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Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention

Donoho, Daniel A. and Pangal, Dhiraj J. and Kugener, Guillaume and Rutkowski, Martin and Micko, Alexander and Shahrestani, Shane and Brunswick, Andrew and Minneti, Michael and Wrobel, Bozena B. and Zada, Gabriel (2021) Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention. Journal of Neurosurgery . ISSN 0022-3085. doi:10.3171/2020.9.JNS202672. (In Press) https://resolver.caltech.edu/CaltechAUTHORS:20210408-072400516

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Abstract

Objective: Internal carotid artery injury (ICAI) is a rare, life-threatening complication of endoscopic endonasal approaches that will be encountered by most skull base neurosurgeons and otolaryngologists. Rates of surgical proficiency for managing ICAI are not known, and the role of simulation to improve performance has not been studied on a nationwide scale. Methods: Attending and resident neurosurgery and otorhinolaryngology surgeons (n = 177) were recruited from multicenter regional and national training courses to assess training outcomes and validity at scale of a prospective educational intervention to improve surgeon technical skills using a previously validated, perfused human cadaveric simulator. Participants attempted an initial trial (T1) of simulated ICAI control using their preferred technique. An educational intervention including personalized instruction was performed. Participants attempted a second trial (T2). Task success (dichotomous), time to hemostasis (TTH), estimated blood loss (EBL), and surgeon heart rate were measured. Results: Participant rating scales confirmed that the simulation retained face and construct validity across eight instructional settings. Trial success (ICAI control) improved from 56% in T1 to 90% in T2 (p < 0.0001). EBL and TTH decreased by 37% and 38%, respectively (p < 0.0001). Postintervention resident surgeon performance (TTH, EBL, and success rate) was superior to preintervention attending surgeon performance. The most improved quartile of participants achieved 62% improvement in TTH and 73% improvement in EBL, with trial success improvement from 25.6% in T1 to 100% in T2 (p < 0.0001). Baseline surgeon confidence was uncorrelated with T1 success, while posttraining confidence correlated with T2 success. Tachycardia was measured in 57% of surgeon participants, but was attenuated during T2, consistent with development of resiliency. Conclusions: Prior to training, many attending and most resident surgeons could not manage the rare, life-threatening intraoperative complication of ICAI. A simulated educational intervention significantly improved surgeon performance and remained valid when deployed at scale. Simulation also promoted the development of favorable cognitive skills (accurate perception of skill and resiliency). Rare, life-threatening intraoperative complications may be optimal targets for educational interventions using surgical simulation.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.3171/2020.9.JNS202672DOIArticle
https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2020.9.JNS202672/article-10.3171-2020.9.JNS202672.xml?body=abstractPublisherArticle
ORCID:
AuthorORCID
Kugener, Guillaume0000-0002-4697-2847
Micko, Alexander0000-0001-9105-3519
Shahrestani, Shane0000-0001-7561-4590
Zada, Gabriel0000-0001-5821-902X
Additional Information:© 2021 American Association of Neurological Surgeons. Online Publication Date: 19 Mar 2021.
DOI:10.3171/2020.9.JNS202672
Record Number:CaltechAUTHORS:20210408-072400516
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20210408-072400516
Official Citation:Donoho, D. A., Pangal, D. J., Kugener, G., Rutkowski, M., Micko, A., Shahrestani, S., Brunswick, A., Minneti, M., Wrobel, B. B., & Zada, G. (2021). Improved surgeon performance following cadaveric simulation of internal carotid artery injury during endoscopic endonasal surgery: training outcomes of a nationwide prospective educational intervention, Journal of Neurosurgery JNS, DOI: 10.3171-2020.9.JNS202672.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:108652
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:09 Apr 2021 00:48
Last Modified:09 Apr 2021 00:48

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