Remote Training of Functional Endoscopic Sinus Surgery With Advanced Manufactured 3D Sinus Models and a Telemedicine System

Abstract

Objective: Traditionally, cadaveric courses have been an important tool in surgical education for Functional Endoscopic Sinus Surgery (FESS). The recent COVID-19 pandemic, however, has had a significant global impact on such courses due to its travel restrictions, social distancing regulations, and infection risk. Here, we report the world-first remote (Functional Endoscopic Sinus Surgery) FESS training course between Japan and Australia, utilizing novel 3D-printed sinus models. We examined the feasibility and educational effect of the course conducted entirely remotely with encrypted telemedicine software.Methods: Three otolaryngologists in Hokkaido, Japan, were trained to perform frontal sinus dissections on novel 3D sinus models of increasing difficulty, by two rhinologists located in Adelaide, South Australia. The advanced manufactured sinus models were 3D printed from the Computed tomography (CT) scans of patients with chronic rhinosinusitis. Using Zoom and the Quintree telemedicine platform, the surgeons in Adelaide first lectured the Japanese surgeons on the Building Block Concept for a three Dimensional understanding of the frontal recess. They in real time directly supervised the surgeons as they planned and then performed the frontal sinus dissections. The Japanese surgeons were asked to complete a questionnaire pertaining to their experience and the time taken to perform the frontal dissection was recorded. The course was streamed to over 200 otolaryngologists worldwide.Results: All dissectors completed five frontal sinusotomies. The time to identify the frontal sinus drainage pathway (FSDP) significantly reduced from 1,292 ± 672 to 321 ± 267 s (p = 0.02), despite an increase in the difficulty of the frontal recess anatomy. Image analysis revealed the volume of FSDP was improved (2.36 ± 0.00 to 9.70 ± 1.49 ml, p = 0.014). Questionnaires showed the course's general benefit was 95.47 ± 5.13 in dissectors and 89.24 ± 15.75 in audiences.Conclusion: The combination of telemedicine software, web-conferencing technology, standardized 3D sinus models, and expert supervision, provides excellent training outcomes for surgeons in circumstances when classical surgical workshops cannot be realized.

Assessment of a novel patient-specific 3D printed multi-material simulator for endoscopic sinus surgery

“…Our efforts to fabricate an increasingly realistic patient-specific simulator are in line with another recent experience of advanced ENT simulators based on 3D printing technology ( Suzuki et al, 2021 ; Suzuki et al, 2022 ) which demonstrates how this kind of training tool may be beneficial to practice on difficult anatomies such as the ones in ESS field.…”

Repetitive simulation training with novel 3D‐printed sinus models for functional endoscopic sinus surgeries

“…In addition, the 3D models facilitate objective assessment of dissection quality by post dissection CT scans. We recently reported the utility of the current 3D models in remote surgical training 3 …”

“…We recently reported the utility of the current 3D models in remote surgical training. 3 Our aims of this study are to validate the model and to evaluate the educational benefit of simulation training with the current 3Dprinted sinus model for FESS.…”

School of Thrombectomy—A 3-Step Approach to Perform Acute Stroke Treatment with Simulator Training and Virtual Supervision by Remote Streaming Support (RESS)

“…Telemedical live support can help to simplify this step and increase the level of safety of the treating physician by incorporating audio-video technology and internet connectivity into the angio suite. The benefit of live telemedicine support has been described in other medical fields such as endoscopic or surgical procedures [ 17 – 20 ]. Overall, the trainees in our study agreed that the virtual presence of the supervisor and the possibility of unmediated communication had significantly improved their personal sense of security.…”