Background Surgical procedure training utilising simulation models employs materials that does not bleed, unlike live animals or human patients. In the majority of instances this is not a problem, as obtaining haemostasis and a bloodless field to work in is the first step in surgery after incision and exposure. In certain emergency surgical interventions managing the haemorrhage while performing life saving procedures is of critical importance. The Head of Simulation Teaching of the Otolaryngology Royal College identified the need for a haptically realistic thyroid phantom capable of bleeding to enable high-fidelity simulation of complicated emergency tracheostomy, and we responded.
Methodology ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) of the desired consistency was prepared and cast in a thyroid mould within collagen sheeting representing the capsule. Small amounts of blood analogue were injected into the ADAMgel at appropriate sites. Then this was repeated using a single puncture using a small bore IV cannula which was attached to a blood analogue source under normal venous pressure. This was then evaluated by the Simulation Lead of the Otolaryngology Royal College.
Results The thyroid capsule and tissue analogues felt like the real thing with incision. Fluid injected into the gel resulted in microtunnels forming out of which the blood analogue leaked out after incision, emulating capillary bleeding. When the microtunnel connected to the venous pressure fluid source was transsected, it created a constant realistic bleed. This could be controlled by clamping and tying off the relevant thyroid portion – as in real life. Cost was <£1, less than the only described alternative.1 It fulfilled all the criteria set by Simulation Lead, and was certified as such.
Conclusions It is possible to construct a realistic thyroid model capable of simulated haemorrhage and control thereof for high fidelity emergency tracheostomy training.
Inglez de Souza MC, Matera JM. Bleeding simulation in embalmed cadavers: bridging the gap between simulation and live surgery. ALTEX 2015;32(1):59–63
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