430 - 3D Rapid Prototyping for Otolaryngology

sub-specialties suggests an emerging role for rapid prototyping technology in surgical edu- cation, procedure simulation, and clinical practice. Introduction Surgical procedures in otolaryngology-head and neck surgery can pose considerable challenges even to the most experienced surgeons during resection of infiltrative diseases and reconstruc- tion of anatomical structures. These challenges arise from performing excision of lesions within critical and anatomically complex structures in the head and neck region. For example, endo- scopic skull base surgery for pituitary gland resection or clivus ablation involves dissection in close proximity to the surrounding optic nerve and carotid arteries. The risk of surgical compli- cations is increased if surgeons are unable to maintain adequate visualization from the endo- scope. Surgical proficiency typically requires a long training process from apprenticeship under senior surgeon supervision and/or cadaveric dissection. Many approaches are under investiga- tion to improve the efficiency of surgical skills learning, while maintaining the overall quality. Snyderman et al. proposed a structural training program that allows the learner to incremen- tally acquire surgical skills in five stages [ 1 ]. Additionally, the availability of image-guided sur- gery (IGS) systems in clinical practice are also now an integral component of surgical skill development [ 2 ]. Virtual reality (VR) systems for the surgical simulation have shown promis- ing outcomes [ 3 – 13 ], however, they are generally expensive and provide limited haptic feed- back. Furthermore, they are limited to use virtual instrument and real surgical instruments not available in surgical simulation [ 14 ]. Development of surgical guidance systems also presents challenges of limited realistic envi- ronments during iterative system performance testing prior to deployment in the operating room. For example, emerging image-guided technologies such as intra-operative CBCT [ 15 ], 3D ultrasound [ 16 ] and interventional MRI [ 17 ] have all undergone extensive pre-clinical eval- uation prior to clinical implementation. Traditional approaches to the development of surgical competency and image-guidance technology involve the use of biological specimens in a pre-clinical setting. However, the use of cadaveric specimens requires considerations of resource availability and bio-safety factors. In contrast, animal studies raise ethical issues and may not provide a realistic representation of human anatomy. In both scenarios, there are costs associated with specimen transport and storage. The need for realistic and reproducible clinical environments for surgical training, simula- tion and image-guidance system development motivates the design and fabrication of realistic anatomical phantoms. The development of realistic 3D phantom models for head and neck surgery has the potential to provide a threefold advantage: 1) from an educational perspective, it provides realistic and customizable environments for surgical trainees; 2) from a surgical per- spective, it enables the fabrication of patient-specific models for surgical planning and proce- dure simulation before embarking on the actual surgery; and 3) from a research perspective, it facilitates technology development in an environment that mimics clinical practice. This manuscript reports the development of a set of high-fidelity surgical models using rapid prototyping technology for endoscopic sinus surgical training, simulation of advanced skull base surgery, and patient-specific mandible plating. Additionally, we used these phantoms to facilitate the development and clinical implementation of an endoscopic augmented reality image-guidance system. Recent advances in rapid prototyping and 3D printing technology The Application of 3D Rapid Prototyping in Head and Neck Surgery PLOS ONE | DOI:10.1371/journal.pone.0136370 September 2, 2015 2 / 18 Competing Interests: The authors have declared that no competing interests exist. | The Surgical Technologist | OCTOBER 2019 470