Ex Vivo Porcine Larynx Model for Microlaryngoscopy Laryngeal Surgery: Proposal for a Structured Surgical Training

Ghirelli, Michael; Mattioli, Francesco; Federici, Gaia; Ferri, Gaetano; Malagoli, Andrea; Trebbi, Marco; Presutti, Livio

doi:10.1016/j.jvoice.2019.02.007

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Here, the experiences of setting up the dedicated space, individual training sessions, and the organization of surgical dissection courses are reported. Based on the literature, it was decided to use porcine and ovine laryngeal models, mainly for laser and open surgery, respectively 10,14,15,19,20,21 . Both the animal models described are easily available and affordable since they are animal waste products in the meat supply chain.…”

Section: Discussionmentioning

confidence: 99%

“…Several groups have reported their experiences with porcine larynx used as a model for TLM 11,12,13,14 . Despite the different dimensions of the cartilaginous skeleton with larger arytenoids and the inability to distinguish between arytenoid, corniculate, and cuneiform cartilage, the glottic plane is very similar to its human counterpart: the arytenoid cartilage has an analogous articulation with the cricoid and similar geometric proportions 15 .…”

Section: Introductionmentioning

confidence: 99%

“…NOTE: Recently the literature has reported a new validated station, approved for CO 2 laser surgery, called LarynxBox. This transparent structure is entirely made by polycarbonate resin, which can safely absorb all the misdirected laser beams 14,24 and could be a replacement for the wooden structure described above. 3.…”

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confidence: 99%

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Learning Modern Laryngeal Surgery in a Dissection Laboratory

Crosetti

Fantini

Lancini

et al. 2020

JoVE

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Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course "Lary-Gym". Further perspectives on robotic surgical training are described.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Learning Modern Laryngeal Surgery in a Dissection Laboratory

Crosetti

Fantini

Lancini

et al. 2020

JoVE

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“…Historically, residents and inexperienced otolaryngologists learned and acquired dexterity by assisting in surgeries by on-the-job training, mentorship from more senior surgeons, or through experimental models out of the operating room. Several models have been described, involving vocal cords from plastic models [12][13][14][15], animals (pigs, canine, sheep, and chicken) [16][17][18][19][20][21], and hybrid [22] or human cadavers [23][24][25][26]. To our knowledge, this is the first published study aiming to validate the use of vocal cords preserved with Thiel's embalming method and to allow otolaryngologists-in-training to develop fundamental phonosurgical skills in an environment more similar to a real clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Phonosurgery Training in Human Larynx Preserved with Thiel’s Embalming Method

Salazar

Gras

Sánchez‐Guillén

et al. 2021

ORL

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Background: To describe the suitability of larynges preserved with Thiel’s embalming method for phonosurgery training. Methods: A training model for phonosurgery techniques simulating vocal pathology and glottal insufficiency is developed to compare and evaluate the perception of embalmed vocal cords through a voluntary and anonymous survey rated on a scale of 1–5. A total of 10 residents and young otolaryngologists participated in the surgical training in phonosurgery. Results: Ten larynges preserved in formalin and 10 Thiel’s embalmed larynges were used for the investigation. Phonosurgery procedures were performed following microflap and injection laryngoplasty techniques. The larynges preserved with Thiel’s method demonstrated vocal cords that maintain their pliability and good tissue quality allowing a sensation of realism compared to the living body and providing suitable conditions for realistic laryngeal training. Participants held a positive experience, believed them to be useful and that these models of embalmed larynges were similar to the clinical setting and improved skills and confidence in performing phonosurgery. Conclusions: The human larynges embalmed with Thiel’s method maintain the pliability of the vocal cords, thus representing a unique model to practice and reproduce training for endolaryngeal procedures without the risks of contamination, anatomical variation, or rigidity of other models.

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“…Furthermore, the vivo or ex vivo animal model have been widely used for the microsurgical training. [4][5][6][7][8][9] The aim of this study is to explore the feasibility and efficacy of a surgical training model on ex vivo ovine head and neck, and to obtain the basic and advanced skills of parotid gland surgery and facial nerve reconstruction/reanimation in a safe environment.…”

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confidence: 99%

Ex Vivo Ovine Model for Surgical and Microsurgical Training on Parotidectomy and Facial Nerve Reanimation: Proposal of Structured Training Program

Ghirelli

Federici

Melchiorri

et al. 2020

J Reconstr Microsurg

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Introduction Facial nerve palsy has a great physical and psychological impact on patients, so the avoidance of facial nerve damage during surgery and its reanimation are important for Otolaryngologists and head and neck surgeons. The acquisition of anatomical knowledge and surgical training regarding the parotid surgery and facial nerve is mandatory, but not easy to achieve. Surgical simulation is a reliable alternative to the on-the-job learning. In the study, we tested an ex vivo animal model to obtain the basic and advanced skills of parotid gland surgery and facial nerve reconstruction/reanimation. Materials and Methods A prospective cohort study has been conducted on ovine head and neck specimen. A junior resident, a senior resident, and an expert surgeon were involved in a step-by-step preplanned dissection, divided in macroscopic and microscopic. Each procedure was recorded and evaluated by an expert surgeon following an adapted rating scale. Results A statistically significant improvement in terms of execution times and quality of the work was show in most of the surgical steps and for many quality items by the junior and senior residents, while the expert surgeon, as expected, did not show any improvement. Discussion Our ex vivo ovine model provided the trainee with close-to-real tissues in term of elastic resistance and consistency, to learn the skills requested in a head and neck surgery, on a reproducible environment. It is mandatory to have a feedback, which focuses on the quality of the work through valid and reliable assessment of technical skills. The judgment parameters should be reproducible and focused on the specific surgical procedure. Some limitations to this study are present, such as anatomical differences between ovine and human and the limited number of study participants. Conclusion This proposal of training program on the ex vivo ovine model for the acquisition of skills needed in head and neck surgery proved to be feasible, effective, repeatable, and cheap.

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Ex Vivo Porcine Larynx Model for Microlaryngoscopy Laryngeal Surgery: Proposal for a Structured Surgical Training

Cited by 6 publications

References 16 publications

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Learning Modern Laryngeal Surgery in a Dissection Laboratory

Phonosurgery Training in Human Larynx Preserved with Thiel’s Embalming Method

Ex Vivo Ovine Model for Surgical and Microsurgical Training on Parotidectomy and Facial Nerve Reanimation: Proposal of Structured Training Program

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