RESUMEN
PURPOSE: Literature reviews outline minimally invasive approaches for abdominal diastasis in patients without skin excess. However, few surgeons are trained in endoscopic rectus sheath plication, and no simulated training programs exist for this method. This study aimed to develop and validate a synthetic simulation model for the training of skills in this approach under the Messick validity framework. METHODS: A cross-sectional study was carried out to assess the participants' previous level of laparoscopic/endoscopic skills by a questionnaire. Participants performed an endoscopic plication on the model and their performance was evaluated by one blinded observer using the global rating scale OSATS and a procedure specific checklist (PSC) scale. A 5-level Likert survey was applied to 5 experts and 4 plastic surgeons to assess Face and Content validity. RESULTS: Fifteen non-experts and 5 experts in abdominal wall endoscopic surgery were recruited. A median OSATS score [25 (range 24-25) vs 14 (range 5-22); p < 0.05 of maximum 25 points] and a median PSC score [11 (range 10-11) vs 8 (range 3-10); p < 0.05 of maximum 11 points] was significantly higher for experts compared with nonexperts. All experts agreed or strongly agreed that the model simulates a real scenario of endoscopic plication of the rectus sheath. CONCLUSION: Our simulation model met all validation criteria outlined in the Messick framework, demonstrating its ability to differentiate between experts and non-experts based on their baseline endoscopic surgical skills. This model stands as a valuable tool for evaluating skills in endoscopic rectus sheath plication.
Asunto(s)
Competencia Clínica , Recto del Abdomen , Entrenamiento Simulado , Humanos , Estudios Transversales , Recto del Abdomen/cirugía , Modelos Anatómicos , Endoscopía/educación , Endoscopía/métodosRESUMEN
OBJECTIVE: Tympanostomy is one of the most commonly performed surgical procedures in otolaryngology, and its complexity is challenging for trainee surgeons. Investing in medical education is a cornerstone of good patient safety practices. For trainees, use of simulators before operating on actual patients helps mitigate risks. This study aimed to develop a three-dimensional printed model simulator for myringotomy, tympanostomy and ventilation tube placement. METHODS: An articulated model with a detachable portion, base and plastic bag to simulate the external auditory canal, middle ear and tympanic membrane, respectively, was modelled and printed. RESULTS: The final simulator was made from acrylonitrile butadiene styrene polymer and measured 4 × 4 × 12 cm. It was designed to mimic the angulation of patient anatomy in the myringotomy position and simulate the texture and colour of the tissues of interest. The cost was low, and testing with an operating microscope and endoscope yielded satisfactory results. The advent of three-dimensional printing technology has made surgical simulation more accessible and less expensive, providing several advantages for medical education. CONCLUSION: The proposed model fulfilled expectations as a safe, inexpensive, reproducible, user-friendly and accessible surgical education tool that can be improved and reassessed for further research.
Asunto(s)
Endoscopía/educación , Microcirugia/educación , Ventilación del Oído Medio/educación , Modelos Anatómicos , Impresión Tridimensional , Entrenamiento Simulado , Adulto , Niño , Preescolar , Competencia Clínica , Humanos , Internado y ResidenciaRESUMEN
Abstract Purpose: To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP). Methods: TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described. Results: This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers. Conclusion: This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.
Asunto(s)
Animales , Modelos Animales , Endoscopía/educación , Endoscopía/métodos , Vértebras Lumbares/cirugía , Estándares de Referencia , Valores de Referencia , Porcinos , Cadáver , Reproducibilidad de los Resultados , Discectomía Percutánea/educación , Discectomía Percutánea/métodos , Endoscopía/instrumentación , Puntos Anatómicos de Referencia , Vértebras Lumbares/anatomía & histología , Vértebras Lumbares/diagnóstico por imagen , AgujasRESUMEN
PURPOSE: To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP). METHODS: TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described. RESULTS: This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers. CONCLUSION: This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.
