Real-Time Light-Guided Vocal Fold Injection As A Simulation-Based Training Tool

Objective: Cricothyroid (CT) approach for vocal fold injection (VFI) has advantages of a low complication rate, suitability for in-office practice, and good patient compliance. However, it requires a high level of experience and a steep learning curve due to invisibility of needle. Recently, real-time light-guided VFI (RL-VFI) was developed for safe and precise injection into laryngeal structures under light guidance. Herein, we describe the development of a simulation-based training (SBT) program using RL-VFI for CT approach and report its preliminary application with in-training otolaryngologists.Methods: The workshop comprised 3 sessions: mini-lectures, and two hands-on training courses of conventional VFI and RL-VFI. Excised canine larynges and the device for RL-VFI were prepared for hands-on courses. Comfort levels for VFI was evaluated using visual analogue scale after each session. Trainees were requested to identify the needle tip on the target point lateral to vocal process. The time (s) to reach the target point was measured in all procedures. After workshop, all participants filled out questionnaires regarding their future preference for conventional VFI and RL-VFI.Results: Eleven otolaryngology residents participated in the study. The mean comfort levels were 1.7 +/- 1.6, 5.5 +/- 2.6, 4.8 +/- 1.7, and 7.5 +/- 1.6 for pre-workshop, post-lecture, post-conventional VFI, and post-RL-VFI (P < .001). The mean time (s) to reach the target point were 146.4 +/- 90.1 and 42.7 +/- 40.5 for conventional VFI and RL-VFI (P = .004). The mean preference scores were 4.2 +/- 1.3 and 8.7 +/- 1.3 for conventional VFI and RL-VFI (P = .004).Conclusion: SBT program using RL-VFI might improve the comfort levels of trainees for VFI with CT approach. It would be helpful for trainees to practice VFI before trying it on actual patients. (c) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.