title: A practical 3D printed simulator for endoscopic endonasal transsphenoidal surgery to improve basic operational skills.
abstract: OBJECTIVE
  We aimed to present a practical three-dimensional (3D) printed simulator to comprehensively and effectively accelerate the learning curve of endoscopic endonasal transsphenoidal surgery (EETS).
  
  
  METHODS
  The 3D printed simulator consists of three parts: (1) skull frame, (2) the nasal passage and the nasal alar of the face, and (3) a modified sella turcica. We aimed to improve three basic operational skills of surgeons: drilling, curetting, and aspirating. Eighteen neurosurgeons and five post-graduates were recruited and consented for the training.
  
  
  RESULTS
  For trainees, (1) as the training progressed, the scores increased gradually, (2) a significant increase in the average scores was observed in the tenth training compared to the first training, and (3) there is a significant decrease in trainee variability in the shortening of the gap. The 18 neurosurgeons were divided into three groups: experts, assistants, and observers. For all three basic operations, (1) the average score of experts was obviously higher than that of the assistants, observers, and trainees' tenth training and (2) the average scores of assistants and observers were obviously higher than that of trainees' first training. A significant high in the average score between the assistants and the observers was seen for aspirating, but not for drilling or curetting. For curetting and aspirating, the tenth training average score of trainees was obviously higher than that of assistants and observers.
  
  
  CONCLUSIONS
  This 3D printed simulator allows different endoscopic basic operations to be simulated and improves the EETS techniques of surgeons. We believed it to be a practical, simple, and low-cost simulator.
authors.affiliation: Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
authors.forename: Guodao
authors.initials: G
authors.lastname: Wen
authors.affiliation: Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
authors.forename: ZiXiang
authors.initials: Z
authors.lastname: Cong
authors.affiliation: Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
authors.forename: KaiDong
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
authors.forename: Chao
authors.initials: C
authors.lastname: Tang
authors.affiliation: School of Medicine, Nanjing Medical University, 104 Hanzhong Road, Nanjing, 210002, China.
authors.forename: Chunyu
authors.initials: C
authors.lastname: Zhong
authors.affiliation: Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China.
authors.forename: Liwen
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, China.
authors.forename: XuJie
authors.initials: X
authors.lastname: Dai
authors.affiliation: Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, People's Republic of China. machiyuan_nju@126.com.
authors.forename: Chiyuan
authors.initials: C
authors.lastname: Ma
mesh_terms: D003198:Computer Simulation; D003200:Computer User Training; D004724:Endoscopy; D006801:Humans; D007396:Internship and Residency; D009296:Nasal Cavity / Q000000981:diagnostic imaging* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000193:education* / Q000379:methods*; D012886:Skull / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery
keywords: Aspirating; Curetting; Drilling; Endoscopic endonasal transsphenoidal surgery; The 3D printed simulator; Three basic operational skills