"Live Cadaver" Model for Internal Carotid Artery Injury Simulation in Endoscopic Endonasal Skull Base Surgery.
"Live Cadaver" Model for Internal Carotid Artery Injury Simulation in Endoscopic Endonasal Skull Base Surgery.
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DOI：
10.1093/ons/opx035
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发表时间：
2017-12-01
期刊：
影响因子：
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通讯作者：
Fernandez-Miranda, Juan C
中科院分区：
文献类型：
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作者：
Pacca, Paolo;Jhawar, Sukhdeep S;Fernandez-Miranda, Juan C
背景：术中颈内动脉损伤是颅底鼻内窥镜手术中最可怕的并发症。在活体手术环境下，颈内动脉损伤的训练几乎是不可能的。目的：评价基于脉动灌注的活体身体模型在实验室环境下模拟颈内动脉损伤。研究的重点是评估控制急性出血的各种方法，并评估该模型在训练中的实用性。方法：将5具防腐的未注射的身体头颅连接到充满人工血液溶液的脉动灌注泵系统进行研究。EES方法用于评估与手术方案相似的不同类型的颈内动脉损伤。评估了处理颈内动脉损伤的各种方法，如填塞、夹闭和夹闭。在实际操作的解剖课程中，通过向参与者发放问卷，评估了活体身体模型的教育优势。结果：受训者面临着几个与实际手术中颈内动脉损伤类似的情景。颈内动脉损伤的填塞、夹闭和夹闭在颈内动脉各节段均成功完成。成功地开发了基于夹层的重建技术。所有受训者都报告获得了新知识，学习了新技术。对问卷的回答证实了该模型具有重要的教育价值。结论：本文提供的活体身体模型提供了实验室环境下EES中主要血管损伤的真实体验。该模式可以显著改善目前EES术中血管损伤的处理训练。
BACKGROUND: Intraoperative injury of the internal carotid artery (ICA) is the most dreaded complication in endoscopic endonasal surgery (EES) of skull base. Training for ICA injury is practically impossible in live operative settings.OBJECTIVE: To evaluate a pulsatile perfusion-based live cadaveric model for ICA injury simulation in a laboratory setting. The major emphasis of the study was to evaluate various means of controlling acute bleeding and evaluating the practical utility of this model for training purposes.METHODS: Five embalmed, uninjected cadaveric heads were prepared for study by connecting to a pulsatile perfusion pump system filled with artificial blood solution. EES approaches were used to evaluate different types of ICA injuries similar to operative scenarios. Various methods of managing ICA injuries such as packing, clipping, and trapping, were evaluated. The educational advantages of the live cadaver model were assessed using questionnaires given to participants in a hands-on dissection course.RESULTS: The trainee was faced with several scenarios similar to those encountered during an actual intraoperative ICA injury. Packing, clipping, and trapping of the ICA injury were successfully achieved in all segments of the ICA. Clip-based reconstruction techniques were successfully developed. All trainees reported gaining new knowledge, learning new techniques. The responses to the questionnaire confirmed the significant educational value of this model.CONCLUSION: The live cadaver model presented here provides real-life experience with major vessel injury during EES in a laboratory setting. This model could significantly improve current training for the management of intraoperative vascular injuries during EES.