title: 3D-printed pediatric endoscopic ear surgery simulator for surgical training.
abstract: BACKGROUND
  Surgical simulators are designed to improve operative skills and patient safety. Transcanal Endoscopic Ear Surgery (TEES) is a relatively new surgical approach with a slow learning curve due to one-handed dissection. A reusable and customizable 3-dimensional (3D)-printed endoscopic ear surgery simulator may facilitate the development of surgical skills with high fidelity and low cost. Herein, we aim to design, fabricate, and test a low-cost and reusable 3D-printed TEES simulator.
  
  
  METHODS
  The TEES simulator was designed in computer-aided design (CAD) software using anatomic measurements taken from anthropometric studies. Cross sections from external auditory canal samples were traced as vectors and serially combined into a mesh construct. A modified tympanic cavity with a modular testing platform for simulator tasks was incorporated. Components were fabricated using calcium sulfate hemihydrate powder and multiple colored infiltrants via a commercial inkjet 3D-printing service.
  
  
  RESULTS
  All components of a left-sided ear were printed to scale. Six right-handed trainees completed three trials each. Mean trial time (n = 3) ranged from 23.03 to 62.77 s using the dominant hand for all dissection. Statistically significant differences between first and last completion time with the dominant hand (p < 0.05) and average completion time for junior and senior residents (p < 0.05) suggest construct validity.
  
  
  CONCLUSIONS
  A 3D-printed simulator is feasible for TEES simulation. Otolaryngology training programs with access to a 3D printer may readily fabricate a TEES simulator, resulting in inexpensive yet high-fidelity surgical simulation.
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Barber
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. Electronic address: Elliott_Kozin@meei.harvard.edu.
authors.forename: Elliott D
authors.initials: ED
authors.lastname: Kozin
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dedmon
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Lin
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Kyuwon
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Sumi
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Black
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Remenschneider
authors.affiliation: Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA; Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lee
mesh_terms: D017076:Computer-Aided Design; D004210:Dissection / Q000193:education; D004424:Ear Canal / Q000033:anatomy & histology; D004432:Ear, Middle / Q000033:anatomy & histology / Q000601:surgery*; D004724:Endoscopy / Q000193:education*; D006801:Humans; D008953:Models, Anatomic; D013506:Otologic Surgical Procedures / Q000193:education*; D010372:Pediatrics / Q000193:education; D066330:Printing, Three-Dimensional; D000066908:Simulation Training / Q000379:methods*
keywords: 3D printing; Endoscopic ear surgery; Simulator; Surgical simulation; Transcanal endoscopic ear surgery