The Hospital for Sick Children (SickKids) has a rich history in simulation for airway surgery. Our predecessors began teaching tracheotomy and open airway surgery on live anesthetized animals in the 1990's. In 2014, we created the annual Toronto International Pediatric Open Airway Surgery Workshop which attracts participants from around the world. That same year, we published the Airway Reconstruction Surgical Dissection Manual (Plural Publishing, San Diego), which is a step-by-step guide used around the globe for teaching tracheotomy and open airway surgery.
The use of animals for training, however, can be limited due to anatomical differences from humans, cost, availability, ethics, need for specialized instruments, facilities and personnel, and a limited ability to archive work or preserve progress.
We therefore aimed to create a synthetic human neck and airway simulator that could offer learners a realistic experience without concern for any of the limitations seen with live animals.
SEGMENTATION & DESIGN
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are routinely obtained from live patients to help diagnose anatomical abnormalities. These scans can then be looked at layer-by-layer on a computer.
To make each synthetic type of tissue look and feel as close to human as possible, each type of tissue was isolated individually in a process called segmentation. This involves carefully outlining each type of tissue separately. The tissues then had to be combined to recreate a three-dimensional neck and airway.
3D PRINTING, CASTING, ASSEMBLY
First, a base is created that seamlessly fits onto the neck of the most common simulators on the market (i.e. SimMan by Laerdal). Molds for each tissue type are then 3D printed. Specially selected synthetic materials that are colour-matched to real tissue in the operating room are poured into the molds and allowed to solidify. The structures are then meticulously assembled to ensure that all the desired surgical procedures can be performed on each model. Each model is then carefully inspected to ensure it is ready for teaching. We take great pride in how our simulators appear, feel, can be incised and sutured and welcome any feedback on how to improve them in the future.
Meet The Team
Dr. Evan J. Propst
Dr. Propst is a full time Paediatric Otolaryngologist - Head & Neck Surgeon at The Hospital for Sick Children (SickKids) in Toronto, Canada. He completed his Residency training and the Surgeon Scientist Program in Toronto followed by Fellowship training at Cincinnati Children's Hospital Medical Center with Dr. Robin Cotton and his faculty. When he started on Staff at SickKids in 2010, he began teaching open airway surgery to trainees on a live porcine model. In 2014, he started the annual Toronto International Pediatric Open Airway Surgery Workshop which attracts participants from around the world. That same year, he published the Airway Reconstruction Surgical Dissection Manual (Plural Publishing, San Diego), which is a step-by-step guide used around the world for teaching tracheotomy and open airway surgery. As the past Fellowship Director, Residency Site Director and Undergraduate Medical Education Site Director, Dr. Propst is always striving to improve medical education for trainees. The Awesim synthetic models are the next step in the evolution of surgical education for endoscopic and open airway surgery.
Dr. Thomas Looi
Dr. Looi is the Program Director of the Centre for Image Guided Innovation & Therapeutic Intervention (CIGITI) at The Hospital for Sick Children. He has a background in biomedical and aerospace engineering and an MBA from the Rotman School of Business. He has been involved in developing numerous high quality surgical simulators, minimally invasive neurosurgical tools, pediatric actuators for the da Vinci surgical robot and MR-guided robotic systems. He has experience licensing technology and as an advisor to several medical device start-up companies.