specific-task checklist (0-16); global rating scale modified for the aim of this study (7-35). Results: The lowest scores and higher time to complete the tasks were observed in the group that used the one-hand technique (mean scores 12.8 and 25, mean time 69 minutes and 4 seconds). The group that used dynamic endoscopy and bimanual dissection achieved the best score and the shorter time (mean score 14 and 28.6, mean time 52 minutes and 26 seconds). Given the small sample size, there was only a trend toward statistical significance (p = 0.56). Conclusions: Many different techniques may be successfully used for endoscopic microsurgery, but the results of this study may suggest that the use of dynamic endoscopy and bimanual dissection techniques in endoscopic microsurgery leads to improved surgical performance.