The utility of cadaver dissection in endoscopic sinus surgery training courses
The utility of cadaver dissection in endoscopic sinus surgery training courses
复制标题
DOI：
10.2500/ajra.2009.23.3297
复制
发表时间：
2009-03-01
影响因子：
2.6
通讯作者：
DelGaudio, John M.
中科院分区：
文献类型：
--
作者：
Zuckerman, Jodi D.;Wise, Sarah K.;DelGaudio, John M.
背景：了解鼻窦解剖结构对鼻内镜手术（ESS）的成功至关重要。本研究旨在评价不同经验水平的参与者在ESS尸体解剖中的主观和客观差异，这些参与者与在医生培训尸体解剖实验室中使用图像引导和计算机辅助技术相关。研究方法：参与者在为期2天的尸体解剖过程中完成每日解剖前调查，评估ESS的主观舒适度。解剖前和解剖后计算机断层扫描（CT）评估解剖的完整性。分析上颌窦造口术、额窦和蝶窦切开术、残留筛窦细胞和分区以及残留额隐窝细胞的图像。结果：共解剖51侧。从第1天开始，参与者的舒适度显著增加。对于总体ESS（p = 0.001）和单个鼻窦（p < 0.001至p = 0.047），在解剖第1天，实践年限越长的参与者未打开的筛窦细胞（p = 0.015）和额隐窝细胞（p = 0.01.4）越少。筛窦分离舒适度增加的受试者在第1天保留的筛窦间隔较少（p 0.017）。解剖第1天未打开的筛窦和额隐窝细胞和保留的筛窦分区观察到的差异在第2天不存在。基于图像引导的使用，未发现任何参数的显著差异。结论：舒适度提高和实践年限增加的外科医生最初可以进行更完整的内窥镜尸体解剖。参与者之间的差异在夹层第2天减少，表明审查夹层后CT扫描的能力可能会提高外科医生的舒适度和夹层的完整性。
Background: Understanding paranasal sinus anatomy is crucial for successful outcomes in endoscopic sinus surgery (ESS). This study was designed to evaluate subjective and objective differences in ESS cadaver dissections among participants of varying experience levels in association with the use of image guidance and computer-aided technologies in a physician training cadaver dissection laboratory. Methods: Participants in a 2-day cadaver dissection course completed daily predissection surveys evaluating subjective comfort with ESS. Pre- and postdissection computer tomography (CT) scans assessed completeness of dissection. Images were analyzed for maxillary antrostomy, frontal and sphenoid sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. Results: Fifty-one sides were dissected. Participant comfort increased significantly from day 1. to 2 for overall ESS (p = 0.001) and for individual sinuses (p < 0.001 to p = 0.047). Participants with more years in practice had fewer unopened ethmoid cells (p = 0.015) and frontal recess cells (p = 0.01.4) on dissection day 1. Participants with increased comfort in ethmoid dissection had fewer retained ethmoid partitions oil day I (p 0.017). Observed differences on dissection day 1 for unopened ethmoid and frontal recess cells and retained ethmoid partitions were not present on day 2. No significant differences were found based on use of image guidance for any parameter. Conclusion: Surgeons with increased comfort and more years in practice had more complete endoscopic cadaver dissections initially. Differences among participants diminished on dissection day 2, indicating the ability to review postdissection CT scans may improve surgeon comfort level and completeness of dissection.