Newall Nicola, Khan Danyal Z, Hanrahan John G, Booker James, Borg Anouk, Davids Joseph, Nicolosi Federico, Sinha Siddharth, Dorward Neil, Marcus Hani J
Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, United Kingdom.
Front Surg. 2022 Dec 6;9:1049685. doi: 10.3389/fsurg.2022.1049685. eCollection 2022.
OBJECTIVE: Endoscopic endonasal transsphenoidal surgery is an established technique for the resection of sellar and suprasellar lesions. The approach is technically challenging and has a steep learning curve. Simulation is a growing training tool, allowing the acquisition of technical skills pre-clinically and potentially resulting in a shorter clinical learning curve. We sought validation of the UpSurgeOn Transsphenoidal (TNS) Box for the endoscopic endonasal transsphenoidal approach to the pituitary fossa. METHODS: Novice, intermediate and expert neurosurgeons were recruited from multiple centres. Participants were asked to perform a sphenoidotomy using the TNS model. Face and content validity were evaluated using a post-task questionnaire. Construct validity was assessed through post-hoc blinded scoring of operative videos using a Modified Objective Structured Assessment of Technical Skills (mOSAT) and a Task-Specific Technical Skill scoring system. RESULTS: Fifteen participants were recruited of which = 10 (66.6%) were novices and = 5 (33.3%) were intermediate and expert neurosurgeons. Three intermediate and experts (60%) agreed that the model was realistic. All intermediate and experts ( = 5) strongly agreed or agreed that the TNS model was useful for teaching the endonasal transsphenoidal approach to the pituitary fossa. The consensus-derived mOSAT score was 16/30 (IQR 14-16.75) for novices and 29/30 (IQR 27-29) for intermediate and experts ( < 0.001, Mann-Whitney ). The median Task-Specific Technical Skill score was 10/20 (IQR 8.25-13) for novices and 18/20 (IQR 17.75-19) for intermediate and experts ( < 0.001, Mann-Whitney U). Interrater reliability was 0.949 (CI 0.983-0.853) for OSATS and 0.945 (CI 0.981-0.842) for Task-Specific Technical Skills. Suggested improvements for the model included the addition of neuro-vascular anatomy and arachnoid mater to simulate bleeding vessels and CSF leak, respectively, as well as improvement in materials to reproduce the consistency closer to that of human tissue and bone. CONCLUSION: The TNS Box simulation model has demonstrated face, content, and construct validity as a simulator for the endoscopic endonasal transsphenoidal approach. With the steep learning curve associated with endoscopic approaches, this simulation model has the potential as a valuable training tool in neurosurgery with further improvements including advancing simulation materials, dynamic models (e.g., with blood flow) and synergy with complementary technologies (e.g., artificial intelligence and augmented reality).
目的:鼻内镜下经蝶窦手术是一种用于切除鞍区和鞍上病变的成熟技术。该手术在技术上具有挑战性,且学习曲线较陡。模拟是一种日益重要的训练工具,可使术者在临床前获得技术技能,并有可能缩短临床学习曲线。我们旨在验证UpSurgeOn经蝶窦(TNS)模型箱在鼻内镜下经蝶窦入路至垂体窝手术中的有效性。 方法:从多个中心招募了新手、中级和专家级神经外科医生。要求参与者使用TNS模型进行蝶窦切开术。使用任务后问卷评估表面效度和内容效度。通过使用改良的客观结构化技术技能评估(mOSAT)和特定任务技术技能评分系统对手术视频进行事后盲法评分来评估结构效度。 结果:共招募了15名参与者,其中10名(66.6%)为新手,5名(33.3%)为中级和专家级神经外科医生。3名中级和专家(60%)认为该模型逼真。所有中级和专家(共5名)强烈同意或同意TNS模型对教授经鼻内镜下经蝶窦入路至垂体窝手术有用。新手的共识衍生mOSAT评分为16/30(四分位间距14 - 16.75),中级和专家为29/30(四分位间距27 - 29)(P < 0.001,曼-惠特尼检验)。新手的特定任务技术技能评分中位数为10/20(四分位间距8.25 - 13),中级和专家为18/20(四分位间距17.75 - 19)(P < 0.001,曼-惠特尼U检验)。OSATS的评分者间信度为0.949(可信区间0.983 - 0.853),特定任务技术技能的评分者间信度为0.945(可信区间0.981 - 0.842)。对该模型的改进建议包括增加神经血管解剖结构和蛛网膜,分别用于模拟出血血管和脑脊液漏,以及改进材料以使其质地更接近人体组织和骨骼。 结论:TNS模型箱模拟模型已证明其作为鼻内镜下经蝶窦入路模拟器的表面效度、内容效度和结构效度。鉴于内镜手术相关的陡峭学习曲线,该模拟模型有潜力成为神经外科中有价值的训练工具,进一步的改进包括改进模拟材料、动态模型(如具有血流)以及与互补技术(如人工智能和增强现实)协同。
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