The Lamb's Head as a Model for Surgical Skills Development in Endonasal Surgery

Abstract

Objectives To test the viability of a lamb's head model for sinonasal surgery training in Brazil by comparing performance of endoscopic procedures in the septum and inferior turbinates.

Design Prospective study.

Settings Universidade Federal do Rio Grande do Sul (2015).

Participants Ten physicians performed septoplasty, inferior turbinoplasty, and middle turbinectomy on 30 lamb's heads.

Main Outcome Measures Degree of difficulty and similarity, opinion of tissue color and texture, and degree of satisfaction.

Results Participants completed a questionnaire at the end of each procedure and a satisfaction survey at the end of the project. Significant between-group differences were found for the perceived degree of difficulty in performing left inferior turbinoplasty, right inferior turbinoplasty, and septoplasty. Final satisfaction with training was scored 9 out of 10, and all participants reported that they would like to receive such training again.

Conclusion The tested model is feasible due to its low cost, its easy availability, and its similarity to human anatomy in terms of dimensions of relevant structures and tissue consistency. It allows effective training in instrument handling and acquisition of the surgical skills related to two-dimensional vision needed for endoscopy. However, it should not be considered a substitute for training of specific surgical techniques.

Keywords

paranasal sinus - animal model - training technique - surgery - education

• References

• 1 Shankar L, Evans K. An Atlas of Imaging of Paranasal Sinus. USA: Taylor & Francis; 2006
• 2 Leunig A. Cirugía endoscópica de la pared nasal lateral, de los senos paranasales y de la base anterior del cráneo. Tuttlingen, Germany: Straub Druck, Medien AG; 2009
• 3 Kennedy DW, Zinreich SJ, Rosenbaum AE, Johns ME. Functional endoscopic sinus surgery. Theory and diagnostic evaluation. Arch Otolaryngol 1985; 111 (9) 576-582
• 4 el-Hennawi DM. Combined functional endoscopic sinus surgery (FESS): a revisited approach. Rhinology 1998; 36 (4) 196-201
• 5 Awad Z, Taghi A, Sethukumar P, Tolley NS. Construct validity of the ovine model in endoscopic sinus surgery training. Laryngoscope 2015; 125 (3) 539-543
• 6 McFerran DJ, Grant HR, Ingrams DR, Fife DG. Endoscopic sinus surgery: are junior doctors being properly trained?. Ann R Coll Surg Engl 1998; 80 (5) 359-363
• 7 Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007; 117 (4) 699-705
• 8 Zuckerman JD, Wise SK, Rogers GA, Senior BA, Schlosser RJ, DelGaudio JM. The utility of cadaver dissection in endoscopic sinus surgery training courses. Am J Rhinol Allergy 2009; 23 (2) 218-224
• 9 Wais M, Ooi E, Leung RM, Vescan AD, Lee J, Witterick IJ. The effect of low-fidelity endoscopic sinus surgery simulators on surgical skill. Int Forum Allergy Rhinol 2012; 2 (1) 20-26
• 10 Sachdeva AK, Russell TR. Safe introduction of new procedures and emerging technologies in surgery: education, credentialing, and privileging. Surg Clin North Am 2007; 87 (4) 853-866 , vi–vii vi–vii.
• 11 Isolan GR. [The young neurosurgeon learning curve: ethical, scientific, philosophical aspects and the importance of the microsurgical laboratory training]. J Bras Neurocirurg 2009; 20 (3) 314-344
• 12 Burge SD, Bunegin L, Weitzel EK, McMains KC. The validation of an endoscopic sinus surgery skills training model: a pilot study. Am J Rhinol Allergy 2012; 26 (5) 409-413
• 13 Steehler MK, Chu EE, Na H, Pfisterer MJ, Hesham HN, Malekzadeh S. Teaching and assessing endoscopic sinus surgery skills on a validated low-cost task trainer. Laryngoscope 2013; 123 (4) 841-844
• 14 8.501 L. No Title. 1992 [Internet]. www. planalto.gov.br/ccicil_03/Leis/L8501.htm . Accessed: October 2015
• 15 Clifton N, Klingmann C, Khalil H. Teaching Otolaryngology skills through simulation. Eur Arch Otorhinolaryngol 2011; 268 (7) 949-953
• 16 Briner HR, Simmen D, Jones N , et al. Evaluation of an anatomic model of the paranasal sinuses for endonasal surgical training. Rhinology 2007; 45 (1) 20-23
• 17 Nogueira JF, Stamm AC, Lyra M, Balieiro FO, Leão FS. Building a real endoscopic sinus and skull-base surgery simulator. Otolaryngol Head Neck Surg 2008; 139 (5) 727-728
• 18 Gardiner Q, Oluwole M, Tan L, White PS. An animal model for training in endoscopic nasal and sinus surgery. J Laryngol Otol 1996; 110 (5) 425-428
• 19 Mladina R, Vuković K, Štern Padovan R, Skitarelić N. An animal model for endoscopic endonasal surgery and dacryocystorhinostomy training: uses and limitations of the lamb's head. J Laryngol Otol 2011; 125 (7) 696-700
• 20 Mladina R. Endoscopic Surgical Anatomy of the Lamb's Head. Germany: Endo Press; 2013
• 21 Dalgorf DM, Harvey RJ. Chapter 1: sinonasal anatomy and function. Am J Rhinol Allergy 2013; 27 (Suppl. 01) S3-S6
• 22 Sisson S, Grossman J. Anatomia dos animais domésticos. Brazil: Guanabara Koogan; 1986
• 23 Bakker NH, Fokkens WJ, Grimbergen CA. Investigation of training needs for functional endoscopic sinus surgery (FESS). Rhinology 2005; 43 (2) 104-108
• 24 Malekzadeh S, Pfisterer MJ, Wilson B, Na H, Steehler MK. A novel low-cost sinus surgery task trainer. Otolaryngol Head Neck Surg 2011; 145 (4) 530-533
• 25 Steehler MK, Pfisterer MJ, Na H, Hesham HN, Pehlivanova M, Malekzadeh S. Face, content, and construct validity of a low-cost sinus surgery task trainer. Otolaryngol Head Neck Surg 2012; 146 (3) 504-509
• 26 Brazil. Presidência da República. Lei No 11.794, de 8 de outubro de 2008. Regulamenta o inciso VII do § 1o do art. 225 da Constituição Federal, estabelecendo procedimentos para o uso científico de animais; revoga a Lei no 6.638, de 8 de maio de 1979; e dá outras providências. [Internet]. Brazil: 2008. http://www.planalto.gov.br/ccivil_03/_ato2007-2010/2008/lei/l11794.htm . Accessed July 23, 2015