Caruso Department of Otolaryngology-Head and Neck Surgery, Keck Medicine of USC, Los Angeles, California.
Depart-ment of General Surgery, Keck Medicine of USC, Los Angeles, California.
Oper Neurosurg (Hagerstown). 2018 Aug 1;15(2):231-238. doi: 10.1093/ons/opx262.
The emergence of minimally invasive endoscopic endonasal skull base surgery has necessitated reproducible and realistic simulators of rare vascular injuries.
To assess the face and content validity of an innovative perfusion-based cadaveric model developed to simulate internal carotid artery (ICA) injury during endoscopic surgery.
Otolaryngology and neurosurgery trainees attempted 3 consecutive trials of endoscopic control of a parasellar ICA injury, with standardized technical feedback. Time to hemostasis (TTH) and blood loss were trended. All participants completed validated questionnaires using a 5-point Likert scale to assess the domains of confidence gain, face validity, content validity, and curriculum applicability.
Among all participants (n = 35), TTH and mean blood loss significantly decreased between first vs second attempt (P = .005), and first vs third attempt (P = .03). Following the first attempt, trainees experienced an average 63% reduction in blood loss and 59% reduction in TTH. In the quartile of most improved participants, average blood loss reduction was 1115 mL (84% reduction) and TTH of 259 s (84% reduction). There were no significant differences between trainees of varying postgraduate year or specialty. Average pre and postprocedural confidence scores were 1.38 and 3.16, respectively (P < .0001). All trainees reported model realism, which achieved mean face validity 4.82 ± 0.41 and content validity 4.88 ± 0.33.
The perfusion-based human cadaveric ICA injury model achieves high ratings of face and content validity across all levels of surgical trainees, and enables safe, realistic simulation for standardized skull base simulation and future curriculum development. Objective improvements in performance metrics may translate to improved patient outcomes.
微创内镜经鼻颅底手术的出现，使得罕见血管损伤的可重复性和现实模拟成为必要。
评估一种创新的基于灌注的尸体模型的表面和内容效度，该模型旨在模拟内镜手术期间颈内动脉（ICA）损伤。
耳鼻喉科和神经外科受训者尝试了 3 次连续的鞍旁 ICA 损伤内镜控制试验，同时提供标准化的技术反馈。记录止血时间（TTH）和失血量。所有参与者使用 5 分李克特量表完成验证后的问卷，评估信心提升、表面效度、内容效度和课程适用性等领域。
在所有参与者（n=35）中，TTH 和平均失血量在第一次与第二次尝试之间（P=0.005）和第一次与第三次尝试之间（P=0.03）均显著降低。在第一次尝试后，受训者的失血量平均减少了 63%，TTH 减少了 59%。在改善最明显的参与者中，平均失血量减少了 1115 毫升（减少 84%），TTH 减少了 259 秒（减少 84%）。不同研究生年或专业的受训者之间没有显著差异。平均术前和术后的信心评分分别为 1.38 和 3.16（P<0.0001）。所有受训者均报告模型的现实性，其表面效度得分为 4.82±0.41，内容效度得分为 4.88±0.33。
基于灌注的人体尸体 ICA 损伤模型在各级手术受训者中均获得了高表面和内容效度评分，并能够安全、真实地模拟标准化的颅底模拟和未来的课程开发。性能指标的客观改善可能转化为患者结局的改善。
