Development and Validation of a Hybrid Bronchoscopy Trainer Using Three-Dimensional Printing.

Abstract

Simulation is an essential component of medical education. Commercially available intubation simulators often lack anatomical fidelity of the lower airway and are therefore not suitable for teaching bronchoscopy or lung isolation. By using a desktop 3-dimensional (3D) printer, we aimed to create and validate a hybrid simulator from an existing mannequin with a 3D-printed lower airway that has anatomical fidelity and is financially affordable compared with commercially available models. Using an anonymized computed tomography scan of an adult male patient, we developed a 3D model of the airway from below the larynx to the 3rd generation bronchi, which was then printed on a desktop 3D printer. The printed airway was attached to an existing mannequin below the larynx via a universal adaptor. Ten anesthesiology attendings performed a blinded comparison of the hybrid mannequin with a commercially available mannequin for tactile and visual fidelity when performing intubation, bronchoscopy, and lung isolation. They were also asked to assess the models for educational suitability. The 3D printed model was judged more suitable for teaching double-lumen tube insertion to novice physicians compared with the commercial model, with median (interquartile range) scores of 5 (4-5) versus 3 (2-4), P = 0.017. Similar results were found for bronchial blocker insertion and bronchoscopy. The visual fidelity of the bronchial anatomy was scored as 5 (4-5) and 2 (1-3) for the 3D-printed and the commercial models, respectively ( P = 0.007). By creating a hybrid model combining an existing commercially available mannequin with a 3D-printed trachea and bronchial tree, we have created an affordable training simulator suitable for teaching lung isolation and bronchoscopy. Enhancing existing mannequins with 3D-printed parts may be of particular interest to institutions that do not have the funds to buy models with anatomical fidelity but do have access to a 3D printer.