The Use of Simulators for Training in GI Endoscopy

Abstract

Quality management and optimal patient care are two of the most important issues in clinical medicine today. While evidence-based medicine is rapidly becoming the "gold standard" for treatment modalities, the responsibility for education, including theoretical background as well as acquisition and refinement of manual skills in gastrointestinal endoscopy, remains in the hands of the individual physician. New endoscopy simulators have rekindled the discussion as to whether it is preferable for training in basic manual skills to take place away from the patient [1].The paper of Ferlitsch et al. from Vienna, published in this issue of Endoscopy, shows that the use of a simulator could or should form part of future education in diagnostic gastroscopy and colonoscopy. Included in the study were 13 beginners and 11 experts. After a short introductory session on the simulator, all participants were evaluated in a baseline assessment. This included the diagnostic steps of a virtual gastroscopy and colonoscopy procedure, and two modules concerned with endoscopic dexterity and skills, called "Endobasket" and "Endobubble." The beginners were then divided into two groups, with seven participants in an intensive training group and six in a control group. This was followed by a 3-week training program of 2 hours of simulator practice daily for 5 days a week, which was offered only to the intensive training group. After 3 weeks the intensively trained group performed significantly better using the simulator than the untrained group, and reduced the initial difference from the expert group to a nonsignificant level.The authors took a simple but important step in the validation of the Symbionix computer simulator as a teaching tool [2, 3]. Experts did better than beginners in the gastroscopy and colonoscopy procedures, as well as in the two virtual skills test modules. The higher performance level of the experts demonstrated the simulator's ability to identify specific quality aspects of the endoscopic procedure. Prior experience in computer games, age, and sex did not have any influence on the result. The study is published in parallel with one described in the June 2002 issue of Surgical Endoscopy [4]. This was carried out using a second type of endoscopy simulator, the "PreOp" of the Immersion Medical Corporation, USA. The authors, from London, also studied the correlation between clinical endoscopic competence in the beginners' state and judgement given by the computer simulator. The participants had to perform a virtual flexible sigmoidoscopy procedure using the simulator. The percentage of colonic mucosa visualized, the time taken, and the path length of endoscope travel were measured. The 45 participants were divided into three groups: novice (no lower gastrointestinal endoscopy ever performed); intermediate (5 -50 clinical examinations performed); and trained (more than 200 examinations). There was a significant difference between all three groups with respect to percentage of mucosa visualized and efficiency ratio (% muc...

Acquiring basic endoscopy skills by training on the GI Mentor II

“…Currently, VR simulators are obtaining an increasingly prominent position in medical education, and they have enhanced training programs for endoscopic skills [1,14]. They still are being thoroughly evaluated because their application must be proven valid before their widespread integration into education and training programs [12,15,16].…”

“…Several VR simulator systems are currently available for lower gastrointestinal flexible endoscopy [12,15,16]. The validity of the different systems for lower gastrointestinal endoscopy skills has been studied previously [7,8,12,15,[17][18][19][20][21][22][23][24][25].…”

“…The validity of the different systems for lower gastrointestinal endoscopy skills has been studied previously [7,8,12,15,[17][18][19][20][21][22][23][24][25]. However, most of these studies did not focus on the basic tasks first, but included multiple (complex) tasks or used a relative small numbers of participants.…”

Building a three-dimensional model of the upper gastrointestinal tract for computer simulations of swallowing

“…Nowadays, the visualization and navigation through anatomical structures represent one of the most significant features in a simulated environment [13], not only for surgical training and planning, but also for computer modeling of dynamic behavior. Models of the heart and aorta are today available for personalized physiological simulations [32], and some of them are shared between scientists and clinicians through web services [14], but this is not yet the case for gastrointestinal structures.…”

ELITE: Ein neues hochimmersives Operationsphantom für NOTES

“…Leider gibt es derzeit keine speziellen Trainingssysteme für NOTES. Die Box-Trainer wie auch die virtuellen OP-Trainer sind entweder für endoskopische [8][9][10][11] oder laparoskopische Eingriffe [12,13] verfügbar. Nur Tiermodelle erlaubten bisher die bekannten NOTES-Zugangswege (transoral, transvaginal, transrektal und transurethral) zu nutzen, um das Lumen zu verlassen und den beabsichtigten Eingriff intraperitoneal durchführen zu können.…”