The traditional approaches to training surgeons are becoming increasingly difficult to
apply to modern surgical procedures. The development of Minimally Invasive
Surgery (MIS) techniques demands new and complex psychomotor skills, and means
that the apprentice-based system described by “see one, do one, teach one” can no
longer be expected to fully prepare surgeons for operations on real patients, placing
patient safety at risk. The use of cadavers and animals in surgical training raises issues
of ethics, cost and anatomical similarity to live humans. Endoscopic sinus surgery
involves further risk to the patient due to the proximity of vital structures such as the
brain, eyes, optic nerve and internal carotid artery. In recent years, simulation has
been used to overcome these problems, exposing surgeons to complex procedures in a
safe environment, similarly to its use in aviation. However, the cases simulated in this
manner may not be customised by training staff to present desired pathology.
This thesis describes the design and development of a new tool for the creation of
customised cases for the training of sinus surgery. Users who are inexperienced and
non-skilled in the use of three-dimensional (3D) Computer Aided Design (CAD)
modelling software may use the tool to implement pathology to the virtual sinus
model, which was constructed from real CT data. Swelling is applied in five
directions (four horizontal, one vertical) to the cavity lining of the frontal and
sphenoid sinuses. Tumours are individually customised and positioned in the frontal,
sphenoid and ethmoid sinuses. The customised CAD model may then be latterly
manufactured using Three-Dimensional Printing (3DP) to produce the complex
anatomy of the sinuses in a full colour physical part for the realistic simulation of
surgical procedures. An investigation into the colouring of the physical model is also
described, involving the study of endoscopic videos to ascertain realistic shades.
The program was evaluated by a group of medical professionals from a range of
fields, and their feedback was taken into account in subsequent redevelopment of the
program, and to suggest further work
