How To: A Simple and Innovative Simulator Model for Sialendoscopy Basket Stone Retrieval Training

INTRODUCTION

Sialendoscopy requires the use of fine, delicate instruments and is mastered by relatively few surgeons worldwide. One of the key components that can facilitate the learning process is the use of simulator models in training courses or for self-directed practice.

Currently, pig heads are the most commonly used models for sialendoscopy training, as they allow for practice on the salivary duct papillae. These models do not provide adequate training for manipulating sialolithiasis, however, and in some countries, sanitation laws may prohibit the use of such animals for training, presenting additional ethical limitations. Human cadaveric heads are difficult to acquire, maintain, and work with, and they are expensive. Additionally, the mandible’s postmortem rigor complicates dissection in both porcine and human cadavers.

To overcome these challenges, it is imperative to develop a low-cost, easily constructed, and reproducible training model that can be applied to any setup (laboratory or operative) and that complies with existing sanitary and ethical guidelines. Such a model could help educate and train novice practitioners, allowing them to gain proficiency in handling delicate surgical instruments before using them in real-life surgeries. In this article, we describe a simple and innovative sialendoscopy basket stone retrieval (BSR) simulator model that we developed and employed in our training courses over the past few years. Preliminary evaluation data obtained from both trainee and instructor participants are also discussed.

METHODS

Description of the sialendoscopy BSR simulator

Our sialendoscopy BSR simulator was designed to mimic the real experience of grasping floating stones from the lumen of the natural major salivary gland ducts. A 1.0-mL plastic insulin syringe with a detachable needle (inner barrel diameter, 4mm; length, 6.0cm) is used to simulate a dilated salivary duct. The syringe needle adaptor, consisting of the plain tip of a syringe barrel (inner diameter: 2mm; length: 8mm), accommodates the outer diameter of the sialendoscope and mimics the narrow entrance to the salivary papilla after dilatation. The syringe barrel is uniformly wrapped with red-colored plastic adhesive tape to mimic the coloration inside the ductal system and provide lumen opacity. Dried guava fruit seeds, which imitate real sialoliths in both consistency and morphology, are inserted into the syringe lumen after filling it with saline solution, ensuring the elimination of air bubbles. The prepared insulin syringe simulator is securely fixed to a flat working table edge using an opaque, wide adhesive surgical tape, aligning the syringe tip with the table edge (Fig. 1).