Objective Validation of Perfusion-Based Human Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery
Objective Validation of Perfusion-Based Human Cadaveric Simulation Training Model for Management of Internal Carotid Artery Injury in Endoscopic Endonasal Sinus and Skull Base Surgery
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DOI：
10.1093/ons/opx262
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发表时间：
2018-08-01
影响因子：
2.3
通讯作者：
Zada, Gabriel
中科院分区：
文献类型：
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作者：
Shen, Jasper;Hur, Kevin;Zada, Gabriel
背景技术背景：微创内窥镜鼻内颅底手术的出现需要可再现的和现实的模拟器罕见的血管injuries.Objective：为了评估一个创新的基于灌注的尸体模型的表面和内容的有效性，该模型被开发用于模拟内窥镜手术期间的颈内动脉（ICA）损伤。耳鼻喉科和神经外科实习生尝试了3个连续的试验内窥镜控制鞍旁ICA损伤，标准化的技术反馈。对止血时间（TTH）和失血量进行趋势分析。所有参与者完成了有效的问卷调查，使用5点李克特量表，以评估领域的信心增益，表面效度，内容效度，和课程applications.RESULTS：Amongall参与者（n = 35），TTH和平均失血量显着下降，第一次与第二次尝试（P = 0.005），第一次与第三次尝试（P = 0.03）。在第一次尝试后，受训者的失血量平均减少63%，TTH减少59%。在改善最多的四分位数参与者中，平均失血量减少1115 mL（减少84%），TTH为259 s（减少84%）。不同研究生年级或专业的学员之间没有显着差异。术前和术后平均置信度评分分别为1.38和3.16（P <.0001）。所有受训者均报告模型真实性，其平均表面效度为4.82 +/-0.41，平均内容效度为4.88 +/-0.33。结论：基于灌注的人尸体颈内动脉损伤模型在各级外科受训者中均获得了较高的表面效度和内容效度评分，为标准化颅底模拟和未来课程开发提供了安全、真实的模拟。性能指标的客观改善可以转化为改善的患者结局。
BACKGROUND: The emergence of minimally invasive endoscopic endonasal skull base surgery has necessitated reproducible and realistic simulators of rare vascular injuries.OBJECTIVE: To assess the face and content validity of an innovative perfusion-based cadaveric model developed to simulate internal carotid artery (ICA) injury during endoscopic surgery.METHODS: Otolaryngology and neurosurgery trainees attempted 3 consecutive trials of endoscopic control of a parasellar ICA injury, with standardized technical feedback. Time to hemostasis (TTH) and blood loss were trended. All participants completed validated questionnaires using a 5-point Likert scale to assess the domains of confidence gain, face validity, content validity, and curriculum applicability.RESULTS: Amongall participants (n = 35), TTHandmeanblood loss significantly decreased between first vs second attempt (P = .005), and first vs third attempt (P = .03). Following the first attempt, trainees experienced an average 63% reduction in blood loss and 59% reduction in TTH. In the quartile of most improved participants, average blood loss reduction was 1115 mL (84% reduction) and TTH of 259 s (84% reduction). There were no significant differences between trainees of varying postgraduate year or specialty. Average pre and postprocedural confidence scores were 1.38 and 3.16, respectively (P < .0001). All trainees reported model realism, which achieved mean face validity 4.82 +/- 0.41 and content validity 4.88 +/- 0.33.CONCLUSION: The perfusion-based human cadaveric ICA injury model achieves high ratings of face and content validity across all levels of surgical trainees, and enables safe, realistic simulation for standardized skull base simulation and future curriculum development. Objective improvements in performance metrics may translate to improved patient outcomes.