Asunto(s)
Endoscopía/educación , Endoscopía/métodos , Vértebras Lumbares/cirugía , Modelos Animales , Puntos Anatómicos de Referencia , Animales , Cadáver , Discectomía Percutánea/educación , Discectomía Percutánea/métodos , Endoscopía/instrumentación , Fluoroscopía/métodos , Vértebras Lumbares/anatomía & histología , Vértebras Lumbares/diagnóstico por imagen , Agujas , Estándares de Referencia , Valores de Referencia , Reproducibilidad de los Resultados , PorcinosRESUMEN
OBJECTIVE: To describe and standardize a reproducible, viable, low-cost lamb's head model for endoscopic sinus surgery training. METHODS: Otorhinolaryngology residents performed the following three endoscopic sinus surgeries using the lamb's head model: inferior turbinectomy, bullectomy, and maxillary antrostomy. Each student dissected 10 specimens before training these procedures on human patients, and the benefit of the animal model training was evaluated. RESULTS: Nineteen resident physicians of comparable academic level participated in training. All participants agreed that the lamb's head model dissections improved their skills in using surgical and videoendoscopic instruments, 90% agreed that the dissections improved their confidence with respect to training in human patients, and all stated they would recommend the same training to future residents. DISCUSSION: Lamb's heads have been used for training in endoscopic sinus surgery. However, no standardization of this training had been performed to ensure that it is a valuable tool for learning and skill-building. The standardized method described in this study increased resident physicians' skills and confidence before beginning their training on human patients. Moreover, our results demonstrate the feasibility of the model, considering its low cost and reproducibility. CONCLUSION: Future studies with this model should be conducted to assess whether the resulting increase in skills prevents and reduces medical errors, increases patient safety, reduces surgical costs, and improves the quality of otorhinolaryngological care.
Asunto(s)
Endoscopía/métodos , Modelos Biológicos , Senos Paranasales/cirugía , Animales , Endoscopía/educación , Internado y Residencia , OvinosRESUMEN
Medical procedures often involve the use of the tactile sense to manipulate organs or tissues by using special tools. Doctors require extensive preparation in order to perform them successfully; for example, research shows that a minimum of 750 operations are needed to acquire sufficient experience to perform medical procedures correctly. Haptic devices have become an important training alternative and they have been considered to improve medical training because they let users interact with virtual environments by adding the sense of touch to the simulation. Previous articles in the field state that haptic devices enhance the learning of surgeons compared to current training environments used in medical schools (corpses, animals, or synthetic skin and organs). Consequently, virtual environments use haptic devices to improve realism. The goal of this paper is to provide a state of the art review of recent medical simulators that use haptic devices. In particular we focus on stitching, palpation, dental procedures, endoscopy, laparoscopy, and orthopaedics. These simulators are reviewed and compared from the viewpoint of used technology, the number of degrees of freedom, degrees of force feedback, perceived realism, immersion, and feedback provided to the user. In the conclusion, several observations per area and suggestions for future work are provided.
Asunto(s)
Entrenamiento Simulado/métodos , Operatoria Dental/educación , Endoscopía/educación , Retroalimentación Formativa , Humanos , Procedimientos Ortopédicos/educación , Palpación/métodos , Técnicas de Sutura/educación , Interfaz Usuario-ComputadorRESUMEN
ABSTRACT INTRODUCTION: Endonasal surgeries are among the most common procedures performed in otolaryngology. Due to difficulty in cadaver acquisition and the intrinsic risks of training residents during operations on real patients, nasosinusal endoscopic dissection courses utilizing real simulators, such as the Sinus Model Otorhino Neuro Trainer are being developed as a new technique to facilitate the acquisition of better anatomical knowledge and surgical skill. OBJECTIVE: To evaluate the efficacy of nasosinusal endoscopic dissection courses with the Sinus Model Otorhino Neuro Trainer simulator in the training of otolaryngology surgeons. METHODS: A prospective, longitudinal cohort study was conducted with 111 otolaryngologists who participated in a theoretical and practical course of endoscopic surgery dissection using the Sinus Model Otorhino Neuro Trainer simulator, with application of questionnaires during and after the course. RESULTS: From the ten procedures performed utilizing the simulator, the evaluation revealed mean scores from 3.1 to 4.1 (maximum of 5). Seventy-seven participants answered the questionnaire six months after the end of the course. 93% of them reported that they could perform the procedures more safely following the course, 98% reported an improvement in their anatomical and clinical knowledge, and 85% related an improvement in their surgical ability. After the course, the number of endoscopic surgeries increased in 40% of the respondents. CONCLUSION: Endoscopic sinus dissection courses using the Sinus Model Otorhino Neuro Trainer simulator proved to be useful in the training of otolaryngologists.
