Fresh Cadaveric Dissections as a Training System of Endoscopic Endonasal Surgery

• Main Author: Minamida, Yoshihiro
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2009-1222336

Background: During the past decade, the endoscopic endonasal transsphenoidal approach has been proposed as a minimally invasive surgical technique for the removal of sellar lesions. The importance of the endoscopic training must be stressed because of the distorted view resulting from the intrinsic optical features of the endoscope (“barrel effect,” i.e., the lack of 3D vision). The aspects of shape, size, and 3D relationships with endoscopic anatomy have been found to be quite different from those of microscopic anatomy. The endoscopic procedure offers the many advantages of a minimally invasive method, with satisfying preliminary results; however, there is a learning curve for its use. Therefore, endoscopic training before clinical practice must be mandatory, by all means. Objectives: The purpose of this study was to compare the flexibility of nostrils in fresh cadavers with that of fixed cadavers, to evaluate the usefulness of fresh cadaver dissections as a training system for endoscopic endonasal surgery. Methods: Size of nostrils was measured in each of 10 fresh cadavers and 10 fixed cadavers. Flexibility was evaluated with the range of motion in all directions, when the endoscope was tracked with the strength of 300 g. The cadaver nostrils were compared with those of patients who underwent surgery in our institution. Results: Size of nostrils was not different in each group. The ranges of mobility in fresh cadavers were 12.3 mm in the rostral direction, 2.5 mm in the caudal direction, 11.7 mm in the lateral direction, and 10.6 mm in the medial direction. In fixed cadavers, the ranges were 3.6 mm in the rostral direction, 1.5 mm in the caudal direction, 3.5 mm in the lateral direction, and 2.8 mm in the medial direction. The ranges of mobility in fresh ones were significantly wider than those in fixed ones, and were equivalent to those in patients. Conclusions: Size and flexibility of nostrils in fresh cadavers were almost similar to those in patients. A surgical training system using fresh cadavers is more beneficial than training with fixed ones because they provide more flexible nostrils and more realistic and beneficial dissection.