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Facial Plast Surg 2024; 40(01): 086-092
DOI: 10.1055/a-2092-6564
Original Research

Surgical Training Simulators for Rhinoplasty: A Systematic Review

P. Gill    *
1   Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
M. Levin   *
2   Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
,
Z. Farhood
3   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
4   FACE Cosmetic Surgery, Toronto, Ontario, Canada
,
J. Asaria
3   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
4   FACE Cosmetic Surgery, Toronto, Ontario, Canada
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Abstract

Rhinoplasty training currently follows an apprenticeship model that is largely observational. Trainees have limited experience in performing maneuvers of this complex surgery. Rhinoplasty simulators can address this issue by providing trainees with the opportunity to gain surgical simulator experience that could improve technical competences in the operating room. This review amalgamates the collective understanding of rhinoplasty simulators described to date. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, OVID Embase, OVID Medline, and Web of Science databases were all searched for original research on surgical simulators for rhinoplasty education and reviewed by independent reviewers. Articles underwent title and abstract screening, and then relevant articles underwent full-text review to extract simulator data. Seventeen studies, published between 1984 and 2021, were included for final analysis. Study participant numbers ranged from 4 to 24, and included staff surgeons, fellows, residents (postgraduate year 1–6), and medical students. Cadaveric surgical simulators comprised eight studies, of which three were with human cadavers, one study was a live animal simulator, two were virtual simulators, and six were three-dimensional (3D) models. Both animal and human-based simulators increased the confidence of trainees significantly. Significant improvement in various aspects of rhinoplasty knowledge occurred with implementation of a 3D-printed model in rhinoplasty education. Rhinoplasty simulators are limited by a lack of an automated method of evaluation and a large reliance on feedback from experienced rhinoplasty surgeons. Rhinoplasty simulators have the potential to provide trainees with the opportunity for hands-on training to improve skill and develop competencies without putting patients in harm's way. Current literature on rhinoplasty simulators largely focuses on simulator development, with few simulators being validated and assessed for utility. For wider implementation and acceptance, further refinement of simulators, validation, and assessment of outcomes is required.

Keywords

rhinoplasty - surgical planning - augmented reality - 3D model - simulator

* Co-first author.