RESUMO INTRODUÇÃO: Cirurgias endonasais são as cirurgias mais realizadas na otorrinolaringologia. Devido à dificuldade de adquirir cadáveres e ao risco inerente em realizar treinamento em pacientes reais, cursos de dissecção endoscópica nasossinusal em simuladores reais, como o sinus model otorhino - neuro trainer - S.I.M.O.N.T, são uma nova proposta de aquisição de maior conhecimento anatômico e habilidades cirúrgicas. OBJETIVO: Avaliar a eficácia dos cursos de dissecção de cirurgia endoscópica nasossinusal com simulador S.I.M.O.N.T. no treinamento de cirurgiões otorrinolaringologistas. MÉTODO: Estudo de coorte contemporâneo longitudinal com 111 otorrinolaringologistas que participaram de curso teórico - prático de dissecção endoscópica nasossinusal em simulador real S.I.M.O.N.T., com aplicação de questionários durante e após a realização do curso. RESULTADOS: Dos dez procedimentos realizados no simulador, a avaliação apontou para médias de notas que variaram de 3,1 a 4,1 (máximo de 5). Setenta e sete participantes responderam a avaliação 6 meses após o curso. Declararam que houve aumento da segurança após o curso, 93% dos mesmos; 98% disseram ter aumentado o conhecimento anátomo-clinico e 85% declararam um aumento da habilidade cirúrgica. Quarenta por cento aumentaram o número de cirurgias endonasais após o curso. CONCLUSÃO: Cursos de dissecção de cirurgia endonasais com simulador real S.I.M.O.N.T. mostraram ser úteis para o treinamento de otorrinolaringologistas.
Asunto(s)
Humanos , Disección/educación , Endoscopía/educación , Otolaringología/educación , Senos Paranasales/cirugía , Competencia Clínica , Estudios de Cohortes , Simulación por Computador , Capacitación de Usuario de Computador , Disección/instrumentación , Endoscopía/métodos , Encuestas y CuestionariosRESUMEN
INTRODUCTION: Endonasal surgeries are among the most common procedures performed in otolaryngology. Due to difficulty in cadaver acquisition and the intrinsic risks of training residents during operations on real patients, nasosinusal endoscopic dissection courses utilizing real simulators, such as the Sinus Model Otorhino Neuro Trainer are being developed as a new technique to facilitate the acquisition of better anatomical knowledge and surgical skill. OBJECTIVE: To evaluate the efficacy of nasosinusal endoscopic dissection courses with the Sinus Model Otorhino Neuro Trainer simulator in the training of otolaryngology surgeons. METHODS: A prospective, longitudinal cohort study was conducted with 111 otolaryngologists who participated in a theoretical and practical course of endoscopic surgery dissection using the Sinus Model Otorhino Neuro Trainer simulator, with application of questionnaires during and after the course. RESULTS: From the ten procedures performed utilizing the simulator, the evaluation revealed mean scores from 3.1 to 4.1 (maximum of 5). Seventy-seven participants answered the questionnaire six months after the end of the course. 93% of them reported that they could perform the procedures more safely following the course, 98% reported an improvement in their anatomical and clinical knowledge, and 85% related an improvement in their surgical ability. After the course, the number of endoscopic surgeries increased in 40% of the respondents. CONCLUSION: Endoscopic sinus dissection courses using the Sinus Model Otorhino Neuro Trainer simulator proved to be useful in the training of otolaryngologists.
