Journal: Journal of Otorhinolaryngology, Hearing and Balance Medicine
Davies T, Leong S. An Evidence-Based Framework for Simulation in Endoscopic Sinus Surgery: A Graded Approach to Training with 3D-Printed Models. J. Otorhinolaryngol. Hear. Balance Med. 2026;7:16. doi: 10.3390/ohbm7010016
Objective
This commentary proposes an evidence-based, graded framework for simulation training in endoscopic sinus surgery (ESS) using high-fidelity three-dimensional (3D)-printed models tailored to the trainee’s stage of training.
Setting
The framework is intended for otolaryngology training environments, including simulation courses and surgical training programmes. It focuses on staged ESS training for early-years and advanced trainees.
Study design
Commentary and evidence-based training framework.
Participants
No new participant cohort was recruited. The article addresses otolaryngology trainees, with early-years trainees focusing on fundamental ESS skills and advanced trainees progressing to complex sinonasal and skull base procedures.
Intervention
The authors describe a graded simulation approach using two commercially available 3D-printed sinus surgery models. The Phacon™ sinus trainer is recommended for early-stage training in anatomical orientation, bimanual dexterity, tissue handling, instrument handling, middle meatal antrostomy and anterior ethmoidectomy. The Fusetec™ sinus surgical training device is recommended for advanced ESS simulation, including frontal and sphenoid sinus surgery, transsphenoidal pituitary approaches, cerebrospinal fluid leak repair, internal carotid artery injury and advanced pathology.
Results
Published validation studies demonstrate high face and content validity for both models. The Phacon™ model supports early ESS skill acquisition, with prior studies reporting usefulness for middle meatal antrostomy, anterior ethmoidectomy, hand–eye coordination and general endoscopic sinus surgery skills. The Fusetec™ model supports advanced simulation, with reported content validity above 80% for middle meatal antrostomy, anterior ethmoidectomy, frontal sinus surgery and sphenoid sinus surgery. Additional validation work supports its use in simulating transsphenoidal pituitary surgery, cerebrospinal fluid leak and carotid artery injury.
Conclusions
A structured, stage-appropriate simulation strategy using high-fidelity 3D-printed models may enhance ESS training by aligning simulation tasks with trainee experience. The authors suggest that 3D-printed models should form the basis of ESS simulation, while recognising limitations including imperfect mucosal realism, variable tissue responsiveness and production costs.