A Novel 3D Printed Multi-Material Simulator for Endoscopic Stapes Surgery: The "3D Stapes Trainer"

To develop and preliminarily validate a 3D-printed, multi-material, patient-specific simulator of the external and middle ear affected by stapes fixation. The simulator was designed for training in endoscopic stapes surgery (SS), addressing the lack of reliable training platforms for this technically challenging procedure.

Imaging data from a CT scan of a patient were used to create a virtual 3D model of significant ear structures. The simulator consisted of a multi-use temporal bone holder and a single-use middle ear box, printed with material Jetting 3D printing technology. Eight participants to a university ear surgery course used the simulator to perform endoscopic stapes surgery. The surgical performance was evaluated using modified Objective Structured Assessment of Technical Skills (OSATS) scoring, and participant feedback was gathered through qualitative questionnaires.

Seven of the eight participants successfully completed the simulated SS, with a mean surgical time of 24 min. OSATS scores showed acceptable performance, with 75% of participants achieving a score above 20. The tactile feedback, particularly for the stapes fixation, was well received, although the chorda tympani was deemed too fragile. The simulator was highly valued for visuomotor coordination development.

The 3D Stapes Trainer represents a promising platform for training in endoscopic SS. Despite its limitations, the model provided young surgeons with a valuable platform to gain confidence in the steps of endoscopic SS, offering a high-fidelity simulation that contributes to the development of the technical skills required in this demanding procedure.

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