Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil Songpa-Gu, Seoul 05505, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, 88 Olympic-Ro 43-Gil, Songpa-gu, Seoul 05505, Republic of Korea.
Comput Methods Programs Biomed. 2023 May;233:107478. doi: 10.1016/j.cmpb.2023.107478. Epub 2023 Mar 12.
Proper airway management during emergencies can prevent serious complications. However, cricothyroidotomy is challenging in patients with obesity. Since this technique is not performed frequently but at a critical time, the opportunity for trainees is rare. Simulators for these procedures are also lacking. Therefore, we proposed a realistic and interactive cricothyroidotomy simulator.
All anatomical structures were modeled based on computed tomography images of a patient with obesity. To mimic the feeling of incision during cricothyroidotomy, the incision site was modeled to distinguish between the skin and fat. To reinforce the educational purpose, capacitive touch sensors were attached to the artery, vein, and thyroid to generate audio feedback. The tensile strength of the silicone-cast skin was measured to verify the similarity of the mechanical properties between humans and our model. The fabrication and assembly accuracies of the phantom between the Standard Tessellation Language and the fabricated model were evaluated. Audio feedback through sensing the anatomy parts and utilization was evaluated.
The body, skull, clavicle, artery, vein, and thyroid were fabricated using fused deposition modeling (FDM) with polylactic acid. A skin mold was fabricated using FDM with thermoplastic polyurethane. A fat mold was fabricated using stereolithography apparatus (SLA) with a clear resin. The airway and tongue were fabricated using SLA with an elastic resin. The tensile strength of the skin using silicone with and without polyester mesh was 2.63 ± 0.68 and 2.46 ± 0.21 MPa. The measurement errors for fabricating and assembling parts of the phantom between the STL and the fabricated models were -0.08 ± 0.19 mm and 0.13 ± 0.64 mm. The measurement errors internal anatomy embodied surfaces in fat part were 0.41 ± 0.89 mm. Audio feedback was generated 100% in all the areas tested. The realism, understanding of clinical skills, and intention to retrain were 7.1, 8.8, and 8.3 average points.
Our simulator can provide a realistic simulation experience for trainees through a realistic feeling of incision and audio feedback, which can be used for actual clinical education.
在紧急情况下进行适当的气道管理可以预防严重的并发症。然而，肥胖患者的环甲切开术具有挑战性。由于该技术并非经常进行，而是在关键时刻进行，因此学员的机会很少。这些程序的模拟器也很缺乏。因此，我们提出了一种现实且互动的环甲切开术模拟器。
根据肥胖患者的计算机断层扫描图像对所有解剖结构进行建模。为了模拟环甲切开术时的切口感觉，将切口部位建模为区分皮肤和脂肪。为了强化教育目的，在动脉、静脉和甲状腺上附加电容式触摸传感器以产生音频反馈。通过测量硅酮铸造皮肤的拉伸强度来验证人体与我们模型之间机械性能的相似性。评估了 Phantom 之间的标准细分语言（STL）和制造模型的制造和组装精度。通过感知解剖结构部分和利用情况评估音频反馈。
使用熔融沉积建模（FDM）和聚乳酸制造了身体、颅骨、锁骨、动脉、静脉和甲状腺。使用 FDM 和热塑性聚氨酯制造了皮肤模具。使用立体光刻设备（SLA）和透明树脂制造了脂肪模具。使用 SLA 和弹性树脂制造了气道和舌头。使用硅酮和聚酯网的皮肤的拉伸强度分别为 2.63 ± 0.68 MPa 和 2.46 ± 0.21 MPa。在 STL 和制造模型之间制造和组装零件的测量误差分别为-0.08 ± 0.19mm 和 0.13 ± 0.64mm。脂肪部分内部解剖体现表面的测量误差为 0.41 ± 0.89mm。在所有测试区域均生成了音频反馈。真实性、对临床技能的理解和重新培训的意愿分别为 7.1、8.8 和 8.3 个平均点。
我们的模拟器可以通过真实的切口感觉和音频反馈为学员提供真实的模拟体验，可用于实际的临床教育。
