Enhancing Cadaver Labs for Endoscopic Spine Surgery: The Glove as the "Lesion"

OBJECTIVE: We describe a novel yet simple training exercise for residents who are being introduced to endoscopic spine surgery. METHODS: Prior to residents training on the endoscopic interlaminar approach, the course faculty performed an endoscopic transforaminal approach and inserted a small piece of a surgical glove into the ventral epidural space of a cadaveric torso. The transforaminal approach did not alter the anatomy of the interlaminar approach, so the residents were able to practice as if it were a de novo situation. Placing the small "lesion" provided an exercise to confirm the residents were able to safely access the area and provided practice for them to carefully grasp the "lesion" and remove it. Prior to resident training on the endoscopic transforaminal approach, the course faculty utilized an interlaminar approach to place the "lesion." A questionnaire with a five-point Likert scale of agreement was completed by the residents to assess their experience with the training exercise. RESULTS: Five residents attended the cadaver lab, and 100% strongly agreed that the cadaver lab provided a realistic representation of the procedure demonstrated, the "lesion" removal added to their educational experience, and they were overall satisfied with the educational session. CONCLUSIONS: One of the lessons learned with this exercise that we will consider in future courses would be to place a radiodense "lesion" that could be visualized on fluoroscopy and serve as a radiologic target to find. This can help guide the trainee in knowing where to search if the "lesion" is more difficult to find.