Evaluation of a re-useable bronchoscopy biosimulator with ventilated lungs

Garner, Justin; Gärner, Stefan; Hardie, R.; Molyneaux, Philip L.; Singh, Suveer; Kemp, Samuel V.; Shah, Pallav L.

doi:10.1183/23120541.00035-2019

Cited by 9 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The porcine tracheobronchial system shares morphological characteristics with that of the human, including similar tracheal length, bronchiolar segmentation, and bronchiolar diameter. Moreover, both porcine and human bronchioles have a highly differentiated pseudostratified epithelial lining and submucosa with submucosal glands and airway smooth muscle [25,37,38] making the pig lung the favoured animal model to train bronchoscopists [39][40][41] and therefore the best choice to model bronchial thermoplasty in the human. We found the maximal temperature of the airway wall was ∼83°C at the bronchial thermoplasty contact points; significantly higher than the intervening wall which reached a maximum of only 60°C.…”

Section: Discussionmentioning

confidence: 99%

Long-term modulation of airway remodelling in severe asthma following bronchial thermoplasty

et al. 2021

View full text Add to dashboard Cite

RationaleBronchial thermoplasty is a mechanical therapeutic intervention that has been advocated as an effective treatment option for severe asthma. The mechanism is promoted as being related to the attenuation of airway smooth muscle which has been shown to occur in the short-term. However, long-term studies of the effects of bronchial thermoplasty on airway remodeling are few with only limited assessment of airway remodeling indices.ObjectivesTo evaluate the effect of bronchial thermoplasty on (a) airway epithelial and smooth muscle cells in culture, and (b), airway remodeling in patients with severe asthma who have been prescribed bronchial thermoplasty up to 12-months post-treatment.MethodsThe distribution of heat within the airway by bronchial thermoplasty was assessed in a porcine model. Culture of human airway smooth muscle cells and bronchial epithelial cells evaluated the impact of thermal injury. Histological evaluation and morphometric assessment were performed on bronchial biopsies obtained from severe asthma patients at baseline, 6-weeks, and 12-months following bronchial thermoplasty.ResultsBronchial thermoplasty resulted in heterogenous heating of the airway wall. Airway smooth muscle cell cultures sustained thermal injury, whilst bronchial epithelial cells were relatively resistant to heat. Airway smooth muscle and neural bundles were significantly reduced at 6-weeks and 12-months post-treatment. At 6-weeks post treatment, submucosal collagen was reduced, and vessel density increased, with both indices returning to baseline at 12-months. Goblet cell numbers, submucosal gland area and subbasement membrane thickness, were not significantly altered at any timepoint examined.ConclusionsBronchial thermoplasty primarily affects airway smooth muscle and nerves with the effects still present at 12-months post-treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term modulation of airway remodelling in severe asthma following bronchial thermoplasty

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Accordingly, the ability to simulate tissue sampling is essential when choosing a simulation model for training of bronchoscopy. Porcine lungs have been evaluated as a supplement to teaching of bronchoscopic techniques, including tissue sampling procedures [ 21 ]. In this study, all bronchoscopists attempted the biopsy procedure in all for models.…”

Section: Discussionmentioning

confidence: 99%

“…Human cadavers have been used in training bronchoscopic procedures and were favored over manikin models for educational purposes [17,18], which is in consistency with the findings of this study. Porcine lungs are promising models for hands-on training of bronchoscopic procedures and the histological structure of the respiratory tract is similar to humans [19][20][21]. However, the difference in anatomy was commented on by multiple participants.…”

