An Evidence-Based Framework for Simulation in Endoscopic Sinus Surgery: A Graded Approach to Training with 3D-Printed Models

Background: Endoscopic sinus surgery (ESS) is a core operative technique in otolaryngology and is associated with a steep learning curve due to complex sinonasal anatomy, limited depth perception with two-dimensional endoscopy, and the requirement for precise bimanual coordination. Given the potential for serious complications, including cerebrospinal fluid leak and visual loss, simulation provides an important opportunity for trainees to develop technical skills in a controlled environment without risk to patients. Recent advances in three-dimensional (3D) printing have enabled the development of high-fidelity models for ESS training. Methods: We describe an evidence-based, graded approach to ESS simulation using two commercially available 3D printed sinus surgery models tailored to the trainee’s stage of training. Early-stage simulation focuses on development of anatomical orientation, endoscopic hand–eye coordination, tissue handling, and basic procedures such as middle meatal antrostomy and anterior ethmoidectomy. Advanced simulation targets more complex procedures, including frontal and sphenoid sinus surgery, transsphenoidal approaches, and management of intraoperative complications. Results: Validation studies demonstrate high face and content validity for both models. Early-stage simulators support acquisition of fundamental technical skills, while advanced models allow simulation of complex anatomy, pathology, and operative complications. Conclusions: A structured, stage-appropriate simulation strategy using high-fidelity 3D printed models may enhance technical skill acquisition and support safe and effective training in endoscopic sinus surgery.