Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator


  • Amanda I. Gillespie Emory University School of Medicine
  • Sandeep Shelly Emory University School of Medicine
  • Sarah Jo Tucker Georgia Institute of Technology and Emory University
  • Scott J. Hollister Georgia Institute of Technology and Emory University
  • Andrew Tkaczuk Emory University School of Medicine
  • Adam Klein Emory University School of Medicine



The objective of this study was to validate the use of a 3-Dimensional Flexible Laryngoscopy Training Simulator. This is a simulation device development and validation study. Anonymized CT scan data from a head/neck CT of a patient with normal anatomy was imported and a head/neck digital model was created. A 3D simulation model was printed using a stiff (Stratasys Vero) and flexible (Stratasys Agilus) material combination with a ShoreA hardness value of 60. Novices and experts were instructed and provided 5 trials to pass the laryngoscope. The videos of the first and the last trial were recorded and evaluated by three different evaluators. Performances were measured by the amount of time spent and precision of the task. Repeated measures of ANOVA and generalized linear model with binomial proportion was used were utilized to analyze the data. The post training scores were statistically significantly higher than pre training scores (Mean: 15.57 vs. 13.01, p  <0.0001) controlling for trainee experience. The time taken to complete a successful pass post training was statistically significantly lesser than pre training (Mean: 62.55 secs vs. 36.36 secs, p-value = 0.0007) controlling for individual’s experience. The odds of becoming skilled at the task was 4 times higher post training in comparison to pre training, controlling for individual’s experience (OR: 4.05, p-value: 0.0026). The 3-Dimensional Flexible Laryngoscopy Training Simulator is a valid trainer for both novice and experienced individuals. The simulator can improve technical skill performance and is critical for medical training.


Simulator, Laryngoscopy, Vocal folds


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P. Colley, J. C. Mace, M. R. Schaberg, T. L. Smith, and A. Tabaee, “Impact of educational intervention on the interrater agreement of nasal endoscopy interpretation,” The Laryngoscope, vol. 125, no. 10, pp. 2259–2265, Mar. 2015, doi: 10.1002/lary.25240.

İ. Yıldız, Y. S. Koca, M. T. Bülbül, and Ö. C. Musri, “Emergency Endoscopy and the Importance of Endoscopy Training in General Surgery Residency: A Survey-Based Study,” Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, vol. 23, pp. 5184–5188, Oct. 2017, doi: 10.12659/MSM.907130.

A. M. Moercke and B. Eika, “What are the clinical skills levels of newly graduated physicians? Self-assessment study of an intended curriculum identified by a Delphi process,” Medical Education, vol. 36, no. 5, pp. 472–478, May 2002, doi: 10.1046/j.1365-2923.2002.01208.x

V. Dell’Era, M. Garzaro, L. Carenzo, P. L. Ingrassia, and P. A. Valletti, “An innovative and safe way to train novice ear nose and throat residents through simulation: the SimORL experience,” Acta Otorhinolaryngologica Italica, vol. 40, no. 1, pp. 19–25, Feb. 2020, doi: 10.14639/0392-100x-n0128.

M. G. Blum, T. W. Powers, and S. Sundaresan, “Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy,” The Annals of Thoracic Surgery, vol. 78, no. 1, pp. 287–291, Jul. 2004, doi: 10.1016/j.athoracsur.2003.11.058.

Vieira, L.M.N., P.A.M. Camargos, and C.D.C. Ibiapina, Bronchoscopy simulation training in the post-pandemic world. J Bras Pneumol, 2022. 48(3): p. e20210361.

D. A. McClusky et al., “Virtual reality training improves junior residents’ operating room performance: Results of a prospective, randomized, double-blinded study of the complete laparoscopic cholecystectomy,” Journal of the American College of Surgeons, vol. 199, no. 3, p. 73, Sep. 2004, doi: 10.1016/j.jamcollsurg.2004.05.157.

Favier, V., et al., Use of simulation-based training of surgical technical skills among ENTs: an international YO-IFOS survey. Eur Arch Otorhinolaryngol, 2021. 278(12): p. 5043-5050.

E. Chebib, V. Lemarteleur, M. Azalé, L. Deneufbourg, P. Ceccaldi and N. Teissier, "Step-by-step development and evaluation of a 3D printed home-made low-cost pediatric tracheobronchial tree for foreign body aspiration extractions", International Journal of Pediatric Otorhinolaryngology, vol. 153, p. 111040, 2022. Available: 10.1016/j.ijporl.2022.111040.

A. Ridgers et al., “Teaching Radial Endobronchial Ultrasound with a Three-Dimensional–printed Radial Ultrasound Model,” ATS Scholar, Nov. 2021, doi: 10.34197/ats-scholar.2020-0152oc.

N. Clifton, C. Klingmann, and H. Khalil, “Teaching Otolaryngology skills through simulation,” European Archives of Oto-Rhino-Laryngology, vol. 268, no. 7, pp. 949–953, Mar. 2011, doi: 10.1007/s00405-011-1554-6.

A. Arora, L. Y. M. Lau, Z. Awad, A. Darzi, A. Singh, and N. Tolley, “Virtual reality simulation training in Otolaryngology,” International Journal of Surgery, vol. 12, no. 2, pp. 87–94, Feb. 2014, doi: 10.1016/j.ijsu.2013.11.007.

C. Chin, C. Chin, K. Roth, B. Rotenberg and K. Fung, "Simulation-based otolaryngology – head and neck surgery boot camp: ‘how I do it’", The Journal of Laryngology & Otology, vol. 130, no. 3, pp. 284-290, 2016. Available: 10.1017/s0022215115003485.

A. M. Klein and J. Gross, “Development and validation of a high-fidelity phonomicrosurgical trainer,” The Laryngoscope, vol. 127, no. 4, pp. 888–893, Sep. 2016, doi: 10.1002/lary.26230.

Y. Lin, X. Wang, F. Wu, X. Chen, C. Wang and G. Shen, "Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill", Journal of Biomedical Informatics, vol. 48, pp. 122-129, 2014. Available: 10.1016/j.jbi.2013.12.010.

N. Coghlan, D. Archard, P. Sipanoun, T. Hayes, and B. Baharlo, “COVID‐19: legal implications for critical care,” Anaesthesia, vol. 75, no. 11, pp. 1517–1528, Jun. 2020, doi: 10.1111/anae.15147.

E. Andrist, R. G. Clarke, and M. Harding, “Paved with good intentions: Hospital visitation restrictions in the age of Coronavirus disease 2019,” Pediatric Critical Care Medicine, vol. 21, no. 10, Jun. 2020, doi: 10.1097/PCC.0000000000002506.

H. K. Kanthimathinathan, U. Pollak, and L. Shekerdemian, “Paediatric intensive care challenges caused by indirect effects of the COVID-19 pandemic,” Intensive Care Medicine, Apr. 2021, doi: 10.1007/s00134-021-06400-7




How to Cite

A. I. Gillespie, S. Shelly, S. J. Tucker, S. J. Hollister, A. Tkaczuk, and A. Klein, “Development and Validation of a 3-Dimensional Flexible Laryngoscopy Training Simulator”, J. Mod. Sim. Mater., vol. 5, no. 1, pp. 1–6, Oct. 2022.