Ex Vivo Porcine Larynx Model for Microlaryngoscopy Laryngeal Surgery: Proposal for a Structured Surgical Training

Purpose: Microlaryngoscopy laryngeal surgery (MLS) is a highly specialized and delicate surgical procedure performed by a single operator. The aim of this study is to report the initial development of a validated and codified training program on ex vivo porcine larynx, allowing residents to obtain the basic skills of the MLS. Methods: Two residents without previous MLS experience were tested with four different exercises on 10 larynxes, one side at a time. The time needed for each exercise was noted. A skilled surgeon performed the same procedure, and this was considered to be the gold standard. Videos of the training exercise were evaluated by the two expert surgeons in a random, blinded sequence, using a modified global rating scale (GRS) to evaluate specific surgical skills. Results: The median execution times and GRS scores were calculated for both residents. Execution times and surgical skill scores were subsequently analyzed. For each exercise, a Spearman test between observations and time was performed to evaluate a significative increasing or decreasing trend in time execution. Execution times and surgical skills were also compared between the two subjects. Wilcoxon rank-sum test was used to evaluate any significant differences between them. A P value ≤0.05 was considered statistically significant. The results showed a significant improvement of the execution times for each resident (P value < 0.01). While the GRS scores for the exercises have remained between 3.0 and 5.0 from the first to the last procedure. Conclusion: MLS training on a porcine ex vivo model is useful, repeatable, and low cost. The work showed that, after only 10 training sessions, two residents without experience in MLS could quickly improve their execution times without statistically significant decrease of the visual analysis of surgical skills