Development and Evaluation of a High Fidelity Simulator for Surgical Training in Tracheostomy and Open Airway Surgery

Ashley Deonarain (1, 2), Karen Gordon (2, 4) , James Drake (1, 3), Evan Propst (2, 4) , Robert Harrison (1, 2, 4),

1) Institute of Biomaterials & Biomedical Engineering, University of Toronto, 2) Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, 3) Department of Surgery, Hospital for Sick Children, 4) Department of Otolaryngology – Head and Neck Surgery, University of Toronto

Background: The challenges of resident work-hour restrictions, growing concerns over patient safety and pressures for increased operating room efficiency limit learning opportunities for surgical trainees in the operating room. Surgical simulation can provide surgical trainees with valuable opportunities to develop and refine technical skills without risk to patient safety. Current synthetic airway simulators lack realistic tissue characteristics and anatomical detail for tracheostomy and complex open airway procedures. The objective of this study was to create a realistic airway simulator for training in tracheostomy and laryngotracheoplasty using anterior costal cartilage and thyroid ala cartilage grafts, and validate it with input from expert otolaryngologists-head & neck surgeons.

Methods: A young adult airway simulator was developed using image segmentation techniques, three-dimensional modeling, and silicone casting. The synthetic simulator’s realism, anatomical accuracy and perceived effectiveness as a training tool for tracheostomy, laryngotracheoplasty using anterior costal cartilage and thyroid ala cartilage grafts were evaluated by 9 expert otolaryngologists-head & neck surgeons using a post-trial questionnaire (5-point Likert scale). Participants also used the questionnaire to rate a live porcine model for these same procedures (gold standard in open airway simulation) for direct comparison to the synthetic simulator.

Results: Experts believed the synthetic simulator would be an effective training tool (median score 5/5) for each surgical procedure (content validity). Realism and anatomical accuracy achieved an overall median rating of 4 for each procedure (face validity). The synthetic simulator had highly comparable scores to a live porcine simulator. Overall, 100% (laryngotracheoplasty using costal cartilage graft), 100% (laryngotracheoplasty using thyroid ala cartilage graft) and 89% (tracheostomy) of participants strongly agreed or agreed that use of the synthetic simulator would increase trainee competency.

Conclusions: The high-fidelity synthetic airway simulator is realistic, comparable to a live porcine model, and has perceived effectiveness as a training tool for the three most common open airway procedures. Future studies are needed to determine if use of the synthetic simulator can enhance tracheostomy and open airway surgical education.