Fabrication and Validation of a Cost-Effective Upper Endoscopy Simulator.

PURPOSE: Beginning with the graduating class of 2018, the American Board of Surgery (ABS) requires that residents complete the ABS Flexible Endoscopy Curriculum, Fundamentals of Endoscopic Surgery (FES). This curriculum includes both didactic and simulator training. In the ideal setting residents gain proficiency using simulation prior to performing endoscopies in the clinical setting. This new requirement creates an increased demand for endoscopic simulators in all General Surgery residency programs. Due to the cost prohibitive nature of virtual reality simulators an economic alternative is needed. METHODS: A mechanical simulator was created from inexpensive items easily acquired at a hardware store and in the hospital. Total cost of the simulator was approximately $120 USD. To validate the simulator, experienced endoscopists completed a training session with the device. A seven-question Likert scale survey (1 - strongly disagree to 5 - strongly agree) was completed after the session evaluated the simulated experience versus live upper endoscopies and the device's ability to meet the goals of the FES curriculum. RESULTS: Eight proficient endoscopists completed the training session and survey and agreed that the device closely replicated live colonoscopies and would meet all training requirements in the FES curriculum. Mean responses to all seven survey questions ranged from 3.8-4.4. CONCLUSION: This device is a cost-effective method for simulating live upper endoscopies and is appropriate for use in FES training.

Fabrication of An Inexpensive but Effective Colonoscopic Simulator.

Because of increasing requirements for simulator training before actual clinical endoscopies, the demand for realistic, inexpensive endoscopic simulators is increasing. We describe the steps involved in the design and fabrication of an effective and realistic mechanical colonoscopic simulator.

Endoscopic Combined Snare-Forceps Technique for Removing Flat Sessile Polyps.

CONTEXT: Current endoscopes have limitations during use in polypectomies. Specifically, polyps that are flat, broad-based and sessile are more difficult to resect. Routine polypectomy procedures allow one endoscopic device to be used at a time limiting the endoscopist. More advanced scopes are not readily available at smaller community hospitals, limiting the endoscopist to using the resources available to them. METHODS: The modification of the standard polypectomy method described here employs both an endoscopic forceps and an endoscopic snare to be used simultaneously during colonoscopy with a single lumen colonoscope. The forceps is introduced into the endoscope so the head is just projecting from the distal end of the scope. The snare is then placed just proximal to the head of the forceps outside of the endoscope. The endoscope is reinserted into the colon until the polyp is reached. Using the snare the polyp is elevated and then the snare secured around the base. RESULTS: This resulted in easier, faster, and more complete removal of flat sessile and poorly located pedunculated polyps on the first try. This technique has been employed successfully in over 20 patients at our institution. CONCLUSIONS: This new method adds another technique for endoscopists when presented with difficult polypectomies.