Journal of Robotic Surgery

, Volume 13, Issue 6, pp 773–778 | Cite as

Novel minimally invasive transoral surgery bleeding model implemented in a nationwide otolaryngology emergencies bootcamp

  • Axel Sahovaler
  • David E. Eibling
  • Ida Bruni
  • Uma Duvvuri
  • S. Danielle MacNeil
  • Anthony C. Nichols
  • John Yoo
  • Kevin Fung
  • Kathryn RothEmail author
Original Article


Post-operative hemorrhage is the most concerning complication after minimally invasive transoral surgery, as can result in airway compromise. Simulation-based medical education provides trainees with structured learning in an intensive and immersive environment allowing deliberate practice of skills and behaviors in the management of real-life situations. We implemented a novel post-oropharyngeal surgery bleeding model in a nationwide otolaryngology emergencies bootcamp, to teach and evaluate technical and non-technical skills required to competently manage this clinical scenario. 28 Otolaryngology residents from 11 programs in Canada participated in the annual Otolaryngology Emergencies Bootcamp of Western University in London, Ontario. After teaching technical aspects of emergency surgical airways in models, the course culminated with a complex scenario of a post-minimally invasive transoral surgery bleeding model using a fresh cadaver. The Non-Technical Skills for Surgeons (NOTSS) rating scale was applied to video analysis and a scenario-specific Medical Expert Checklist was implemented. The model design in a cadaveric torso is described for use in a simulation of a high-volume oropharyngeal bleed after a minimally invasive approach. Participants agreed that the model evoked an elevated degree of realism and conveyed the emotion of a life-threatening event. NOTSS analysis identified a marginal score in the domains of decision-making and communication and teamwork. Critical action checklist analysis highlighted the early mobilization of available resources and time to decision for surgical airway. We present the first report of a post-minimally invasive transoral surgery bleeding model. It was successful in recreating with high fidelity such a high-stake event and to teach technical and non-technical skills.


TORS TLM Post-operative bleeding Training Bootcamp 


Author contributions

AS: data collection, analysis and manuscript preparation. DEE, IB, UD, SDM, AN, JY, KF, KR: manuscript preparation. All authors read and approved the final manuscript.


This is a self-funded study.

Compliance with ethical standards

Conflict of interest

Authors AS, DE, IB, UD, SDM, AN, JY, KF, and KR declare they have no conflicts of interest.

Research involving human participants or animals

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Axel Sahovaler
    • 1
    • 2
  • David E. Eibling
    • 3
  • Ida Bruni
    • 4
  • Uma Duvvuri
    • 3
  • S. Danielle MacNeil
    • 1
  • Anthony C. Nichols
    • 1
  • John Yoo
    • 1
  • Kevin Fung
    • 1
  • Kathryn Roth
    • 1
    Email author
  1. 1.Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and DentistryWestern UniversityLondonCanada
  2. 2.General Surgery Department, Head and Neck Surgery UnitItalian Hospital of Buenos AiresBuenos AiresArgentina
  3. 3.Department of OtolaryngologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  4. 4.Department of Anesthesia and Perioperative Medicine London Health Sciences Centre, Schulich School of Medicine and DentistryWestern UniversityLondonCanada

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