title: Development and Validation of a High-Fidelity Porcine Laryngeal Surgical Simulator.
abstract: OBJECTIVE
  Design and validate a laryngeal surgical simulator to teach phonomicrosurgical techniques.
  
  
  METHODS
  Device development and prospective validation.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  A novel laryngeal fixation device and custom laryngoscope were produced for use with ex vivo porcine larynx specimens. Vocal fold lesions such as nodules and keratotic lesions were simulated with silicone injections and epithelial markings. A prospective validation using postsimulation surveys, global rating scales, and procedure-specific checklists was performed with a group of 15 medical students, otolaryngology residents, fellows, and attending laryngologists. Three procedures were performed: vocal fold augmentation, excision of a simulated vocal fold nodule, and excision of a simulated vocal fold keratosis.
  
  
  RESULTS
  Participants overwhelmingly agreed that the simulator provided a realistic dissection experience that taught skills that would transfer to real operating scenarios. Expert performance was statistically superior to novice performance for excision of simulated vocal fold nodules and keratotic lesions, while no difference was observed for injection laryngoplasty.
  
  
  CONCLUSIONS
  The ability to learn and rehearse surgical procedures in a safe environment is invaluable, particularly for delicate and highly technical phonomicrosurgical operations. We have developed a high-fidelity laryngeal surgical simulator complete with pathological lesions such as nodules and keratoses to teach these procedures. A prospective study demonstrated validity of our global rating scale and checklist assessments for vocal fold nodule and keratosis excision procedures, allowing them to be confidently incorporated into phonomicrosurgical training programs for surgeons of all levels of expertise.
authors.affiliation: Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA matthew_dedmon@meei.harvard.edu.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Dedmon
authors.affiliation: Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Paddle
authors.affiliation: Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Jeananne
authors.initials: J
authors.lastname: Phillips
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
authors.forename: Leo
authors.initials: L
authors.lastname: Kobayashi
authors.affiliation: Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Ramon A
authors.initials: RA
authors.lastname: Franco
authors.affiliation: Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Song
mesh_terms: D000328:Adult; D000818:Animals; D057189:Checklist; D004195:Disease Models, Animal; D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D004867:Equipment Design; D005260:Female; D006801:Humans; D020704:Laryngoscopes; D007830:Larynx / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000193:education*; D008953:Models, Anatomic; D010036:Otolaryngology / Q000193:education*; D011446:Prospective Studies; D015203:Reproducibility of Results; D013552:Swine; D014741:Video Recording
keywords: education; laryngeal surgery; laryngology; phonomicrosurgery; simulation; validation