Synthetic Simulator for Surgical Training in Tracheostomy and Open Airway Surgery

OBJECTIVE(S)

To create and validate a synthetic simulator for teaching tracheostomy and laryngotracheal reconstruction (LTR) using anterior costal cartilage and thyroid ala cartilage grafts.

METHODS

A late adolescent/adult neck and airway simulator was constructed based on CT scans from a cadaver and a live patient. Images were segmented to create three-dimensional printed molds from which anatomical parts were casted. To evaluate the simulator, expert otolaryngologists - head and neck surgeons performed tracheostomy and LTR using anterior costal cartilage and thyroid ala cartilage grafts on a live anesthetized porcine model (gold standard) followed by the synthetic simulator. They evaluated each model for face validity (realism and anatomical accuracy) and content validity (perceived effectiveness as a training tool) using a five-point Likert scale. For each expert, differences for each item on each simulator were compared using Wilcoxon Signed-Rank tests with Sidak correction.

RESULTS

Nine expert faculty surgeons completed the study. Experts rated face and content validity of the synthetic simulator an overall median of 4 and 5, respectively. There was no difference in scores between the synthetic model and the live porcine model for any of the steps of any of the surgical procedures.

CONCLUSION

The synthetic simulator created for this study has high face and content validity for tracheostomy and LTR with anterior costal cartilage and thyroid ala cartilage grafts and was not found to be different than the live porcine model for these procedures.

LEVEL OF EVIDENCE

5 Laryngoscope, 131:E2378-E2386, 2021.

Training Residents to Perform Tracheotomy Using a Live Swine Model

A tracheotomy is a basic operation for the otorhinolaryngologist. According to reports from the United States and from our experience, there has been a steady decline in the number of tracheostomies performed by young resident doctors. Due to concerns for inadequate training of young residents, we developed a tracheotomy course consisting of a lecture, a live animal model, and questionnaires. The aim of this study was to evaluate the effectiveness of this training model. Twelve volunteer resident doctors joined the training course and, following a lecture by a senior surgeon, practiced tracheostomies with a 4-month-old female swine weighing 32 kg. We recorded the procedure time, blood loss, and complications. The doctors' procedural competence was recorded using questionnaires before and after the training. All operations were completed within 30 minutes, and the blood loss was less than 5 ml. There were no serious acute complications. After the training, young residents had improved scores on surgical landmark recognition, overall procedural competence, confidence in performing the procedure, and understanding of the surgical procedures and equipment (P < .05). Our findings reveal that an animal model-based tracheotomy course is an effective training model for young resident doctors.

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology - head & neck surgery in Ontario, Canada

Background

An analysis of the scope of practice of recent Otolaryngology – Head and Neck Surgery (OHNS) graduates working as general otolaryngologists has not been previously performed. As Canadian OHNS residency programs implement competency-based training strategies, this data may be used to align residency curricula with the clinical and surgical practice of recent graduates.

Methods

Ontario billing data were used to identify the most common diagnostic and procedure codes used by general otolaryngologists issued a billing number between 2006 and 2012. The codes were categorized by OHNS subspecialty. Practitioners with a narrow range of procedure codes or a high rate of complex procedure codes, were deemed subspecialists and therefore excluded.

Results

There were 108 recent graduates in a general practice identified. The most common diagnostic codes assigned to consultation billings were categorized as ‘otology’ (42%), ‘general otolaryngology’ (35%), ‘rhinology’ (17%) and ‘head and neck’ (4%). The most common procedure codes were categorized as ‘general otolaryngology’ (45%), ‘otology’ (23%), ‘head and neck’ (13%) and ‘rhinology’ (9%). The top 5 procedures were nasolaryngoscopy, ear microdebridement, myringotomy with insertion of ventilation tube, tonsillectomy, and turbinate reduction. Although otology encompassed a large proportion of procedures billed, tympanoplasty and mastoidectomy were surprisingly uncommon.

Conclusion

This is the first study to analyze the nature of the clinical and surgical cases managed by recent OHNS graduates. The findings demonstrated a prominent representation of ‘otology’, ‘general’ and ‘rhinology’ based consultation diagnoses and procedures. The data derived from the study needs to be considered as residency curricula are modified to satisfy competency-based requirements.