title: Ex vivo ovine model for pediatric flexible endoscopy training.
abstract: OBJECTIVE
  Medical students and residents in training have limited opportunities to develop pediatric endoscopy skills and would benefit from a realistic simulation model. We sought to develop such a model for flexible endoscopy using fresh head and neck tissue from young sheep.
  
  
  METHODS
  Tissue was collected from pre-pubescent sheep (n=5; mean age: 4 months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated 4-6cm above the sternal notch and stored at 5°C for 1-5 days. With the preparation was supported in supine position, flexible nasopharyngolaryngoscopy and transnasal endoscopic intubation were performed with video recording.
  
  
  RESULTS
  Five sheep were studied. Endoscopy was performed by a medical student under direct supervision by a pediatric otolaryngologist. Differences between ovine and human pediatric airway anatomy were defined.
  
  
  CONCLUSIONS
  Despite variations in proportion and structure, the experience of passing a flexible nasopharyngoscope through a sheep's airway is remarkably similar to pediatric endoscopy. The nasal anatomy is elongated, but very much like a child's in terms of anatomy, color and texture. The tactile feedback is nearly identical. Annoying secretions and their associated "whiteout" phenomena nicely simulate these challenges in pediatric endoscopy. When performing transnasal intubation, navigating to the larynx and advancing an endotracheal tube under guidance have the look and feel of the pediatric procedure. Issues of cost, availability, risk of zoonotic infection, and ethics are discussed.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Temple University School of Medicine, United States; Department of Pediatrics, Temple University School of Medicine, United States. Electronic address: glenn.isaacson@temple.edu.
authors.forename: Glenn
authors.initials: G
authors.lastname: Isaacson
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, Temple University School of Medicine, United States; Department of Pediatrics, Temple University School of Medicine, United States; Department of Medicine, Temple University School of Medicine, United States; Department of Physiology, Temple University School of Medicine, United States; Department of Thoracic Medicine and Surgery, Temple University School of Medicine, United States; The Centers for Inflammation, Translation and Clinical Lung Research, Temple University School of Medicine, United States; CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Temple University School of Medicine, United States.
authors.forename: David C
authors.initials: DC
authors.lastname: Ianacone
authors.affiliation: Department of Pediatrics, Temple University School of Medicine, United States; Department of Medicine, Temple University School of Medicine, United States; Department of Physiology, Temple University School of Medicine, United States; Department of Thoracic Medicine and Surgery, Temple University School of Medicine, United States; The Centers for Inflammation, Translation and Clinical Lung Research, Temple University School of Medicine, United States; CENTRe: Collaborative for Environmental and Neonatal Therapeutics Research, Temple University School of Medicine, United States.
authors.forename: Marla R
authors.initials: MR
authors.lastname: Wolfson
mesh_terms: D000818:Animals; D002648:Child; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy / Q000193:education*; D023421:Models, Animal; D010036:Otolaryngology / Q000193:education*; D010372:Pediatrics / Q000193:education*; D012756:Sheep; D000066908:Simulation Training / Q000379:methods*; D014741:Video Recording
keywords: Fiberoptic intubation; Laryngoscopy; Pediatric airway; Pediatric endoscopy; Sheep; Surgical simulation