gms | German Medical Science

Objective: Transsphenoidal endoscopic surgery has gained popularity in the last 2 decades and is becoming the standard technique for resection of pituitary adenomas. In contrast to their ENT colleagues, neurosurgical residents have practically no endoscopic experience when they reach the training stadium of transsphenoidal procedures. Cadaveric workshops are expensive and cannot be repeated frequently. Endoscopic software simulators do exist but are expensive as well and although they allow repetition they lack the tactile feedback needed pituitary surgery. We have developed an affordable method for repetitive training of endoscopic work in a narrow channel, allowing training of the movements needed for resection of pituitary adenoma.

Method: In collaboration with ENT and the ETH Zurich we developed a model of the nasal cavity made of Duraform PA-12. The model has been patented. For validation already several neurosurgery residents (Basel and St. Gall) have performed the task, of which data will be compared to those of the experts.

Results: The final model consists of a hard 3D reconstruction of the head with a softer removable part in the region of the nose and sphenoid sinus. The boiled egg is inserted in a dedicated box at the level of the sella. The model allows training of the resection of the egg yolk under sparing of the egg white after careful opening of the shell. It is a realistic simulation of the movements done under the endoscope through a narrow approach at a depth of 12 cm. Subjectively, independent neurosurgeons, not involved in the development, find this model close-to-reality. Objectively the official validation data will be finished in January 2014 and showed accordingly.

Conclusions: Our model is affordable, offers tactile feedback and allows infinite repetitions in training for pituitary surgery. It could be used for training of advanced neurosurgical residents, who thus far have very few possibilities of acquiring endoscopic experience.