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A basic model for training of microscopic and endoscopic transsphenoidal pituitary surgery: the Egghead

  • Experimental research - Neurosurgery Training
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Transsphenoidal endoscopic surgery has gained popularity in the last 2 decades and is becoming a 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 stage for transsphenoidal procedures. We have developed an affordable method for repetitive training in endoscopic (and microscopic) work in a narrow channel, allowing training of the basic movements needed for resection of pituitary adenoma.

Methods

In collaboration with colleagues in the ENT Department, Cantonal Hospital St. Gall, and the Technical University of Zurich, a three-dimensional model of the nasal cavity was developed and patented. The Egghead model consists of a 3D synthetic reconstruction of the head nasal cavity and sphenoid sinus. A boiled egg represents the sella. For validation, 17 neurosurgical residents from the Department of Neurosurgery, University Hospital of Basel, and Department of Neurosurgery, Cantonal Hospital of St. Gall, St. Gall, Switzerland, and two experts performed a standardized procedure mimicking a transsphenoidal pituitary procedure by dissecting a corridor to the egg yolk and resecting it, respecting the surrounding egg white. This procedure was performed under both microscopic and video-endoscopic visualization. A score for the precision and speed of the surgical performance was developed and used.

Results

The model allows repetitive training of the resection of the egg yolk under sparing of the egg white after careful opening of the shell. The validation data showed a steeper learning curve using the endoscopic technique than performing the same task using the microscope. After three repetitions, the quality of resection was better with the endoscopic technique.

Conclusions

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

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Acknowledgments

This project was funded by the Clinical Trials Unit Commission of the Canton of St. Gall, Switzerland. The authors thank Karl Storz® for providing the endoscopic setup. The authors also thank Prof. Rachel Rosenthal, Department of Surgery, Basel University, for input on training models in surgery and Karin Inauen, BSc, for assistance during the experiments.

Conflict of interest

The authors declare that they have no conflict of interest. The services of Inspire AG (Schindel and Schmidt) for cooperation with development and production were reimbursed at regular rates.

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Author notes

  1. Doortje C. Engel

    Present address: Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, D-72076, Tuebingen, Germany

Authors and Affiliations

  1. Department of Neurosurgery, Cantonal Hospital of St. Gall, St. Gall, Switzerland

    Doortje C. Engel & Jean-Yves Fournier

  2. Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland

    Andrea Ferrari & Luigi Mariani

  3. Department of ENT, Cantonal Hospital of St. Gall, St. Gall, Switzerland

    Abel-Jan Tasman

  4. Inspire® - ETH Zurich, St. Gall, Switzerland

    Raphael Schmid & Ralf Schindel

  5. Clinical Trials Unit, Cantonal Hospital of St. Gall, St. Gall, Switzerland

    Sarah R. Haile

Authors
  1. Doortje C. Engel
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  2. Andrea Ferrari
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  3. Abel-Jan Tasman
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  4. Raphael Schmid
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  5. Ralf Schindel
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  6. Sarah R. Haile
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  7. Luigi Mariani
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  8. Jean-Yves Fournier
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Corresponding author

Correspondence to Doortje C. Engel.

Additional information

Comment

This is an interesting article describing an affordable training model for endoscopic transsphenoidal surgery—this could easily be incorporated into any neurosurgical training program. It seems a very good introduction to endoscopic neurosurgery in general. The methodology of the study is sound. It will be interesting in the future to gain more insight into the value of the type of practical technical skill training in neurosurgery and whether such training tools can be used to judge the aptitude of the individual trainee for certain types of procedures. It is indeed interesting that some of the trainees outperformed the experts, even though they had no previous hands-on experience with the surgical technique. It might well be that this is because the generation of upcoming neurosurgeons has spent more time playing video games, as suggested by the authors. Therefore, we need to consider the indications of such results. Should there be a change of guard where the older "non-video game" generation steps aside and lets the best man or woman do the job—or should we spend a bit more time playing video games? As funny as this might seem, it is always worth considering how we can assure that operations are always performed by the best possible technician in the unit.

Jannick Brennum

Copenhagen,Denmark

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Engel, D.C., Ferrari, A., Tasman, AJ. et al. A basic model for training of microscopic and endoscopic transsphenoidal pituitary surgery: the Egghead. Acta Neurochir 157, 1771–1777 (2015). https://doi.org/10.1007/s00701-015-2544-z

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  • DOI: https://doi.org/10.1007/s00701-015-2544-z

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