Nebor Ivanna, Hussein Ahmed E, Montemagno Kora, Fumagalli Rebecca, Labiad Ikrame, Xu Alice, Anderson Zoe, Patil Yash, Sedaghat Ahmad R, Forbes Jonathan A
Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
J Neurol Surg B Skull Base. 2021 Mar 2;83(Suppl 2):e260-e265. doi: 10.1055/s-0041-1725027. eCollection 2022 Jun.
Endonasal suturing is an investigational method for dural repair that has been reported to decrease the incidence of cerebrospinal fluid fistula. This method requires handling of single-shaft instrumentation in the narrow endonasal corridor. In this study, we designed a low-cost, surgical model using three-dimensional (3D) printing technology to simulate dural repair through the endonasal corridor and subsequently assess the utility of the model for surgical training. Using an Ultimaker 2+ printer, a 3D-printed replica of the cranial base and nasal cavity was fitted with tissue allograft to recapitulate the dural layer. Residents, fellows, and attending surgeons were asked to place two sutures using a 0-degree endoscope and single-shaft needle driver. Task completion time was recorded. Participants were asked to fill out a Likert scale questionnaire after the experiment. Twenty-six participants were separated into groups based on their prior endoscope experience: novice, intermediate, and expert. Twenty-one (95.5%) residents and fellows rated the model as "excellent" or "good" in enhancing their technical skills with endoscopic instrumentation. Three of four (75%) of attendings felt that the model was "excellent" or "good" in usefulness for training in dural suturing. Novice participants required an average of 11 minutes for task completion, as compared with 8.7 minutes for intermediates and 5.7 minutes for experts. The proposed model appears to be highly effective in enhancing the endoscopic skills and recapitulating the task of dural repair. Such a low-cost model may be especially important in enhancing endoscopic facility in countries/regions with limited access to cadaveric specimens.
鼻内缝合是一种用于硬脑膜修复的研究性方法，据报道可降低脑脊液瘘的发生率。该方法需要在狭窄的鼻内通道中操作单轴器械。在本研究中，我们使用三维（3D）打印技术设计了一种低成本的手术模型，以模拟通过鼻内通道进行硬脑膜修复，随后评估该模型在手术训练中的实用性。
使用Ultimaker 2+打印机，为颅底和鼻腔的3D打印复制品配备同种异体组织以模拟硬脑膜层。要求住院医师、研究员和主治外科医生使用0度内窥镜和单轴持针器放置两根缝线。记录任务完成时间。实验结束后，要求参与者填写李克特量表问卷。
26名参与者根据其先前的内窥镜经验分为新手、中级和专家组。21名（95.5%）住院医师和研究员将该模型在提高他们使用内窥镜器械的技术技能方面评为“优秀”或“良好”。四名主治医生中有三名（75%）认为该模型在硬脑膜缝合训练的实用性方面“优秀”或“良好”。新手参与者完成任务平均需要11分钟，中级参与者为8.7分钟，专家为5.7分钟。
所提出的模型在提高内窥镜技能和模拟硬脑膜修复任务方面似乎非常有效。这种低成本模型在增加尸体标本获取机会有限的国家/地区提高内窥镜设备方面可能特别重要。
