Endoscopic ultrasound-guided fine needle aspiration training: evaluation of a new porcine lymphadenopathy model for in vivo hands-on teaching and training, and review of the literature

Fritscher-Ravens, Annette; Cuming, Tamzin; Dhar, Shantiswaroop; Parupudi, Sreeram; Patel, Kirti; Ghanbari, Atefeh; Holland, C K; Hadeler, Klaus‐Gerd; Arlt, Alexander; Ellrichmann, Mark

doi:10.1055/s-0032-1325931

Cited by 28 publications

(21 citation statements)

References 26 publications

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“…Live pigs serve as very good models because their anatomy is close to humans, which is particularly suited for learning diagnostic EUS 8. Fritscher-Ravens and colleagues reported a study in which they enrolled two fellows who performed 96 EUS-FNA on living pigs 16. They demonstrated a significant improvement in the procedure times on patients, when comparing their performance before and after this training.…”

Section: Discussionmentioning

confidence: 99%

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Learning curve for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions in a novel ex-vivo simulation model

et al. 2016

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Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is essential in the management of digestive cancers. However, teaching and learning this technique remain challenging due to the lack of cost-effective models. Material and methods: This was a prospective experimental study using a complete porcine upper gastrointestinal ex-vivo organ package, placed in an Erlangen Active Simulator for Interventional Endoscopy (EASIE-R), and prepared with one cyst and two solid masses (2 cm). Five fellows inexperienced in EUS-FNA were enrolled, performing 10 procedures on each lesion, alternatively. The total time, number of attempts for success, of needle view losses, and of scope handling were recorded, associated with an independent skills rating by procedure. We compared the first 15 procedures with the last 15 for each fellow. Results: The fellows successfully performed all procedures in 2 to 40 minutes, requiring 1 to 6 attempts. All (5/5) improved their total time taken (P < 0.001), number of times when the EUS view of the needle was lost (P < 0.05), scope handling (P < 0.005), and skills rating (P < 0.001), whereas 4/5 (80 %) improved their number of attempts. The overall evaluation showed a significant decrease (P < 0.001) in the total time taken (11.2 ± 7.8 vs 4.3 ± 2.2 minutes), number of attempts (2.6 ± 1.2 vs 1.2 ± 0.7), number of times when the EUS view of the needle was lost (2.3 ± 2 vs 0.5 ± 0.7), and need for scope handling (1.1 ± 1.7 vs 0.1 ± 0.2). We also observed an improvement in skills rating (5 ± 1.9 vs. 7.7 ± 1.1). Conclusion: This newly designed ex-vivo model seems to be an effective way to improve the initial learning of EUS-FNA, by performing 30 procedures.

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Section: Discussionmentioning

confidence: 99%

“…Hands-on training in EUS-FNA has traditionally used various models: (1) phantoms devoid of animal material (Olympus, Tokyo, Japan) 13; (2) models using porcine organs (upper digestive EUS-FNA) 14; and (3) live pigs 8 15 16. Simulators do not currently offer training in FNA.…”

Section: Introductionmentioning

confidence: 99%

Learning curve for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions in a novel ex-vivo simulation model

et al. 2016

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“…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.…”

Section: Live Animalsmentioning

confidence: 99%

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

Badash¹,

Burtt²,

Solorzano³

et al. 2016

Ann. Transl. Med.

239

165

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As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future.Evidence from the literature highlights the benefits of including simulations in surgical training; skills acquired through simulations translate into improvements in operating room performance. Moreover, simulations are rapidly incorporating new medical technologies and offer increasingly high-fidelity recreations of procedures. As a result, both novice and expert surgeons are able to benefit from their use. As dedicated, structured curricula are developed that incorporate simulations into daily resident training, simulated surgeries will strengthen the surgeon's skill set, decrease hospital costs, and improve patient outcomes.

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“…Prior exposition to lymph node FNA in porcine models may improve trainee performance, confidence and procedural comfort when returning to patient examinations. [910]…”

Section: Current Knowledge On Eus-fna Trainingmentioning

confidence: 99%

Training in endoscopic ultrasound-guided fine needle aspiration

Paquin

2014

Endosc Ultrasound

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Like any other technique, fine needle aspiration (FNA) proficiency requires adequate experience. Although this technique is not difficult to master, formal training will allow endosonographers to achieve better results. The following article is derived in two parts: (1) To review current knowledge on endoscopic ultrasound (EUS)-FNA training, discuss the current recommendations on training guidelines, explore other training adjuncts and review the latest studies evaluating the validity of current recommendations; and (2) to provide some basic grounds on the EUS-FNA technique. EUS-FNA can be broken down into a series of steps. Proper execution of each step will make FNA easier and likely increase its diagnostic yield. Adequate positioning of the lesion in regards to the ultrasound probe is a key factor to obtain best results. The following will discuss useful tips in order to achieve maximal success rates.

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Endoscopic ultrasound-guided fine needle aspiration training: evaluation of a new porcine lymphadenopathy model for in vivo hands-on teaching and training, and review of the literature

Cited by 28 publications

References 26 publications

Learning curve for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions in a novel ex-vivo simulation model

Learning curve for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions in a novel ex-vivo simulation model

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

Training in endoscopic ultrasound-guided fine needle aspiration

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