A Cost-Effective and Reproducible Cadaveric Training Model for Internal Carotid Artery Injury Management during Endoscopic Endonasal Surgery: The Submersible Peristaltic Pump

Background: Internal carotid artery injury (ICAI) represents one of the most challenging complications in endoscopic endonasal neurosurgery (EEN) and its rarity results in limited opportunities for trainees and surgeons to achieve proficiency in its management. Currently, available models for ICAI have employed costly systems that prevent their widespread use.

Objective: To validate an affordable submersible peristaltic pump (SPP)-based model as a reproducible and realistic paradigm for ICAI management training.

Methods: An endoscopic endonasal approach to the sella turcica was performed and a laceration of the left parasellar internal carotid artery (ICA) was purposedly performed in two human cadaveric heads ([Fig. 1]).

An artificial blood substitute was perfused to ensure a perfusion flow of 1 L/min mimicking an intraoperative scenario using an affordable SPP ([Figs. 2], [3]).

A cohort of 10 senior neurosurgery and otolaryngology residents (PGY 6 and 7) and clinical fellows were enrolled to evaluate the realism and content validity of the model by performing a repair attempt using the ICAI model and by filling in a validated 5-grade questionnaire.

Results: The model proved to mimic a real intraoperative scenario of ICAI with high-pressure extravasation and an expected output flow of 1 L/min ([Fig. 4]).

Questionnaire responses from all participants reported a realistic experience favored by the addition of the perfusion model. The trainees reported an impact of this model on improving their surgical coordination and their capability to perform the most accepted repair technique using suctions, cottonoids, and muscle grafts. The use of a fixed non-injected head allowed the reproducibility of the training session without the additional cost of new fresh-frozen heads. The affordable SPP allowed an impactful reduction of ICAI model training expenses maintaining the high realism of the model.

Conclusion: The SPP-based ICAI model with fixed non-injected cadaveric specimens is an affordable and cost-effective system that allows easy reproducibility and proven realism. These qualities lay the foundation for its widespread and standardized use in neurosurgery and otolaryngology training curricula and in dissection courses.

Fig. 1 Cadaveric dissections showing an endoscopic endonasal approach to the sellar region. A sphenoidotomy has been performed and a rescue flap prepared (A). The floor of the sella as well as the medial and lateral recesses bilaterally are exposed. An injury of the left parasellar ICA has been purposedly performed (B). ICAI, internal carotid artery injury. IT, inferior turbinate. LOCR, lateral opticocarotid recess. MOCR, medial opticocarotid recess. MT, middle turbinate. NF, nasal floor. RFP, rescue flap pedicle. Sph, sphenoidotomy.

Fig. 2 Pump structure as described in the instruction leaflet.

Fig. 3 ICAI model setup using a formalin-flushed, ethanol-fixed and noninjected cadaveric specimen and an SPP.

Fig. 4 Brisk blood extravasation after SPP activation.

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Artikel online veröffentlicht:
01. Februar 2023