Section: Anatomical Fidelitymentioning

confidence: 99%

Four different models for simulation-based training of bronchoscopic procedures

Kronborg,

Karbing,

Arshad

et al. 2024

BMC Pulm Med

View full text Add to dashboard Cite

Background Flexible bronchoscopy procedures require detailed anatomical knowledge and advanced technical skills. Simulation-based training offers a patient-safe training environment that can be more efficient than patient-based training. Physical models are cheaper than virtual reality simulators and allow trainees to be acquainted with the equipment used in the clinic. The choice of a physical model for training depends on the local context. The aim of this study was to compare four different bronchoscopy models for flexible bronchoscopy training. Methods The BronchoBoy manikin, the Koken manikin, a human cadaver, and a preserved porcine lung were included in the study. Seven physicians experienced in bronchoscopy performed a bronchoscopic airway inspection, bronchoalveolar lavage (BAL), and tissue sampling on all four models with performance evaluated by observation and participant evaluation of models by questionnaire. Results Nineteen segments were identified in all human anatomy models, and the only significant difference found was that only the Thiel embedded cadaver allowed all participants to enter RB1 with an instrument in the working channel (p = 0.001). The Thiel embedded cadaver and the BronchoBoy manikin had low fluid return on BAL (22 and 52 ml), whereas the Koken manikin and the preserved porcine lung had high return (132 and 134 ml), (p = 0.017). Tissue samplings were only completed in the preserved porcine lung and the Thiel embedded cadaver (p < 0.001). Conclusions An anatomically correct bronchoscopy is best simulated with the Koken manikin or the Thiel embedded cadaver. Bronchoalveolar lavage should be simulated with the Koken manikin or the preserved porcine lung. Tissue sampling procedures are best simulated using the Thiel embedded cadaver or the preserved porcine lung.

show abstract

“…Though, there is to mention that several trials have shown, that also low fidelity simulators, as 3D-printed models of the bronchial tree are effective for acquiring basic flexible bronchoscopy skills [ 8 – 11 ] by presenting an equal or even more realistic imaging compared to the high-fidelity models [ 9 , 10 , 12 ]. Other, less investigated models are available, for example one study used a low-cost device that simulates an intubated and ventilated patient, employing re-useable, inflatable, BioFlex-preserved, porcine lungs, with similar effects on trainee performance realism of the bronchial tree and usability [ 13 ]. For programs with budgetary constraints those models can be an alternative [ 14 ], as costs are significantly lower, ranging from 40 to 250 US$ [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Man or machine? Impact of tutor-guided versus simulator-guided short-time bronchoscopy training on students learning outcomes

2021

View full text Add to dashboard Cite

Background Simulation based medical education is efficient for the acquisition of flexible bronchoscopy navigational skills and the knowledge of the tracheobronchial anatomy. However, bronchoscopy simulator training is not routinely integrated into pneumologic fellowship programs or undergraduate medical education for time and/or cost reasons. Our study compares the effect of self-guided bronchoscopy simulator training versus tutor guided training on the acquisition of navigational skills and knowledge of the bronchial anatomy. Methods Third-year undergraduate medical students were randomized to either a tutor- or simulator guided bronchoscopy simulator training focusing on the acquisition of navigational skills and the knowledge of the tracheobronchial anatomy. Every student performed a baseline bronchoscopy followed by a structured bronchoscopy simulator training and finally an assessment bronchoscopy at the end of the training program. Groups were compared by means of a repeated measurement ANOVA and effect sizes calculated as Cohens’ d. Results Fifty-four eligible students participated in the study. Knowledge of the tracheobronchial anatomy significantly increased from pre- to post training (all p < 0.001; all d > 2), navigational skills significantly decreased (all p < 0.005; all d < 1). There were no significant differences between groups. Instruction by the simulator as well as by the tutor was rated as helpful by the students. Twenty-two (84.6%) of the participants of the simulator guided group would have appreciated an additional instruction by a tutor. Conclusion Short-time simulator guided bronchoscopy training improves knowledge of the tracheobronchial anatomy in novice bronchoscopists as much as tutor guided training, but navigational skills seem to worsen in both groups. Further studies assessing transfer to clinical practice are needed to find the optimal teaching method for basic flexible bronchoscopy.

show abstract

Evaluation of a re-useable bronchoscopy biosimulator with ventilated lungs

Cited by 9 publications

References 23 publications

Long-term modulation of airway remodelling in severe asthma following bronchial thermoplasty

Long-term modulation of airway remodelling in severe asthma following bronchial thermoplasty

Four different models for simulation-based training of bronchoscopic procedures

Man or machine? Impact of tutor-guided versus simulator-guided short-time bronchoscopy training on students learning outcomes

Contact Info

Product

Resources

About