Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: AHNS25
Session Name: Scientific Session 5 - Technology & Education
Session Date: Thursday, May 15, 2025
Session Time: 10:15 AM - 11:00 AM
Development and Pilot Testing of a High-Fidelity Transoral Robotic Surgery Simulator
Brett Campbell; Lauren Schlegel; Scharukh Jalisi; Ernest Gomez; Beth Israel Deaconess Medical CenterObjective: Simulation offers the opportunity for trainees to practice technically challenging or high-risk procedures in a low-risk environment. Prior transoral robotic surgery (TORS) simulators have relied on cadaveric, animal, and silicone models that each pose logistical challenges to widespread adoption. Here we describe the development and evaluation a high-fidelity, low-cost, hydrogel-based, electrocautery-compatible simulator for TORS tongue base resection that can be implemented in situ.
Study Design: Prospective observational study.
Methods: Utilizing a multi-modal manufacturing approach consisting of 3D modeling, 3D printing, negative molding, and hydrogel casting, we designed and developed a task trainer that allows for surgeons and trainees to practice transoral robotic surgery. The tongue and oropharynx are composed of a polyvinyl alcohol, a soft tissue-mimicking hydrogel that can be dissected with real electrocautery. Attending surgeons and trainees used the model to simulate TORS tongue base resection. Participants then completed surveys evaluating the realism and usefulness of the simulator. Model strengths and weaknesses were recorded, and the ability to assess surgical margins was assessed.
Results: The simulator was developed with a baseplate, a modified 3D printed calvarium and mandible, and soft tissue mimicking organs composed of polyvinyl alcohol (PVA) hydrogel. The simulator is modular, and each hydrogel piece consisting of the oral cavity and oropharynx costs 10 cents to produce. All participants noted that the model allows for realistic simulation of the electrocautery techniques and mimics the pliability of native human tissues. All participants reported realistic simulation of the spatial constraints of the oropharynx and felt the model allows for practice of tissue-to-instrument and instrument-to-instrument collision avoidance. Margin status was successfully assessed in each pilot trial by gross and microscopic examination of the resection specimen.
Conclusion: Multi-modal manufacturing and utilization of soft tissue mimicking PVA hydrogel models allow for a high fidelity, low-cost, and modular task trainer that allows trainees the opportunity to practice the operative steps of TORS tongue base resection with electrocautery without requiring transportation of a robotic surgical system out of the operating room. This design methodology utilizing these materials is the first of its kind in otolaryngology and may enable widespread adoption of simulation-based training for TORS.
