Education for Endonasal Endoscopic Surgery: Evaluation and Guiding of Surgical Skill and Ability with the Technique of Behavioral Engineering

We present a step-up training system for endonasal endoscopic surgery based on the evaluation by the trainers and self-assessments. Step 1: The trainees are taught basic anatomy and the pre-operative planning. The navigation system is useful in this step. Step 2: We developed a surgical skill training system (HyperMirror interface). We analyzed the difference of a handling of surgical instruments, a loading force, and invasiveness between trainees and trainers using a precise nasal model. In easy tasks, the surgical time got comparable between the trainees and trainers after the repeated training. In difficult tasks, however, the surgical time depended on personal ability, and simple repeated training was not enough to improve the surgical time. Large difference was found between the trainees and trainers in the force power of the instruments to a model and the range of bone dissection. Using a precise nasal model and a navigation system, it was possible to compare endoscopic view and macroscopic observation in a three-dimensional manner. Step 3: In the operation theater, the instructor do the surgery using a precise nasal model made on the patients’ own CT scan. The trainees can learn the safe / precise operation by following the surgical field made by the instructor using a model. To improve the quality of surgery education, it will be necessary to evaluate an ability of instructors and the mental load of trainees. Finally, we hope to develop a new educational program that every trainee can learn standard surgical techniques efficiently.