Utilization and dissection for endoscopic sinus surgery training in the residency program

To develop an animal cadaver model that would allow residents to learn functional endoscopic sinus surgery as a complementary model.

Prospective experimental study.

Two of our first-year residents were included in the study, and each operated on 5 sheep noses. All the routine steps of endoscopic sinus surgery were performed, except for sphenoidotomy, and their success and complication scores were recorded. The residents' performance for maxillary antrostomy, ethmoidectomy, and frontal sinusotomy in sheep cadaver noses were evaluated by the authors. Predissection and postdissection computer tomography assessed the completeness of dissection. Images were analyzed for maxillary antrostomy, frontal sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. The first and last 5 sides of residents were analyzed together as the first 10 sides (group 1) and last 10 sides (group 2).

Group 2 had significantly better outcomes for frontal sinusotomy and ethmoidectomy (P = 0.011 and P = 0.003, respectively). The mean duration of procedures for group 1 was 15.7 minutes and that for group 2 was 10.3 minutes (P = 0.000). The difference was not significant between the 2 groups when comparing the success rates of maxillary antrostomy and the complication rates (P > 0.05).

The nasal cavity of the sheep is anatomically similar to the human nasal cavity, and the model using sheep cadaver for endoscopic sinus surgery training is a cost-effective and useful model for the first step of the learning curve.