Publication History

Accepted Manuscript online:
12 May 2023

Article published online:
08 June 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Zammit D, Ponnudurai N, Safran T, Gilardino M. Reevaluating the current model of rhinoplasty training and future directions: a role for focused, maneuver-specific simulation. Plast Reconstr Surg 2019; 144 (04) 597e-605e
    CrossrefPubMedGoogle Scholar
  • 2 Quong WL, Shih JG, Knox ADC. et al. Resident exposure to aesthetic surgical and nonsurgical procedures during Canadian residency program training. Aesthet Surg J 2021; 41 (12) 1456-1467
    CrossrefPubMedGoogle Scholar
  • 3 Chen JX, Riccardi AC, Shafique N, Gray ST. Are otolaryngology residents ready for independent practice? A survey study. Laryngoscope Investig Otolaryngol 2021; 6 (06) 1296-1299
    CrossrefPubMedGoogle Scholar
  • 4 Chivers QJ, Ahmad J, Lista F. et al. Cosmetic surgery training in Canadian plastic surgery residencies: are we training competent surgeons?. Aesthet Surg J 2013; 33 (01) 160-165
    CrossrefPubMedGoogle Scholar
  • 5 Hashem AM, Waltzman JT, D'Souza GF. et al. Resident and program director perceptions of aesthetic training in plastic surgery residency: an update. Aesthet Surg J 2017; 37 (07) 837-846
    CrossrefPubMedGoogle Scholar
  • 6 Vargas CR, Long TC, Kumar AR. Trainee operative autonomy in plastic surgery. Ann Plast Surg 2020; 85 (05) 553-560
    CrossrefPubMedGoogle Scholar
  • 7 Gettelfinger JD, Paulk PB, Schmalbach CE. Patient safety and quality improvement in otolaryngology education: a systematic review. Otolaryngol Head Neck Surg 2017; 156 (06) 991-998
    CrossrefPubMedGoogle Scholar
  • 8 Leung G, Pickett AT, Bartellas M. et al. Systematic review and meta-analysis of 3D-printing in otolaryngology education. Int J Pediatr Otorhinolaryngol 2022; 155: 111083
    CrossrefPubMedGoogle Scholar
  • 9 Sommer GM, Broschewitz J, Huppert S. et al. The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: visual spatial ability as a predictor for improved surgical performance: a randomized trial. Medicine (Baltimore) 2021; 100 (50) e27844
    CrossrefPubMedGoogle Scholar
  • 10 Zaed I, Chibbaro S, Ganau M. et al. Simulation and virtual reality in intracranial aneurysms neurosurgical training: a systematic review. J Neurosurg Sci 2022; 66 (06) 494-500
    CrossrefPubMedGoogle Scholar
  • 11 Meling TR, Meling TR. The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis. Neurosurg Rev 2021; 44 (02) 843-854
    CrossrefPubMedGoogle Scholar
  • 12 Aydın A, Ahmed K, Abe T. et al; SIMULATE Trial Group. Effect of simulation-based training on surgical proficiency and patient outcomes: a randomised controlled clinical and educational trial. Eur Urol 2022; 81 (04) 385-393
    CrossrefPubMedGoogle Scholar
  • 13 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
    CrossrefPubMedGoogle Scholar
  • 14 Dini PDGM, Gonella PDHA, Fregadolli L, Nunes B, Gozzano R. Training rhinoseptoplasty, sinusectomy, and turbinectomy in an animal model. Plast Reconstr Surg 2012; 130 (01) 224e-226e
    CrossrefPubMedGoogle Scholar
  • 15 Zabaneh G, Lederer R, Grosvenor A, Wilkes G. Rhinoplasty: a hands-on training module. Plast Reconstr Surg 2009; 124 (03) 952-954
    CrossrefPubMedGoogle Scholar
  • 16 Podolsky DJ, Wong Riff KW, Drake JM, Forrest CR, Fisher DM. A high fidelity cleft lip simulator. Plast Reconstr Surg Glob Open 2018; 6 (09) e1871
    CrossrefPubMedGoogle Scholar
  • 17 Zammit D, Safran T, Ponnudurai N. et al. Step-specific simulation: the utility of 3D printing for the fabrication of a low-cost, learning needs-based rhinoplasty simulator. Aesthet Surg J 2020; 40 (06) NP340-NP345
    PubMedGoogle Scholar
  • 18 Cöloğlu H, Uysal A, Koçer U, Kankaya Y, Oruç M, Uysal S. Rhinoplasty model in rabbit. Plast Reconstr Surg 2006; 117 (06) 1851-1859
    CrossrefPubMedGoogle Scholar
  • 19 Demir CI, Yaşar EK, Davun K, Gök A, Uzun C, Alagöz MŞ. Creation of experimental human nose model with lyophilized and decellularized bovine cartilage xenograft. J Craniofac Surg 2018; 29 (04) 1097-1100
    CrossrefPubMedGoogle Scholar
  • 20 McKinney P. Teaching model for rhinoplasty. Plast Reconstr Surg 1984; 74 (06) 846-847
    CrossrefPubMedGoogle Scholar
  • 21 Constantian MB, Ehrenpreis C, Sheen JH. The expert teaching system: a new method for learning rhinoplasty using interactive computer graphics. Plast Reconstr Surg 1987; 79 (02) 278-283
    CrossrefPubMedGoogle Scholar
