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)


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.


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