Date Published: June 29, 2017
Publisher: Public Library of Science
Author(s): Henrique Fernandes de Oliveira, Valdes Roberto Bollela, Wilma Terezinha Anselmo-Lima, Carlos Augusto Pires de Oliveira Costa, Márcio Nakanishi, Gustavo Pradilla.
To describe and standardize a reproducible, viable, low-cost lamb’s head model for endoscopic sinus surgery training.
Otorhinolaryngology residents performed the following three endoscopic sinus surgeries using the lamb’s head model: inferior turbinectomy, bullectomy, and maxillary antrostomy. Each student dissected 10 specimens before training these procedures on human patients, and the benefit of the animal model training was evaluated.
Nineteen resident physicians of comparable academic level participated in training. All participants agreed that the lamb’s head model dissections improved their skills in using surgical and videoendoscopic instruments, 90% agreed that the dissections improved their confidence with respect to training in human patients, and all stated they would recommend the same training to future residents.
Lamb’s heads have been used for training in endoscopic sinus surgery. However, no standardization of this training had been performed to ensure that it is a valuable tool for learning and skill-building. The standardized method described in this study increased resident physicians’ skills and confidence before beginning their training on human patients. Moreover, our results demonstrate the feasibility of the model, considering its low cost and reproducibility.
Future studies with this model should be conducted to assess whether the resulting increase in skills prevents and reduces medical errors, increases patient safety, reduces surgical costs, and improves the quality of otorhinolaryngological care.
Rhinology, particularly rhinologic surgery, has undergone major transformations in recent decades since the advent of videoendoscopy. The access routes of various nasal and paranasal surgical procedures have changed to incorporate the many benefits provided by the nasal endoscope, including smaller surgical scars, decreased operative time, and fewer complications.
The study was approved by the relevant Institutional Animal Care and Use Committee at School of Medicine, Universidade de Brasília with protocol number 153674/2012. The research was approved in 2012 and data collection, and data collection took place from 2013 to 2016, which means that the research was conducted only after its approval. The above committee evaluates all investigations performed in the institution, including those with human subjects. Therefore, the committee approved the use of both humans and animals in the present study. All the residents that took part in this study gave written consent after they had received detailed information about the project. All procedures were conducted in exact compliance with the approved protocol.
A total of 19 residents (6 men and 13 women) from the same academic year and residency period performed the three surgeries proposed for each endoscopic dissection. Each resident performed 10 dissections in 5 lamb’s heads over an average period of 5 to 8 weeks. There were four cohorts of residents over 4 years.
Use of the lamb’s head model helped overcome the difficulties of using human cadavers and the limitations of alternative methods. This model complies with the principles of ethical animal use; because the study specimens do not have commercial value, this material is usually discarded after slaughter. Therefore, this training model is low-cost and complies with legal requirements.
Nasal dissection using the lamb’s head model proposed in this study is a viable, low-cost alternative to the use of human cadavers. Future studies with this model would help demonstrate whether the resulting acquisition of skills can prevent and reduce medical errors, increase patient safety, decrease surgical costs, and improve the quality of otorhinolaryngological care.