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

Abstract

Background: The purpose of this study was to find a utility of a newly developed 3D-printed sinus model and to evaluate the educational benefit of simulation training with the models for functional endoscopic sinus surgery (FESS).

Material and methods: Forty-seven otolaryngologists were categorized as experts (board-certified physicians with ≥200 experiences of FESS, n = 9), intermediates (board-certified physicians with <200 experiences of FESS, n = 19), and novices (registrars, n = 19). They performed FESS simulation training on 3D-printed models manufactured from DICOM images of computed tomography (CT) scan of real patients. Their surgical performance was assessed with the objective structured assessment of technical skills (OSATS) score and dissection quality evaluated radiologically with a postdissection CT scan. First we evaluated the face, content, and constructive values. Second we evaluated the educational benefit of the training. Ten novices underwent training (training group) and their outcomes were compared to the remaining novices without training (control group). The training group performed cadaveric FESS surgeries before and after the repetitive training.

Results: The feedback from experts revealed high face and content value of the 3D-printed models. Experts, intermediates, and novices demonstrated statistical differences in their OSATS scores (74.7 ± 3.6, 58.3 ± 10.1, and 43.1 ± 11.1, respectively, p < .001), and dissection quality (81.1 ± 13.1, 93.7 ± 15.1, and 126.4 ± 25.2, respectively, p < .001). The training group improved their OSATS score (41.1 ± 8.0 to 61.1 ± 6.9, p < .001) and dissection quality (122.1 ± 22.2 to 90.9 ± 10.3, p = .013), while the control group not. After training, 80% of novices with no prior FESS experiences completed surgeries on cadaver sinuses.

Conclusion: Repeated training using the models revealed an initial learning curve in novices, which was confirmed in cadaveric mock FESS surgeries.

Level of evidence: N/A.

Keywords: 3D printer; cadaver surgery; endoscopic surgery; surgical education; surgical training.

FIGURE 1

The flow of the present study. Forty‐seven otolaryngologists took part in the present study. The experts (n = 9), intermediates (n = 19), and novices (n = 19) were classified based on the certification of official board member of the Japanese otolaryngology society and the number of experienced FESS cases. The simulation trainings were conducted once by the experts and intermediates. Among the novices, those who requested more training performed simulation trainings total seven times (the training group). The other novices performed the simulation training three times (the control group).

FIGURE 2

Face and content validity of the 3D models and the simulation training. The face validity and content validity of the 3D models and the training were assessed. (A) The face validation of the models was undergone by the experts using VAS score (0: not at all to 100: completely representative of human paranasal sinuses). (B) The content validation of the simulation training was also assessed by the experts using the VAS score (0: not at all to 100: exactly valid).

FIGURE 3

Surgical performance of the simulation training by the experts, the intermediates, and the novices. The simulation training by the experts, the intermediates, and the novices were assessed with OSATS score (A), progress of surgeries (B), time for mini‐FESS completion (C), and sagittal and coronal CT scan assessment scores (D and E).

FIGURE 4

Comparison of surgical performances in the training and the control group in second and final dissection session. To assess the educational efficacy of the training, surgical performance was compared between the training group and the control group in points of OSATS score (A), progress of surgeries (B), time for mini‐FESS completion (C), and sagittal and coronal CT scan (D and E).

FIGURE 5

The assessment of the cadaveric mock surgeries by five nonexperienced surgeons after the second and final dissection session. (A) The OSATS score in cadaveric mock surgeries was significantly improved after the dissection session. (B) After the dissection session, the surgeries were significantly more progressed than before. Noteworthy, most of the novice (80%) completed Full‐House FESS in cadaveric mock surgery after the training session, despite that they had never experienced any actual surgeries. (C) There was significant positive correlation between OSATS score in dissection session and cadaveric mock surgeries. (D) The progress of cadaveric mock surgeries was significantly correlated with the progress in the dissection session.