None of the authors have any commercial interest in any of the products described in this technical note.
Background
Junior trainees perform fewer procedures than ever, meaning greater emphasis is placed on simulation. In otolaryngology, early proficiency in tonsillectomy is important. The national tonsillectomy audit showed that cold steel dissection with ties minimises the post-tonsillectomy haemorrhage risk.1 Tying securely at depth requires regular practice and we describe one simulator to accomplish this.
Other authors have designed simple, inexpensive models.2,3 However, our adaptation of the AirSim Bronchi (TruCorp, Belfast, UK)4 increases realism, familiarisation with more equipment and the ability to practise other procedures.
Technique
A replica tonsil is created from gauze and secured in the oropharynx by a Birkett forceps inserted in the oesophagus. The procedure now occurs using standard equipment, with Draffin rods in pre-existing grooves (Fig 1). A headlamp is recommended to become accustomed to its use.5
Figure 1.
The complete model with a trainee demonstrating application of silk ligature to inferior pole of tonsil
Discussion
We feel the high initial cost is easily outweighed by many rotating trainees safely acquiring new skills on realistic models.
References
- 1.Royal College of Surgeons of England. National Prospective Tonsillectomy Audit. London: RCS; 2005. [Google Scholar]
- 2.Wasson JD, De Zoysa N, Stephens J. Tissue-box tonsillar tie trainer. Clin Otolaryngol 2009; 34: 175–176. [DOI] [PubMed] [Google Scholar]
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- 4.AirSim Bronchi. TruCorp. http://www.trucorp.com/products/airsim/bronchi/ (cited September 2014).
- 5.Raja MK, Haneefa MA, Chidambaram A. Yorick’s skull model for tonsillectomy tie training. Clin Otolaryngol 2008; 33: 187–188. [DOI] [PubMed] [Google Scholar]