Inexpensive anatomical trainer for bronchoscopy

Abstract

Flexible fiberoptic bronchoscopy is an indispensable tool for optimal management of intensive care unit patients. However, the acquisition of sufficient training in bronchoscopy is not straightforward during residency, because of technical and ethical problems. Moreover, the use of commercial simulators is limited by their high cost. In order to overcome these limitations, we realized a low-cost anatomical simulator to acquire and maintain the basic skill to perform bronchoscopy in ventilated patients. We used 1.5 mm diameter iron wire to construct the bronchial tree scaffold; glazier-putty was applied to create the anatomical model. The model was covered by several layers of newspaper strips previously immersed in water and vinilic glue. When the model completely dried up, it was detached from the scaffold by cutting it into six pieces, it was reassembled, painted and fitted with an endotracheal tube. We used very cheap material and the final cost was euro16. The trainer resulted in real-scale and anatomically accurate, with appropriate correspondence on endoscopic view between model and patients. All bronchial segments can be explored and easily identified by endoscopic and external vision. This cheap simulator is a valuable tool for practicing, particularly in a hospital with limited resources for medical training.

Reliable and Valid Assessment of Clinical Bronchoscopy Performance

“…Since then more and more institutions have acquired a virtual reality bronchoscopy simulator [34]. These have been sold at prohibitive prices, which have encouraged groups to make paper mache models [35], use porcine or rubber models [36,37], or develop their own virtual reality bronchoscopy simulator [38]. Fortunately, new professional competition [39] and small, portable systems [40] are emerging which are bound to lower the prices and thereby increase the prevalence of bronchoscopy simulators.…”

Simulation-Based Training in Flexible Bronchoscopy and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): A Systematic Review

“…In total, there were 10 validation studies [14,17,18 [11,12,25] . The remaining studies [13, 19-23, 27, 28, 32, 34, 37, 38] either tested various training methods [20,27,28,32,34,37,38] , simulators [21][22][23]28] or a new approach to skills assessment [13,19] .…”

“…for heightening the realism. Two studies described building a low-fidelity model out of inexpensive materials [11,25] . Other studies used animal cadavers or manikins that replicated lung anatomy to simulate a realistic bronchial tree.…”

“…Studies Developing and/or Exploring Simulation Equipment Thirteen studies either gathered validity evidence for a simulation-based test [14,18,26,30,31] , compared different simulators [21,23,28] or described the effectiveness of alternative simulators, e.g., a human cadaver, a portable simulator or low-cost models [11,12,16,22,25] . When gathering validity evidence, the outcome measure that consistently differentiated novices from experts was procedure time.…”

Bronchoscopy simulation: a brief review

“…A group of Italian investigators recently proposed a far less expensive alternative. Di Domenico et al (2007), use simple material similar to papier-mâché costing $20 to create a real-scale and anatomically accurate tracheo-bronchial tree. In addition to the VR simulators and inanimate models, live and euthanized animals are still used for training in some institutions.…”