Asunto(s)
Disección/educación , Endoscopía/educación , Otolaringología/educación , Senos Paranasales/cirugía , Competencia Clínica , Estudios de Cohortes , Simulación por Computador , Capacitación de Usuario de Computador , Disección/instrumentación , Endoscopía/métodos , Humanos , Encuestas y CuestionariosRESUMEN
Para elevar la calidad del posgrado se expone la utilidad de la aplicación de evaluaciones diagnósticas en los programas referidos a temas de cirugía laparoscópica y endoscopia digestiva. Se dio respuesta a la interrogante que refiere si existen diferencias de niveles de formación previa, en los alumnos de posgrado del Centro Nacional de Cirugía de Mínimo Acceso (CNCMA), al identificar las desigualdades de los que matricularon en 6 programas de estudio de posgrado en los años 2010 y 2011. Se aplicaron pruebas diagnósticas que permitieron ponderar los errores cometidos por los estudiantes en las temáticas de los programas de posgrado a impartir, detectando diferencias en las condiciones cognoscitivas iniciales en el período analizado. Los porcentajes generales de errores se presentaron por debajo del 50 por ciento con la excepción del Curso de Cirugía laparoscópica ginecológica que tuvo un 51 por ciento general de errores. Los resultados avalaron la pertinencia de la aplicación de las pruebas diagnósticas para permitir que los profesores puedan saber qué grado de conocimientos previos poseen los alumnos, necesarios para asimilar los contenidos de los programas docentes y en qué grado pueden haber alcanzado ya los objetivos propuestos en dichos programas(AU)
For the purpose of increasing the quality of postgraduate education, this paper presented the advantages of diagnostic evaluations in the programs including topics of laparoscopic surgery and digestive endoscopy. It gave response to the question of whether there are differences in the previous levels of formation of undergraduate students of the National Center of Minimum Access Surgery by way of identifying the inequalities among those who registered for 6 postgraduate studies in 2010 and 2011. Diagnostic tests were applied, which allowed weighing the mistakes made by the students in postgraduate topics and detecting the differences in the initial cognitive conditions during the analyzed period. The general percentages of mistakes were under 50 percent, except for the laparoscopic gynecological surgery course that showed 51 percent of mistakes. The results supported the importance of using diagnostic tests so that the professor can know in advance the level of knowledge of the participating students to assimilate the contents of the educational programs, and also to what extent they could have reached the objectives put forward in these programs(AU)
Asunto(s)
Evaluación Educacional/métodos , Educación de Postgrado en Medicina , Endoscopía/educación , Laparoscopía/educaciónRESUMEN
Para elevar la calidad del posgrado se expone la utilidad de la aplicación de evaluaciones diagnósticas en los programas referidos a temas de cirugía laparoscópica y endoscopia digestiva. Se dio respuesta a la interrogante que refiere si existen diferencias de niveles de formación previa, en los alumnos de posgrado del Centro Nacional de Cirugía de Mínimo Acceso (CNCMA), al identificar las desigualdades de los que matricularon en 6 programas de estudio de posgrado en los años 2010 y 2011. Se aplicaron pruebas diagnósticas que permitieron ponderar los errores cometidos por los estudiantes en las temáticas de los programas de posgrado a impartir, detectando diferencias en las condiciones cognoscitivas iniciales en el período analizado. Los porcentajes generales de errores se presentaron por debajo del 50 por ciento con la excepción del Curso de Cirugía laparoscópica ginecológica que tuvo un 51 por ciento general de errores. Los resultados avalaron la pertinencia de la aplicación de las pruebas diagnósticas para permitir que los profesores puedan saber qué grado de conocimientos previos poseen los alumnos, necesarios para asimilar los contenidos de los programas docentes y en qué grado pueden haber alcanzado ya los objetivos propuestos en dichos programas
