Simulation-Based Training for endoscopic Internal Carotid Artery Injury Management: Performance and Confidence Outcomes Using a Live Porcine Model

Objective: To evaluate the educational outcomes of a structured simulation program using a live porcine model for internal carotid artery (ICA) injury management during endoscopic endonasal surgery, analyzing both objective and subjective participant data. Methods: This study included 80 surgeons with different levels of experience who participated, between 2021 and 2024, in a hands-on simulation course on ICA injury management. Demographic data, hemorrhage control time, and self-perceived technical confidence—assessed using a visual analog scale (VAS)—were collected before and after the training. Statistical analyses included normality tests, Mann–Whitney, Spearman correlation, and stepwise linear regression, with significance set at p<0.05. Results: Participants had a mean age of 38.8 ± 8.6 years. The mean hemorrhage control time was 106.5 ± 37.4 seconds. VAS confidence scores improved significantly from a mean of 1.94 (pre-training) to 8.50 (post-training) (p<0.001), indicating a substantial gain in technical confidence. Regression analysis showed that a higher annual volume of endoscopic surgeries and greater experience in endoscopic surgery, measured in years (estimate: -2.71; p=0.007; Spearman’s ρ=-0.308), were significantly associated with shorter hemorrhage control times. Prior training also had a marked impact, with participants who had undergone previous training achieving faster control (69.8 seconds vs. 110.6 seconds; p<0.001), while specialty (neurosurgery vs. otolaryngology) showed no significant difference (p=0.602). Conclusion: The simulation program demonstrated strong educational effectiveness, significantly improving technical performance and self-confidence. These findings support the integration of high-fidelity simulation programs into residency and fellowship curricula for skull base surgery.