A modular surgical simulator for microlaryngoscopy using standard instruments and the carbon dioxide laser.

Objective: Build a microlaryngoscopy surgical simulator for endoscopic laryngeal surgery using standard microsurgical instruments and a CO2 laser. Study design: Anatomical modeling, CAD design and 3D printed manufacturing. Subjects and methods: We created a modular design for a microlaryngoscopy simulator in CAD software. Components include plastic and stainless-steel models of a standard operating laryngoscope and a cassette system for mounting porcine or synthetic models of the vocal folds. All simulator parts, including the metallic laryngoscope model, were manufactured using 3D printing technology. Tumors were simulated in porcine tissue models by injecting a soy protein-based tumor phantom. Residents and faculty in the Louisiana State University otolaryngology department evaluated the system. Each participant performed microlaryngoscopy with laser resection on a porcine larynx and cold instrument procedures on synthetic vocal folds. Participants scored the simulator using a 5-point Likert scale. Results: The microlaryngeal surgical simulator demonstrated in this project is realistic, economical, and easily assembled. We have included 3D printed parts files and detailed assembly instructions that will enable educators interested in surgical simulation to build the device.Participants in the simulator evaluation session felt that the simulator faithfully represented the procedure to resect vocal fold lesions using a CO2 laser. The synthetic model allows the trainee to develop hand-eye coordination while using standard laryngeal instruments. Conclusions: The simulator described herein will enable surgeons to acquire the surgical skills necessary to perform operative microlaryngoscopy prior to operating on live patients.

Water quality in the inshore Great Barrier Reef lagoon: Implications for long-term monitoring and management.

Coastal and inshore areas of the Great Barrier Reef lagoon receive substantial amounts of material from adjacent developed catchments, which can affect the ecological integrity of coral reefs and other inshore ecosystems. A 5-year water quality monitoring dataset provides a 'base range' of water quality conditions for the inshore GBR lagoon and illustrates the considerable temporal and spatial variability in this system. Typical at many sites were high turbidity levels and elevated chlorophyll a and phosphorus concentrations, especially close to river mouths. Water quality variability was mainly driven by seasonal processes such as river floods and sporadic wind-driven resuspension as well as by regional differences such as land use. Extreme events, such as floods, caused large and sustained increases in water quality variables. Given the highly variable climate in the GBR region, long-term monitoring of marine water quality will be essential to detect future changes due to improved catchment management.