For the purpose of increasing the quality of postgraduate education, this paper presented the advantages of diagnostic evaluations in the programs including topics of laparoscopic surgery and digestive endoscopy. It gave response to the question of whether there are differences in the previous levels of formation of undergraduate students of the National Center of Minimum Access Surgery by way of identifying the inequalities among those who registered for 6 postgraduate studies in 2010 and 2011. Diagnostic tests were applied, which allowed weighing the mistakes made by the students in postgraduate topics and detecting the differences in the initial cognitive conditions during the analyzed period. The general percentages of mistakes were under 50 percent, except for the laparoscopic gynecological surgery course that showed 51 percent of mistakes. The results supported the importance of using diagnostic tests so that the professor can know in advance the level of knowledge of the participating students to assimilate the contents of the educational programs, and also to what extent they could have reached the objectives put forward in these programs
Asunto(s)
Educación de Postgrado en Medicina , Endoscopía/educación , Evaluación Educacional/métodos , Laparoscopía/educaciónAsunto(s)
Humanos , Masculino , Femenino , Endoscopía/educación , Sociedades Médicas , Cursos de Capacitación , Universidades , Gastroenterología , TutoríaRESUMEN
BACKGROUND: Hip arthroscopy has become an increasingly used technique in orthopedic surgery; the learning curve of this procedure has been discussed recently. The purpose of this study is to assess the learning curve of arthroscopic hip surgery using the complications occurred during the surgery as an objective parameter to measure the outcomes. METHODS: Hip arthroscopic surgeries were performed. Patients were divided into two groups, group A corresponded to the learning curve of the first surgeon and group B includes the remaining surgeries. The demographic, surgical, functional and complications data for both groups were collected. RESULTS: Group A: 30 patients were included, the traction time during surgery was a mean of 75 minutes (range: 45-120). Five complications occurred (16.6%), all of them related to transient neuropraxia of the pudendal nerve. Group B: 67 patients were included, traction time during surgery was a mean of 63 minutes (range: 35-90), 2 complications (2.9%) occurred. CONCLUSIONS: Before performing hip arthroscopy it is necessary to have knowledge of arthroscopic surgery and the regional anatomy, and to have received specific training, given that this technique involves a long learning curve.
Asunto(s)
Artroscopía , Competencia Clínica , Luxación de la Cadera/cirugía , Adulto , Artroscopía/efectos adversos , Endoscopía/educación , Femenino , Humanos , Complicaciones Intraoperatorias/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios ProspectivosRESUMEN
BACKGROUND: Training and experience of the surgical team are fundamental for the safety and success of complex surgical procedures, such as laparoscopic common bile duct exploration. METHODS: We describe an inert, simple, very low-cost, and readily available training model. Created using a "black box" and basic medical and surgical material, it allows training in the fundamental steps necessary for laparoscopic biliary tract surgery, namely, (1) intraoperative cholangiography, (2) transcystic exploration, and (3) laparoscopic choledochotomy, and t-tube insertion. RESULTS: The proposed model has allowed for the development of the skills necessary for partaking in said procedures, contributing to its development and diminishing surgery time as the trainee advances down the learning curve. Further studies are directed towards objectively determining the impact of the model on skill acquisition. CONCLUSION: The described model is simple and readily available allowing for accurate reproduction of the main steps and maneuvers that take place during laparoscopic common bile duct exploration, with the purpose of reducing failure and complications.
