Lamb larynx model for training in endoscopic and CO2 laser-assisted surgeries for benign laryngotracheal obstructions
With adequate indication and meticulous execution, endoscopic procedures can efficiently treat a subset of adult and pediatric benign laryngotracheal stenosis and obstructions, but these procedures are precise and very demanding. The difference between a successful and a failed surgery, with potentially debilitating side effects, resides in small details. The learning curve is long and very few centers worldwide have a sufficient case load making adequate training difficult. While indications and concepts of endoscopic procedures can be learned in books and by observing trained colleagues, the dexterity and the precise realization need to be practiced, ideally not initially on patients.
We describe here the lamb model system for the initial training in such procedures. We provide a step-by-step guide for endoscopic approaches intended to treat pathologies such as laryngomalacia, bilateral vocal fold paralysis, posterior glottic stenosis, and laryngotracheal clefts.
The lamb model system does not pose ethical issues, and it is easy to obtain and to handle. It was used during an international training course for laryngotracheal stenosis by novice and advanced airway surgeons. It was unanimously judged as relevant and useful by the participants.
KeywordsLaryngotracheal stenosis Laser surgery Animal model
The authors would like to thank Dr. Andrea Ricci-Maccarini, ENT Department, Bufalini Hospital, and Mr Luigi Biffero—Cesena, Italy for providing the laryngeal holders. The authors also would like to thank Lasermed SA for providing, free of charge, laser units, laser fibers and smoke evacuators, Leica Microsystems for providing, free of charge, the microscope units, Anklin AG for providing, free of charge, surgical instruments, and Ethicon Switzerland for providing, free of charge, and suture material. The authors also would like to thank Marion Brun for illustration and video editing, and Sylvie Bakhouy-Perret and Giuseppe Andreoli for skilled technical assistance. Finally, the authors would like to thank Dr. G. Armas, Dr. V. Kokje, and Dr. P. Guilcher for excellent organizational and technical assistance.
All costs were covered by the Airway Sector of the Department of Otolaryngology, Head and Neck Surgery, University Hospital of Lausanne (CHUV).
Compliance with ethical standards
All permissions were obtained from institutional review board and local veterinarian authorities.
Conflict of interest
The authors have no conflicts of interest to disclose.
Video 1: Supraglottoplasty. Edited video showing the steps of right side type II supraglottoplasty (AVI 390096 KB)
Video 2: Epiglottopexy. Edited video showing the steps of endoscopic epiglottopexy (AVI 202439 KB)
Video 3: Cricoid split. Edited video showing the steps of posterior cricoid split, anterior cricoid split, balloon dilatation and posterior graft interposition (AVI 75373 KB)
Video 4: Arytenoidectomy. Edited video showing the steps of laser-assisted subtotal mucosa saving arytenoidectomy (AVI 103280 KB)
Video 5: Endoscopic vocal cord lateropexy. Edited video showing the steps of endoscopic lateropexy (AVI 20329 KB)
Video 6: Closure of a laryngotracheal cleft. Edited video showing the steps of the endoscopic closure of a simulated type I laryngotracheal cleft (AVI 188255 KB)