The Erlangen Endo-Trainer: Life-Like Simulation for Diagnostic and Interventional Endoscopic Retrograde Cholangiography

Abstract

The Erlanger Endo-Trainer offers a large spectrum of training possibilities in endoscopic techniques using life-like biological specimens. We organised the first pilot study of interventions at the papilla and the bile duct under x-ray control. Specially prepared upper visceral porcine organ packages including the esophagus, stomach, duodenum, liver, gallbladder and bile ducts were implanted into the Endo-Trainer. Furthermore, small stones were introduced into the bile duct. The test study was carried out by a senior endoscopist assisted by his endoscopy nurse. The following steps could therefore be carried out as a structured team-training scheme: Introduction of the side-viewing endoscope and passage into the duodenum; identification and adjustment at the papilla; cannulation of the papilla; selective bile duct imaging with contrast application under x-ray vision; placement of a guidewire; papillotomy; stone extraction and finally placement of a plastic stent. The special value of this type of simulation is the fact that endoscopic techniques can be trained in the usual manner with real tissue-feeling using regular commercial instruments. Although there is general consent that individual practice on the patient cannot be completely replaced by simulator training, a suitable and realistic simulation model can be of great value, for initial steps prior to "real" patient contact as well as for refining techniques and tactics.

Laparoskopische Cholezystektomie

“…1), ein Trainingsmodell, das sich bereits bei zahlreichen Trainingsworkshops für die interventionelle Endoskopie bewährt hat [16] und mit dem bereits erste Evaluierungen eines Bewertungssystems für endoskopische Basistechniken nach einem Score-Card-Protokoll durchgeführt wurden [17,18] Ende des Kurses (Tag 5), so zeigt sich eine signifikante Zunahme als Maß für einen deutlichen Lernerfolg der Teilnehmer (medianer Wert= 1,5 an Tag 1 vs. 44 an Tag 5; Tabelle 2). Ebenfalls anhand Tabelle 2 wird ersichtlich, dass der Lernerfolg bezüglich der Parameter "Präparation des Ductus cysticus" sowie "Präparation der Arteria cystica" am deutlichsten nachzuvollziehen ist.…”

Training and assessment of competence (Preparing the endoscopist)

“…A more commonly used training model is the ex-vivo porcine stomach model with attached biliary system that allows trainees to practice with real scope and accessories [9]. However, the anatomical variation, that is, close proximity of the papilla to the pylorus in the porcine model makes scope positioning and cannulation more difficult.…”

Training and Credentialing in Gastrointestinal Endoscopy

“…In the original Erlangen EndoTrainer model, the pig organs are inserted into a dummy mannequin. This model may also be used to simulate various laparoscopic surgical procedures [108]. A smaller portable, lightweight version, the compact-EASIE retains the basic tabletop platform to which only the organs needed for endoscopy simulation are pinned.…”

“…A similar non-randomized study was also conducted in France with similar results from a one day intensive course [111]. The Hochberger group has conducted a number of training courses using the EASIE model in other areas, including endoscopic mucosal resection (EMR), stricture management, vital staining, polypectomy, and ERCP [107,[112][113][114][115]. The techniques can vary from basic biliary cannulation, wire exchanges, stone extraction, and plastic stent insertion, to choledochoscopy, laser lithotripsy, and placement of bilateral hilar metal stents.…”