A Cost-effective and Reproducible Cadaveric Model for Internal Carotid Artery Injury Management During Endoscopic Endonasal Surgery: The Submersible Peristaltic Pump

Introduction: Internal carotid artery injury (ICAI) represents one of the most challenging complications in endoscopic endonasal neurosurgery (EEN) and its rarity results in limited opportunities for trainees and surgeons to achieve proficiency in its management. Currently, available models for ICAI have employed costly systems that prevent their widespread use.
The aim of this study is to validate an affordable submersible peristaltic pump (SPP) based model as a reproducible and realistic paradigm for ICAI management training.

Methods: A laceration of the left parasellar internal carotid artery (ICA) was purposedly carried out in two human cadaveric heads. A blood substitute was perfused to ensure a perfusion flow of 1 L/min using an affordable SPP. A cohort of 10 neurosurgery and otolaryngology residents and fellows were enrolled to evaluate the realism and content validity of the model using a validated 5-grade questionnaire.

Results: The model proved to mimic a real intra-operative scenario of ICAI with an expected output flow of 1 L/min. Questionnaire responses reported a realistic experience and the impact of this model on improving trainee surgical coordination and capability to rehearse the most accepted repair technique. The use of a fixed non-injected head allowed the reproducibility of the training session without the additional cost of new fresh-frozen heads. The affordable SPP allowed an impactful reduction of ICAI model training expenses maintaining high realism.

Conclusion : The SPP-based ICAI model with non-injected cadaveric specimens is an affordable and cost-effective system that allows reproducibility and realism. These qualities favor greater adoption in neurosurgery and otolaryngology training curricula.