Asunto(s)
Competencia Clínica , Conducto Colédoco/cirugía , Cirugía General/educación , Colangiografía , Endoscopía/educación , Humanos , Laparoscopía , Enseñanza/métodos , Materiales de EnseñanzaAsunto(s)
Educación , Endoscopía/educación , Gastroenterología/educación , Enfermedades Gastrointestinales , Agencias Internacionales , América Central , Costa Rica , Endoscopía/métodos , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/terapia , Humanos , América del SurRESUMEN
OBJECTIVE: Prospectively investigate endoscopic extra peritoneal radical prostatectomy (EERP) learning curve impact on outcomes. MATERIALS AND METHODS: In a 5 year period (2004-2008) 270 patients underwent 5-6 ports laparoscopic radical prostatectomy at a referral center in Brazil. The initial 70 cases learning curve protocol included low body mass index patients with low volume, low grade prostate cancer. After that there were no criteria to exclude laparoscopic surgery. The patients were analyzed in two groups: Group 1, first 70 patients (30 transperitoneal and 40 extra peritoneal)-learning curve and Group 2, last 200 patients - EERP only. Surgical and outcome parameters were compared through Student's t test and Fisher's Exact Test. RESULTS: The mean age was 65 years (+/-8.2) and comparing Groups 1 and 2, mean operative time was 300 (+/-190) versus 180 (+/-100) minutes, blood loss 330 (+/-210) versus 210 (+/-180) mL, hospital stay 3 (2 to 5) versus 2 (1 to 3) days, positive surgical margins 15% versus 10%, erection sufficient to penetration in previous potent patients 73.3% versus 75%, respectively with no difference between groups. Overall, 78% of patients referred no previous impotence with groups' equivalence. Severe urinary incontinence, transfusion and complications rates were higher in group 1 (p<0.05): 10% versus 2%, 12% versus 2.25% and 30% versus 12.5%, respectively. Peritoneum perforation occurred in 40% and conversion to open surgery was not required. Nerve sparing procedure was applied in 85%. In 3.5-years mean follow-up 90% of patients were free of PSA recurrence with no difference between groups. CONCLUSION: Severe urinary incontinence, transfusion and complications rates are related to learning curve which is continuous, although a significant improvement is pragmatic after 70 cases. An intensive mentored training program should be considered to minimize the learning outlays.
Asunto(s)
Competencia Clínica/estadística & datos numéricos , Endoscopía/educación , Prostatectomía/educación , Prostatectomía/métodos , Anciano , Humanos , Laparoscopía , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Prospectivos , Factores de TiempoRESUMEN
Introducción: El Curso Básico de Entrenamiento en Habilidades para Cirugía Endoscópica desarrollado por el Centro Latinoamericano de Investigación y Entrenamiento en Cirugía de Mínima Invasión (CLEMI) suministra al estudiante las herramientas necesarias para el aprendizaje de conceptos básicos en cirugía mínimamente invasiva. El objetivo de este estudio es conocer el grado de satisfacción de los profesionales en formación con el curso. Materiales y métodos: entre los meses de junio y octubre del año 2008, se realizaron 7 cursos básicos con un total de 40 estudiantes. Se elaboraron dos encuestas que los estudiantes diligenciaron antes y después del curso. Las encuestas exploraron el perfil del estudiante, sus expectativas con respecto al curso y su grado de satisfacción. Resultados: de los 40 encuestados, 36 (90%) eran especialistas en ortopedia, ginecología, urología y cirugía general. El 69,6% de los que habían recibido entrenamiento en cirugía de mínima invasión, lo hizo con pacientes. El 100% de los estudiantes le confirieron una importancia máxima a los objetivos esencialmente prácticos del curso que corresponden al desarrollo de habilidades y destrezas en espacios bidimensionales, triangulación y precisión así como disección, corte y sutura en plantillas y modelos anatómicos de animales no vivos. El 97% de los profesionales estuvo satisfecho con el cumplimiento de los objetivos del curso. Discusión: el curso básico es un proyecto innovador en Latinoamérica que busca satisfacer las necesidades de entrenamiento de los cirujanos de las diferentes especialidades. Los resultados muestran el cumplimiento de las expectativas de formación demandadas por los profesionales.
