Snyderman Carl, Kassam Amin, Carrau Ricardo, Mintz Arlan, Gardner Paul, Prevedello Daniel M
Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Laryngoscope. 2007 Apr;117(4):699-705. doi: 10.1097/MLG.0b013e318031c817.
Endonasal surgery represents a radical change in the practice of cranial base surgery and requires the acquisition of new knowledge and surgical skills. The optimal training program for surgeons has not been established.
We reviewed our experience with endonasal cranial base surgery from 1998 to 2006 to develop a training plan for the acquisition of surgical skills. It consists of a modular and incremental approach to endonasal skull base surgery that is designed to train surgeons to function as a team, learn endoscopic skull base anatomy, and develop fundamental endoscopic skills.
Stages of training are established for the otolaryngologist-head and neck surgeon and the neurosurgeon that are based on level of technical difficulty, potential risk of vascular and neural injury, and unfamiliar endoscopic anatomy. Mastery of each level is recommended before attempting procedures at a higher level.
Standardization of training and the adoption of a modular, incremental training program are expected to facilitate the training of endonasal surgeons in both surgical specialties. Adherence to such a program during the growth phase of endoscopic skull base surgery may decrease the risk of complications as the surgeon's knowledge and surgical expertise develop.
鼻内镜手术代表了颅底外科手术实践的根本性变革，需要掌握新的知识和手术技能。目前尚未确立针对外科医生的最佳培训方案。
我们回顾了1998年至2006年期间鼻内镜颅底手术的经验，以制定一项获取手术技能的培训计划。该计划采用模块化、循序渐进的方法进行鼻内镜颅底手术，旨在培训外科医生团队协作、学习内镜下颅底解剖结构并培养基本的内镜技能。
根据技术难度水平、血管和神经损伤的潜在风险以及不熟悉的内镜解剖结构，为耳鼻喉头颈外科医生和神经外科医生制定了培训阶段。建议在尝试更高水平的手术之前掌握每个级别。
培训的标准化以及采用模块化、循序渐进的培训计划有望促进两个外科专业的鼻内镜外科医生的培训。在内镜颅底手术的发展阶段坚持这样的计划，随着外科医生知识和手术专业技能的发展，可能会降低并发症的风险。
