Ethanol and laser ablation of benign thyroid nodules is bursting rapidly in clinical practice because of its efficacy, safety and economy. However, these techniques require some manual operator training. In order to facilitate this hands-on training, we propose two homemade, cheap and specific simulators to practice these clinical procedures.
Material and methods
Two models were optimized: Gel-Phantom Coruna VR16 (gelatine and plantago-ovata with inlays of different objects simulating pure and mixed cysts) and Proteon-Phantom Coruna VR17 (pork loin with inlays of different objects simulating solid nodules (homogeneous, heterogeneous and with microcalcifications). For enolization, pure ethanol and a 2-way device (Device Coruna VR15, poster 94, 58th Congress Malaga, Spain, SEEN 2016) were used for sequential ethanol-NSS instillation (to reduce irritation of the capsule upon withdrawal of the needle). For laser ablation, a 1064 nm Nd-YAG laser through a thin optic fiber of 300um obtained from an EchoLaser generator (Elesta, Florencia-Italy) was used. Monitoring was performed with the Acusson 2000 Hellix ultrasound platform (Siemens, Forchheim-Germany). The assessment was performed among different operators (n=12), especially those attending the Coruna Workshop on Laser Ablation.
For cystic nodules simulation and practicing ethanol sclerosis, the most valued simulators were: fluid on a knotted glove (pure cyst), grapes or dwarfish tomatoes (mixed cyst), piece of wet sponge wrapped in knotted kitchen plastic (sponge cyst) and anchovy stuffed olive (hyperechoic nodule with hypoechoic center). For solid-state nodules simulation and practicing laser ablation, the most valued were: beef liver wrapped in knotted plastic (solid isoechoic nodule), cooked yolk wrapped in knotted plastic (hyperechoic solid nodule), raisins and water wrapped in knotted plastic (heterogeneous nodule), and raisins, water and eggshells (heterogeneous nodule with microcalcifications).
Conclusion: In summary Gel-Phantom Coruna VR16 and Proteon-Phantom Coruna VR17 simulators were surprisingly useful for practicing percutaneous ethanol and laser ablation procedures. In addition, we highlight their low cost and easy preparation.
20 - 23 May 2017
European Society of Endocrinology