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3D Skull Reconstruction with Selective Laser Sintering for Endoscopic Cranial Base Surgical Simulation and Training
Introduction: The training of surgeons is not dissimilar to that of pilots. Each profession has a responsibility to achieve a minimum safety standard and technical proficiency. This in most instances may only be achieved by many hours of experience, as well as practicing in mock or simulated emergency scenarios. Each quality airline provides its pilots with regular simulator events to train for particular emergency scenarios as well as simulator certification requirements. Surgeons have no such training requirement. Since there is no formal assessment of surgical skills for board and state licensure, surgeons are expected to self-regulate their own training. As advancements in medicine are made, surgeons are expected to know more and to be able to perform more types of procedures. In the USA, increasing restrictions on residency work hours are adding a new hurdle to surgical training. Restrictions on resident work hours means that many residents will not have optimum operating experience once they graduate from residency. For this reason, just as pilots spend hundreds of hours training in simulation suites, surgeons may also augment and complement their technical skills with simulation based training. In fields such as neurosurgery or otolaryngology, the endoscope is used in minimally invasive surgery. Junior residents may not have adequate exposure to this as their time practicing with endoscopes is limited by the dynamics of their residency program and case-load. By being able to train these residents in a realistic scenario, patient safety and quality of care can be improved. Data has shown that surgeons trained with simulation systems have shown improved parameters in the operating room such as technical profiency with the endoscope, as well as faster mean operating time.
Materials and Methods: Current 3D printed training models on the market are prohibitively expensive and do not have tactile properties which accurately mimic real bone. Current methods also have difficulty in replicating the bony architecture of the skull base. We have developed a method of producing an anatomically accurate and realistic 3D printed skull with selective later sintering (SLS), using a material made from a polymer of polylactic acid (PLA) and limestone (Fig. 1). Our institute is developing the models around a suite of training features: various pathologies will be included, paired with real patient case histories and imaging for surgeons to review before they embark to practice on the skull model.
Discussion: Methods for training surgeons in endoscopic surgery include virtual simulators, cadaveric training, and skull model based training. Virtual simulators are limited by the lack of tactile feedback, and cadaveric training is limited by ethical and cost issues. Training with skull based models has been shown to have comparative tactile feedback to the cadaveric model and actual surgery.
Conclusion: Our institution has developed a method of manufacturing accurate 3D printed skull based models as part of an endoscopic surgery training suite.