Novel minimally invasive transoral surgery bleeding model implemented in a nationwide otolaryngology emergencies bootcamp
- 16 Downloads
Post-operative hemorrhage is the most concerning complication after minimally invasive transoral surgery, as can result in airway compromise. Simulation-based medical education provides trainees with structured learning in an intensive and immersive environment allowing deliberate practice of skills and behaviors in the management of real-life situations. We implemented a novel post-oropharyngeal surgery bleeding model in a nationwide otolaryngology emergencies bootcamp, to teach and evaluate technical and non-technical skills required to competently manage this clinical scenario. 28 Otolaryngology residents from 11 programs in Canada participated in the annual Otolaryngology Emergencies Bootcamp of Western University in London, Ontario. After teaching technical aspects of emergency surgical airways in models, the course culminated with a complex scenario of a post-minimally invasive transoral surgery bleeding model using a fresh cadaver. The Non-Technical Skills for Surgeons (NOTSS) rating scale was applied to video analysis and a scenario-specific Medical Expert Checklist was implemented. The model design in a cadaveric torso is described for use in a simulation of a high-volume oropharyngeal bleed after a minimally invasive approach. Participants agreed that the model evoked an elevated degree of realism and conveyed the emotion of a life-threatening event. NOTSS analysis identified a marginal score in the domains of decision-making and communication and teamwork. Critical action checklist analysis highlighted the early mobilization of available resources and time to decision for surgical airway. We present the first report of a post-minimally invasive transoral surgery bleeding model. It was successful in recreating with high fidelity such a high-stake event and to teach technical and non-technical skills.
KeywordsTORS TLM Post-operative bleeding Training Bootcamp
AS: data collection, analysis and manuscript preparation. DEE, IB, UD, SDM, AN, JY, KF, KR: manuscript preparation. All authors read and approved the final manuscript.
This is a self-funded study.
Compliance with ethical standards
Conflict of interest
Authors AS, DE, IB, UD, SDM, AN, JY, KF, and KR declare they have no conflicts of interest.
Research involving human participants or animals
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 2.Lörincz BB, Möckelmann N, Busch C-J, Knecht R (2015) Functional outcomes, feasibility, and safety of resection of transoral robotic surgery: single-institution series of 35 consecutive cases of transoral robotic surgery for oropharyngeal squamous cell carcinoma. Head Neck 37(11):1618–1624. https://doi.org/10.1002/hed.23809 CrossRefGoogle Scholar
- 3.Lörincz BB, Jowett N, Knecht R (2016) Decision management in transoral robotic surgery: Indications, individual patient selection, and role in the multidisciplinary treatment for head and neck cancer from a European perspective. Head Neck 38(Suppl 1):E2190–E2196. https://doi.org/10.1002/hed.24059 CrossRefGoogle Scholar
- 4.Gleysteen J, Troob S, Light T et al (2017) The impact of prophylactic external carotid artery ligation on postoperative bleeding after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma. Oral Oncol 70:1–6. https://doi.org/10.1016/j.oraloncology.2017.04.014 CrossRefGoogle Scholar
- 12.Nichols AC, Yoo J, Hammond JA et al. (2013) Early-stage squamous cell carcinoma of the oropharynx: Radiotherapy vs. Trans-oral robotic surgery (ORATOR)—study protocol for a randomized phase II trial. 13(1):133. https://doi.org/10.1186/1471-2407-13-133
- 14.Musbahi O, Aydin A, Al Omran Y, Skilbeck CJ, Ahmed K. Current status of simulation in otolaryngology: a systematic review. J Surg Educ 74(2):203–215. https://doi.org/10.1016/j.jsurg.2016.09.007