Computer-aided design and 3D printing for airway graft carving simulation and the effect on participants performance and confidence

Background: Airway reconstruction is a complex procedure that relies on specialized skills and experience. Surgical simulation can provide adequate opportunities within a safe non-operative environment to refine practice and achieve clinical competency. Three-dimensional (3D) printing via computer-aided design (CAD) is used in this study to create a high-fidelity simulation model, with the aim to assess the usefulness and value of such a tool to improve trainees’ ability and confidence in airway reconstruction techniques. Methods: Using a prospective observational design, participants performed a physical simulator task using a 3D printed costal cartilage graft model. Participants’ ability and confidence was measured using a Likert-scale questionnaire. Results: There were 26 participants included, of which 66.7% had not participated prior in an airway reconstructive procedure. With both anterior and posterior grafts, there was a significant improvement in mean time taken to carve the second graft when compared with the first graft. Participant confidence, as well as self-rated ability, also increased with subsequent grafts performed, in both anterior and posterior grafts. These results were further substantiated by assessment of ability by a senior airway surgeon. Conclusions: This Australian study demonstrates the value of 3D printing to create a producible, inexpensive simulation model for cartilage graft carving in airway reconstruction, and ultimately improve participant performance and confidence.