Ranguis S, Ryan P, Cheng A T
Department of Surgery, The Children's Hospital at Westmead, Westmead, NSW, Australia.
Department of Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.
Int J Pediatr Otorhinolaryngol. 2019 Mar;118:181-184. doi: 10.1016/j.ijporl.2019.01.005. Epub 2019 Jan 7.
There are increasing pressures on the health system and training programs to provide adequate training opportunities for surgical trainees. This is particularly true with respect to complex procedures that are performed less commonly. We sought to develop an ovine model for the simulation of pediatric laryngotracheal reconstruction (LTR) and validate its use for training.
Knee-high lamb specimens were sourced from an accredited Australian abattoir that included structures of the neck, cervical spine and subcutaneous tissues from the thyroid cartilage to the carina. Specimens were positioned and draped to simulate surgical exposure. Otorhinolaryngology residents and consultants performed two LTRs on separate specimens that were video recorded for assessment of performance.
Sixteen LTRs were performed by eight participants. Performance of experienced (advanced) participants was significantly better than novice participants (p = 0.001). There was a strong linear association between general surgical competence and procedural performance (r = 0.88). The developed assessment scales demonstrated strong reliability and internal consistency (Cronbach's α = 0.83).
The complexity of pediatric airway surgery makes simulation an attractive option for developing skills that are transferrable to the operating setting. The ovine model presented here has similarities in size, structure and tissue characteristics to the pediatric airway that make it an ideal model for simulating pediatric LTR. It is a low-cost, readily available option for otorhinolaryngology residents to develop and refine essential skills throughout their training.
卫生系统和培训项目面临着越来越大的压力，需要为外科住院医师提供充足的培训机会。对于那些较少进行的复杂手术来说尤其如此。我们试图开发一种用于模拟小儿喉气管重建（LTR）的绵羊模型，并验证其在培训中的应用。
从一家经认可的澳大利亚屠宰场获取齐膝高的羔羊标本，标本包括颈部结构、颈椎以及从甲状腺软骨到隆突的皮下组织。将标本摆放并覆盖以模拟手术暴露。耳鼻咽喉科住院医师和会诊医师在不同的标本上进行了两次LTR，并进行视频记录以评估操作表现。
8名参与者共进行了16次LTR。经验丰富（高级）参与者的表现明显优于新手参与者（p = 0.001）。普通外科能力与手术操作表现之间存在很强的线性关联（r = 0.88）。所制定的评估量表显示出很强的可靠性和内部一致性（Cronbach's α = 0.83）。
小儿气道手术的复杂性使得模拟成为培养可转移到手术环境中的技能的一个有吸引力的选择。这里介绍的绵羊模型在大小、结构和组织特征方面与小儿气道相似，使其成为模拟小儿LTR的理想模型。它是耳鼻咽喉科住院医师在整个培训过程中培养和完善基本技能的一种低成本、易于获得的选择。