  • 22 Vartanian AJ, Holcomb J, Ai Z, Rasmussen M, Tardy ME, Thomas JR. The virtual nose: a 3-dimensional virtual reality model of the human nose. Arch Facial Plast Surg 2004; 6 (05) 328-333
    CrossrefPubMedGoogle Scholar
  • 23 Coan BS, Neff E, Mukundan Jr S, Marcus JR. Validation of a cadaveric model for comprehensive physiologic and anatomic evaluation of rhinoplastic techniques. Plast Reconstr Surg 2009; 124 (06) 2107-2117
    CrossrefPubMedGoogle Scholar
  • 24 Weinfeld AB. Chicken sternal cartilage for simulated septal cartilage graft carving: a rhinoplasty educational model. Aesthet Surg J 2010; 30 (06) 810-813
    CrossrefPubMedGoogle Scholar
  • 25 Chark D, Oliaei S, Manuel C, Wong BJ. Porcine cartilage model for simulation of nasal tip aesthetics and mechanics. Aesthet Surg J 2011; 31 (05) 501-505
    CrossrefPubMedGoogle Scholar
  • 26 Chen JX, Kozin ED, Shaye DA, Hadlock T, Lindsay R, Lee LN. Educational cadaveric module for teaching percutaneous and intranasal osteotomies in rhinoplasty. Otolaryngol Head Neck Surg 2017; 156 (06) 1088-1090
    CrossrefPubMedGoogle Scholar
  • 27 Oh CJ, Tripathi PB, Gu JT, Borden P, Wong BJF. Development and evaluation of rhinoplasty spreader graft suture simulator for novice surgeons. Laryngoscope 2019; 129 (02) 344-350
    CrossrefPubMedGoogle Scholar
  • 28 Ho M, Goldfarb J, Moayer R. et al. Design and printing of a low-cost 3D-printed nasal osteotomy training model: development and feasibility study. JMIR Med Educ 2020; 6 (02) e19792
    CrossrefPubMedGoogle Scholar
  • 29 Gupta N, Fitzgerald CM, Ahmed MT, Tohidi S, Winkler M. Feasibility of a 3D printed nasal model for resident teaching in rhinoplasty. J Plast Reconstr Aesthet Surg 2021; 74 (10) 2776-2820
    CrossrefPubMedGoogle Scholar
  • 30 Sheckter CC, Kane JT, Minneti M. et al. Incorporation of fresh tissue surgical simulation into plastic surgery education: maximizing extraclinical surgical experience. J Surg Educ 2013; 70 (04) 466-474
    CrossrefPubMedGoogle Scholar
  • 31 Wong K, Yee HM, Xavier BA, Grillone GA. Applications of augmented reality in otolaryngology: a systematic review. Otolaryngol Head Neck Surg 2018; 159 (06) 956-967
    CrossrefPubMedGoogle Scholar
  • 32 Chen JX, Kozin ED, Dedmon MM, Lee LN. Teaching and practice patterns of lateral osteotomies for rhinoplasty. Am J Otolaryngol 2017; 38 (04) 498-500
    CrossrefPubMedGoogle Scholar
  • 33 Levin M, McKechnie T, Khalid S, Grantcharov TP, Goldenberg M. Automated methods of technical skill assessment in surgery: a systematic review. J Surg Educ 2019; 76 (06) 1629-1639
    CrossrefPubMedGoogle Scholar
  • 34 Chen G, Jiang M, Coles-Black J, Mansour K, Chuen J, Amott D. Three-dimensional printing as a tool in otolaryngology training: a systematic review. J Laryngol Otol 2020; 134 (01) 14-19
    CrossrefPubMedGoogle Scholar
  • 35 Javia L, Deutsch ES. A systematic review of simulators in otolaryngology. Otolaryngol Head Neck Surg 2012; 147 (06) 999-1011
    CrossrefPubMedGoogle Scholar
  • 36 Musbahi O, Aydin A, Al Omran Y, Skilbeck CJ, Ahmed K. Current status of simulation in otolaryngology: a systematic review. J Surg Educ 2017; 74 (02) 203-215
    CrossrefPubMedGoogle Scholar
  • 37 Arora A, Lau LYM, Awad Z, Darzi A, Singh A, Tolley N. Virtual reality simulation training in otolaryngology. Int J Surg 2014; 12 (02) 87-94
    CrossrefPubMedGoogle Scholar
  • 38 Sethia R, Kerwin TF, Wiet GJ. Performance assessment for mastoidectomy. Otolaryngol Head Neck Surg 2017; 156 (01) 61-69
    CrossrefPubMedGoogle Scholar
  • 39 Hovgaard LH, Al-Shahrestani F, Andersen SAW. Current evidence for simulation-based training and assessment of myringotomy and ventilation tube insertion: a systematic review. Otol Neurotol 2021; 42 (09) e1188-e1196
    CrossrefPubMedGoogle Scholar
  • 40 Mohd Slim MA, Hurley R, Lechner M, Milner TD, Okhovat S. A systematic review of facial plastic surgery simulation training models. J Laryngol Otol 2022; 136 (03) 197-207
    CrossrefPubMedGoogle Scholar
  • 41 Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-printed models for temporal bone surgical training: a systematic review. Otolaryngol Head Neck Surg 2021; 165 (05) 617-625
    CrossrefPubMedGoogle Scholar
  • 42 Ishman SL, Stewart CM, Senser E. et al. Qualitative synthesis and systematic review of otolaryngology in undergraduate medical education. Laryngoscope 2015; 125 (12) 2695-2708
    CrossrefPubMedGoogle Scholar