Experimental setup
A life-size, anatomically realistic model of the head (AirSim®. TruCorp® Co. Armagh, Northern Ireland, U.K) was used in this study (Figure 1a). All simulations of tonsil surgery were undertaken in the operating theatre suite at [removed for blind peer review]. The hospital is a recent construction (2015) incorporating modern airflow techniques in each of its operating theatres. The model was placed at the top edge of the operating table in an extended neck position, akin to the conventional way of doing a tonsillectomy in a patient, with an appropriately sized Boyle–Davis mouth-gag which was supported by Draffin rods (Figure 1a). Pillows were placed at the bottom of the model to simulate the chest and upper abdomen of a patient. The model and surgical setup was then covered by an impervious black square sheet.
Fresh strawberries cut in half and soaked overnight in nontoxic fluorescein dye (1mg in 25mL. Monument Tools, MAP UK (TA Tool Chimp) Ltd. Essex, U.K) was used to simulate tonsils (Figure 1b). The CoblationTM ProciseTM EZ wand (Smith&Nephew Ltd. Hull, U.K) was used in default energy settings (Coblate = 7, coagulate = 3). Diluted fluorescein dye was also added to the irrigation bag; 1g dye diluted in 250mL irrigation fluid. (Figure 1c).
Tonsil surgery was undertaken by two trained members of the team ([removed for blind peer review]) who undertook five experiments each, wearing standard personal protective equipment (PPE).