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Development and Initial Evaluation of a Novel, Ultraportable, Virtual Reality Bronchoscopy Simulator: The Computer Airway Simulation System

Casso, Gabriele MD*; Schoettker, Patrick MD; Savoldelli, Georges L. MD; Azzola, Andrea MD§; Cassina, Tiziano MD*

doi: 10.1213/ANE.0000000000003316
Technology, Computing, and Simulation: Original Clinical Research Report

BACKGROUND: Virtual reality (VR) simulation is an effective and safe method of teaching bronchoscopic skills. Few VR bronchoscopy simulators exist; all are expensive. The present study aimed to describe the design, development, and evaluation of a new, affordable, VR bronchoscopy simulator.

METHODS: Anesthesiologists and engineers collaborated to design and develop the Computer Airway Simulation System (CASS), an iPad-based, high-fidelity, VR bronchoscopy simulator. We describe hardware and software development, as well as the technical and teaching features of the CASS. Twenty-two senior anesthesiologists evaluated various aspects of the simulator (using a 5-point Likert scale) to assess its face validity.

RESULTS: Anesthesiologists performed a simulated bronchoscopy (mouth to carina) with a median (range) procedural time of 66 seconds (30–96). The simulator’s ease of use was rated 4.3 ± 0.8 and the bronchoscope proxy’s handling 4.0 ± 0.7. Criticisms included that excessive system reactivity created handling difficulties. Anatomical accuracy, 3-dimensional bronchial segmentation, and mucosal texture were judged to be very realistic. The simulator’s usefulness for teaching and its educational value were highly rated (4.9 ± 0.3 and 4.8 ± 0.4, respectively).

CONCLUSIONS: We describe the design, development, and initial evaluation of the CASS—a new, ultraportable, affordable, VR bronchoscopy simulator. The simulator’s face validity was supported by excellent assessments from senior anesthesiologists with regard to anatomical realism, quality of graphics, and handling performance, even though some future refinements are required. All the practitioners agreed on the significant educational potential of the CASS.

From the *Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland

Department of Anesthesiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland

Department of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland

§Division of Pulmonology, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland.

Published ahead of print 29 December 2017.

Accepted for publication December 29, 2017.

Funding: Cardiocentro Ticino’s Department of Cardiac Anesthesia and Intensive Care in Lugano, Switzerland, employs Gabriele Casso and Tiziano Cassina. This institution received financial support for the CASS research and development project from the Foundation for Cardiological Research and Education and the FLAVA Foundation (Fondation Latine des Voies Aériennes), both charitable (not-for-profit) organizations.

Conflicts of Interest: See Disclosures at the end of the article.

Reprints will not be available from the authors.

Address correspondence to Gabriele Casso, MD, Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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