Asunto(s)
Educación Médica Continua , Endoscopía/educación , Procedimientos Quirúrgicos Mínimamente Invasivos/educación , Comportamiento del Consumidor , América LatinaRESUMEN
INTRODUCTION: The pterygopalatine fossa (PPF) is a narrow space located between the posterior wall of the antrum and the pterygoid plates. Surgical access to the PPF is difficult because of its protected position and its complex neurovascular anatomy. Endonasal approaches using rod lens endoscopes, however, provide better visualization of this area and are associated with less morbidity than external approaches. Our aim was to develop a simple anatomical model using cadaveric specimens injected with intravascular colored silicone to demonstrate the endoscopic anatomy of the PPF. This model could be used for surgical instruction of the transpterygoid approach. METHODS: We dissected six PPF in three cadaveric specimens prepared with intravascular injection of colored material using two different injection techniques. An endoscopic endonasal approach, including a wide nasoantral window and removal of the posterior antrum wall, provided access to the PPF. RESULTS: We produced our best anatomical model injecting colored silicone via the common carotid artery. We found that, using an endoscopic approach, a retrograde dissection of the sphenopalatine artery helped to identify the internal maxillary artery (IMA) and its branches. Neural structures were identified deeper to the vascular elements. Notable anatomical landmarks for the endoscopic surgeon are the vidian nerve and its canal that leads to the petrous portion of the internal carotid artery (ICA), and the foramen rotundum, and V2 that leads to Meckel's cave in the middle cranial fossa. These two nerves, vidian and V2, are separated by a pyramidal shaped bone and its apex marks the ICA. CONCLUSION: Our anatomical model provides the means to learn the endoscopic anatomy of the PPF and may be used for the simulation of surgical techniques. An endoscopic endonasal approach provides adequate exposure to all anatomical structures within the PPF. These structures may be used as landmarks to identify and control deeper neurovascular structures. The significance is that an anatomical model facilitates learning the surgical anatomy and the acquisition of surgical skills. A dissection superficial to the vascular structures preserves the neural elements. These nerves and their bony foramina, such as the vidian nerve and V2, are critical anatomical landmarks to identify and control the ICA at the skull base.
Asunto(s)
Endoscopía/educación , Seno Maxilar/anatomía & histología , Procedimientos Quirúrgicos Otorrinolaringológicos/educación , Hueso Paladar/anatomía & histología , Hueso Esfenoides/anatomía & histología , Materiales de Enseñanza , Cadáver , Arteria Carótida Interna/anatomía & histología , Colorantes , Disección , Humanos , Nervio Mandibular/anatomía & histología , Arteria Maxilar/anatomía & histología , Nervio Maxilar/anatomía & histología , Seno Maxilar/irrigación sanguínea , Seno Maxilar/inervación , Modelos Anatómicos , Nariz/irrigación sanguínea , Órbita/inervación , Hueso Paladar/irrigación sanguínea , Hueso Paladar/inervación , Hueso Petroso/irrigación sanguínea , Hueso Petroso/inervación , Base del Cráneo/anatomía & histología , Hueso Esfenoides/irrigación sanguínea , Hueso Esfenoides/inervaciónRESUMEN
BACKGROUND: Minimum-invasion surgery is performed by means of 2-dimensional visual feedback and without haptic sensitivity. This demands that specialty surgeons adapt to and develop new psychomotor abilities. These abilities can only be learned, developed, and maintained through training. Training technology has been divided into virtual trainers and physical trainers. The former, due to their high cost, have not had the expected academic impact, whereas the latter, although an excellent low-cost alternative, do not offer the visual handling options for refining the required psychomotor abilities. The purpose of this article is to describe the design of a box trainer which can establish a closer relationship with the visual and functional perspectives of optics during surgery, thus establishing better learning protocols. METHODS: A laparoscopic surgery trainer was designed and built based on the shape of the abdominal cavity formed during such surgery. The visual feedback is achieved with a color mini-camera whose position and orientation are controlled by means of a magnetic system with 0 and 45-degree optics options. RESULTS: A trainer which allows for changes in visual perspective, for developing abilities and skills, with optics other than those of 0 degrees within a geometric space similar to that of the pneumoperitoneum has been designed. CONCLUSIONS: A training system which provides illumination and visual perspective conditions similar to those of real surgery using 0 and 45-degree optics has been designed. The training system is portable and easy to connect for training purposes. Its ports allow for various options that help to improve skills and propose new approaches.