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Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit
Shi Ying Hey1, Nigel K F Koo Ng1, Gerald W McGarry1
11 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
Ear, Nose, & Throat Journal
|March 20, 2019
Summary
Endoscopic sphenopalatine artery ligation (ESPAL) is effective for severe nosebleeds, with a 92.3% success rate. Trainee-performed ESPAL, with proper training, yields comparable outcomes to consultant-led procedures, ensuring patient safety.
Area of Science:
- Otolaryngology
- Minimally Invasive Surgery
Background:
- Refractory epistaxis management often requires endoscopic sphenopalatine artery ligation (ESPAL).
- ESPAL is a core competency for Ear, Nose, and Throat (ENT) trainees in the UK.
- Assessing ESPAL efficacy in teaching hospitals is crucial for training standards.
Purpose of the Study:
- To evaluate the efficacy and outcomes of endoscopic sphenopalatine artery ligation (ESPAL) for epistaxis management.
- To assess the role of trainee surgeons in performing ESPAL procedures.
- To analyze factors influencing ESPAL success rates, including operator grade and technique.
Main Methods:
- Retrospective review of 67 ESPAL procedures for epistaxis from December 2005 to December 2013.
- Analysis of ligation techniques, operator experience (consultant vs. trainee), and supervision levels.
- Correlation of outcomes with surgical technique, operator grade, and supervision.
Main Results:
- Overall ESPAL success rate was 92.3% (60/65 patients), with 5 rebleeds within 30 days.
- Procedures were performed by consultants (47.7%) and trainees (52.3%), with or without supervision.
- No significant correlation found between rebleed rates and operator grade, supervision, or ligation technique.
Conclusions:
- Endoscopic sphenopalatine artery ligation (ESPAL) is a safe and effective treatment for epistaxis, achievable by surgeons of varying experience levels with appropriate training.
- Trainee-performed ESPAL demonstrates comparable outcomes to consultant-led procedures.
- Simulation-based training can further enhance ESPAL skills and contribute to continuous professional development.
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