Department of Neurosurgery, Hospital Madre Teresa, Belo Horizonte, Brazil.
Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil.
World Neurosurg. 2020 Oct;142:e378-e384. doi: 10.1016/j.wneu.2020.07.027. Epub 2020 Jul 13.
Cerebrovascular bypass surgical procedures require highly developed dexterity and refined bimanual technical skills. To attain such a level of prowess, neurosurgeons and residents have traditionally relied on "flat" models (without depth of field), such as chicken wings, live rats, silicone vessels, and other materials that stray far from the reality of the operating room, albeit more accessible. We have explored the use of a hybrid ex vivo simulator that takes advantage of the availability of placenta vessels and retains the complexity of surgery performed on a human skull to create a more realistic method for the development of cerebrovascular bypass surgical skills.
Twelve ex vivo simulators were constructed using 3 human placentas and 1 synthetic human skull for each. Face, content, construct, and concurrent validity were assessed by 12 neurosurgeons (6 trained vascular surgeons and 6 general neurosurgeons) and compared with those of other bypass models.
The fidelity grade was ranked as low (Linkert scale score, 1-2), medium (score, 3), and high (score, 4-5). The face and content validity of the model showed high fidelity to superficial temporal artery-middle cerebral artery bypass surgery. Construct validity showed that cerebrovascular neurosurgeons had better performance, and concurrent validity highlighted that all surgical steps were present.
The simulator was found to have strong face and content, construct, and concurrent validity for microsurgical cerebrovascular training, allowing for simulation of all surgical steps of the bypass procedure. The hybrid simulator seems to be a promising method for shortening the bypass surgery learning curve. However, more studies are required to evaluate the predictive validity of the model.
脑血管旁路手术需要高度发达的灵巧性和精细的双手技术。为了达到这样的水平，神经外科医生和住院医生传统上依赖于“扁平”模型（没有景深），如鸡翅、活老鼠、硅胶血管和其他远离手术室现实的材料，尽管更容易获得。我们已经探索了使用混合式离体模拟器的方法，该模拟器利用胎盘血管的可用性，并保留在人类颅骨上进行手术的复杂性，以创建一种更现实的方法来发展脑血管旁路手术技能。
使用 3 个人胎盘和 1 个人工合成颅骨为每个模拟器构建了 12 个离体模拟器。由 12 名神经外科医生（6 名训练有素的血管外科医生和 6 名普通神经外科医生）评估面、内容、构建和同时效度，并与其他旁路模型进行比较。
逼真度等级评为低（Linkert 量表评分 1-2）、中（评分 3）和高（评分 4-5）。该模型的面和内容效度对颞浅动脉-大脑中动脉旁路手术具有高度逼真度。构建效度表明脑血管神经外科医生的表现更好，同时效度突出了所有手术步骤都存在。
该模拟器被发现具有强大的面和内容、构建和同时效度，可用于模拟旁路手术的所有手术步骤。混合模拟器似乎是缩短旁路手术学习曲线的有前途的方法。然而，需要更多的研究来评估该模型的预测效度。
