Animal models for endoscopic training: do we really need them?

Abstract

Gastrointestinal endoscopy currently includes many therapeutic methods that are technically challenging and frequently associated with a significant risk of complications. Several issues such as the limited number of clinical cases and practice in emergency situations, and technical difficulty may limit the opportunity for training, and increased exposure in more relaxed situations would be desirable. Moreover, providing the patient with the best possible standard of care is a must. Animal models are the most easily available simulators. Training in these models has been recommended for several complex techniques, among which hemostasis, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and endoscopic submucosal dissection are reviewed here. Ex vivo models are much easier to set up and, from an ethical standpoint, they should be used for the initial step in training whenever possible before moving on to in vivo models. Although simulation with animal models has been the subject of a good number of studies, very few of them have evaluated the impact on clinical outcomes, and clearly more studies are needed. Nevertheless, available evidence does suggest that practicing on animal models has an influence on the learning curve and facilitates the acquisition of skills in the complex endoscopic techniques reviewed.

An Innovative Ex-Vivo Model for Rapid Change of the Papilla for Teaching Advanced Endoscopic Retrograde Cholangiopancreatography Procedures

“…Also has two others limitations: the location of native papilla and the natural orifice of the pancreatic duct is located more distally in the duodenum 1 , 4 , 5 . …”

“…Due to these difficulties, some authors have developed models using chicken´s heart to simulate the duodenal papilla (neo papilla) 5 , 6 , 7 . But this model takes a long time to prepare, because the papilla (chicken hearts) is sutured into the porcine stomach 6 .…”

Innovations in surgery simulation: a review of past, current and future techniques

“…Moreover, since operating on live animals closely emulates the actual operative setting, working with these simulators also allows multiple resident physicians to practice the communication and teamwork essential in the operating room (17,21). Because of the numerous benefits to working with live animals, in vivo porcine and canine models have been used extensively in endoscopic, laparoscopic and other forms of training, including endoscopic submucosal dissection, cholecystectomy and coronary bypass (17,22). Many studies have been conducted on the efficacy of these forms of training, and most have validated their use in improving technical skills and selfconfidence (22)(23)(24).…”

“…Because of the numerous benefits to working with live animals, in vivo porcine and canine models have been used extensively in endoscopic, laparoscopic and other forms of training, including endoscopic submucosal dissection, cholecystectomy and coronary bypass (17,22). Many studies have been conducted on the efficacy of these forms of training, and most have validated their use in improving technical skills and selfconfidence (22)(23)(24). Ex vivo animal tissue is also sometimes used in surgical training, but offers lower-fidelity simulation than live animals.…”

The Ideal Experimental Training Session for Minimally Invasive Endoluminal Techniques

“…While it is clear that skills acquisition improves with experience, the minimum number of procedures to achieve competence has not clearly been defined [14]. The process of skills acquisition has been described as a sequential process.…”