Sheep's Head as an Anatomic Model for Basic Training in Endoscopic Sinus Surgery

Abstract

Background and Objectives: This study aims to establish the sheep head as a viable anatomical model for training in functional endoscopic sinus surgery through comprehensive anatomical examination and training-based assessment of participants' satisfaction. Materials and Methods: Participants were divided into three groups according to their prior experience in endoscopic sinus surgery; in total, 24 participants were included. Each participant in the study was assigned to perform the designated procedures on a single sheep's head. Following the completion of the procedures, each participant was provided with a 14-item comprehensive satisfaction questionnaire with a scale attributed from 1 to 5. The normality of distribution was checked by applying the Shapiro-Wilk Test. The Kruskal-Wallis test was applied to compare study group sentiment of agreement towards individual procedures. Results: No significant differences were noted between the answers of the different groups. For the resident group, the average satisfaction score was 4.09 ± 0.54; junior specialist group 4.00 ± 0.55; for the senior specialist group overall satisfaction average score was 4.2 ± 0.77. Conclusions: The sheep's head can be successfully used for learning and practicing manual skills and the use of instruments specific to functional endoscopic sinus surgery. Moreover, the sheep head model can be used for training in other diagnostic or surgical procedures in the field of otorhinolaryngology, such as endoscopy of the salivary glands, open laryngotracheal surgery, or in otologic surgery, but also in other different surgical fields such as neurosurgery, ophthalmology or plastic surgery. Despite the differences between the ovine model and human anatomy, it provides a resourceful and cost-effective model for beginners in endoscopic nasal surgery.

Keywords: FESS; animal model; simulation; sinus surgery; surgical training.

Figure 1

View of the sheep’s head secured in the Karl Storz^® special head holder.

Figure 2

(a) Endoscopic view of the sheep’s left nasal fossa. 1—inferior part of inferior turbinate; 2—superior part of inferior turbinate; 3—nasal septum; (b) endoscopic view of the posterior septal defect specific to the ovine model described by Mladina [7]—dotted white line. Right nasal fossa, 1—the lower limit of the septal defect; 2—the superior limit of the septal defect; 3—inferior turbinate; 4—lateral nasal wall; 5—nasal floor.

Figure 3

(a) Endoscopic view—left nasal fossa—1—middle turbinate; 2—lateral nasal wall; 3—septum. (b) Endoscopic view—left nasal fossa; 1—medialized middle turbinate; 2—natural ostium of the maxillary sinus; 3—uncinate process.

Figure 4

Endoscopic images of sub-perichondral dissection of the septum and turbinate fracture. (a) Sub-perichondral dissection of the septum, (b) Instrumental lateral fracture of the inferior turbinate. 1—lateral nasal wall; 2—inferior turbinate; 3—Cottle dorsal scissors; 4—insertion of the inferior turbinate to the lateral nasal wall.

Figure 5

(a,b) Endoscopic images of instrumental removal of ethmoidal cells.

Figure 6

Total satisfaction scoring regarding participant groups.