J Neurol Surg B 2015; 76(05): 365-371
DOI: 10.1055/s-0034-1544124
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Impact of Dynamic Endoscopy and Bimanual-Binarial Dissection in Endoscopic Endonasal Surgery Training: A Laboratory Investigation

Francisco Vaz-Guimaraes1, Milton M. Rastelli Jr1, Juan C. Fernandez-Miranda1, Eric W. Wang2, Paul A. Gardner1, Carl H. Snyderman1, 2
  • 1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • 2Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
Further Information

Publication History

22 October 2014

25 November 2014

Publication Date:
13 May 2015 (eFirst)

Abstract

Objective The lack of a standard technique may be a relevant issue in teaching endoscopic endonasal surgery (EES) to novice surgeons. The objective of this article is to compare different endoscope positioning and microsurgical dissection techniques in EES training.

Methods A comparative trial was designed to evaluate three techniques: group A, one surgeon performing binarial two-hands dissection using an endoscope holder (rigid endoscopy); group B, two surgeons performing a combined binarial two- and three-handed dissection with one surgeon guiding the endoscope (dynamic endoscopy); and group C, two surgeons performing a binarial two-hands dissection with one surgeon dedicated to endoscope positioning and the other dedicated to a two-handed dissection. Trainees were randomly assigned to these groups and oriented to complete surgical tasks in a validated training model for EES. A global rating scale, and a specific-task checklist for EES were used to assess surgical skills.

Results The mean scores of the global rating scale and the specific-task checklist were higher (p = 0.001 and 0.002, respectively) for group C, reflecting the positive impact of dynamic endoscopy and bimanual dissection on training performance.

Conclusions We found that dynamic endoscopic and bimanual-binarial microdissection techniques had a significant positive impact on EES training.

Note

Portions of this work were presented at the 24th Annual North American Skull Base Society Meeting in San Diego, California, on February 15, 2014.