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Tools for Training in Sinus Surgery

Brianna K. Crawley, MD; Gregory C. Barkdull, MD; Stephen Dent, MD; Michael Bishop, MD; Terence M. Davidson, MD

Arch Otolaryngol Head Neck Surg. 2009;135(10):994-999.

Objectives  To quantify the safety and efficiency of Postgraduate-Year II head-and-neck-surgery residents who perform endoscopic sinus surgery, to observe any changes that accompanied accrued experience, and to measure and correlate blood loss and temporal efficiency with anesthesia-induced relative hypotension.

Design  Retrospective study.

Setting  University of California, San Diego, Medical Center.

Patients  One hundred two patients with chronic rhinosinusitis operated on between July 1, 2005, and June 30, 2006, by 3 Postgraduate-Year II head-and-neck-surgery residents.

Intervention  Endoscopic sinus surgery.

Main Outcome Measures  Operative times, blood loss, case complexity, and anesthetic components were recorded and analyzed.

Results  One hundred two patients with chronic rhinosinusitis with and without polyposis received operative management. Mean operative time, with the inclusion of injection (10 minutes) and image guidance setup (5 minutes), was 77 minutes. Estimated blood loss averaged 42 mL for patients with chronic rhinosinusitis and 58 mL for patients with chronic rhinosinusitis and nasal polyps. The mean intraoperative blood pressure was 101/65 mm Hg. No major complications occurred.

Conclusions  Endoscopic sinus surgery may be safely performed by Postgraduate-Year II head-and-neck-surgery residents by means of hypotensive anesthesia techniques and image guidance. Outcome analysis demonstrates minimal blood loss, efficient operative times, and no significant complications.

Author Affiliations: Department of Surgery, Division of Otolaryngology/Head and Neck Surgery, University of New Mexico School of Medicine, Albuquerque (Dr Crawley); Division of Otolaryngology/Head and Neck Surgery, University of California, San Diego, School of Medicine, VA San Diego Healthcare System (Drs Barkdull, Dent, and Davidson); and Department of Anesthesiology, University of California, San Diego, School of Medicine (Dr Bishop).

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