Development of 3-dimensional printed simulation surgical training models for endoscopic endonasal and transorbital surgery

Abstract

BackgroundEndoscopic skull base surgery (ESBS) is complex, requiring methodical and unremitting surgical training. Herein, we describe the development and evaluation of a novel three-dimensional (3D) printed simulation model for ESBS. We further validate the efficacy of this model as educational support in neurosurgical training.MethodsA patient-specific 3D printed simulation model using living human imaging data was established and evaluated in a task-based hands-on dissection program. Endoscopic endonasal and transorbital procedures were simulated on the model by neurosurgeons and otorhinolaryngology surgeons of varying experience. All procedures were recorded using a high-definition camera coupled with digital video recorder system. The participants were asked to complete a post-procedure questionnaire to validate the efficacy of the model.ResultsFourteen experts and 22 trainees participated in simulations, and the 32 participants completed the post-procedure survey. The anatomical realism was scored as 4.0/5.0. The participants rated the model as helpful in hand-eye coordination training (4.7/5.0) and improving surgical skills (4.6/5.0) for ESBS. All participants believed that the model was useful as educational support for trainees (4.7 [ ± 0.5]). However, the color (3.6/5.0) and soft tissue feedback parameters (2.8/5) scored low.ConclusionThis study shows that high-resolution 3D printed skull base models for ESBS can be generated with high anatomical accuracy and acceptable haptic feedback. The simulation program of ESBS using this model may be supplemental or provide an alternative training platform to cadaveric dissection.

Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models

“…Fourteen studies of simulation with synthetic models were identified. 11,15,[27][28][29][30][31][32][33][34][35][36][37][38] 27,[29][30][31]35,36 Oyama et al described one of the most complete synthetic simulation models, in which the anterior, middle, and posterior fossa could be accessed through both sagittal and coronal plane approaches. 31 [29][30][31][32]35,36,38 whereas Wen et al enhanced the training of sellar tumor resection by curetting the inner content of an egg.…”

“…11,15,[27][28][29][30][31][32][33][34][35][36][37][38] 27,[29][30][31]35,36 Oyama et al described one of the most complete synthetic simulation models, in which the anterior, middle, and posterior fossa could be accessed through both sagittal and coronal plane approaches. 31 [29][30][31][32]35,36,38 whereas Wen et al enhanced the training of sellar tumor resection by curetting the inner content of an egg. 28 In addition, Shah et al aimed to produce a model that assisted in identifying patient-specific sphenoid sinus landmarks and tested the participant's acquired knowledge in the operating room.…”

“…30 Moreover, Lee et al and Oyama et al described using their training models for endoscopic transorbital surgery. 31,35 Nebor et al presented the only synthetic training model simulating CSF leak repair. 37 Based on imaging studies, Huang et al, Zheng et al, Shinomiya et al, and Lee et al were able to recreate specific lesions and integrate them into the model.…”

“…37 Based on imaging studies, Huang et al, Zheng et al, Shinomiya et al, and Lee et al were able to recreate specific lesions and integrate them into the model. 27,[33][34][35] Huang et al and Shinomiya et al established the validity of their own synthetic model in surgical planning of EEN for pituitary adenomas. 33,34 Huang et al implemented this synthetic modeling tool in their practice, reporting improved clinical outcomes for patients who were simulated preooperatively.…”

“…27 In addition, multi-material and multicolor models are being developed to improve texture and realism. 27,31,35 Through these models, it is possible to visualize and interact with specific pathologies as well as dissect, cut, and drill through the endonasal corridor. Hence, synthetic models may be particularly suitable for surgical planning and testing various surgical approaches.…”