Simulation and training in transluminal endoscopy

Patel, Pikul; Thakkar, Shyam

doi:10.1016/j.tgie.2011.02.011

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…Ex vivo simulators can be more realistic than virtual simulators and have overcome some of the limitations of live-animal models. 19,20 Like these, Simuldog is a realistic simulator based on the anthropometric study of MRI images of Beagles. The uncovered abdomen and realistic illustration of the organs around it allow operators to relate the movements of the tip of the endoscope to the way in which they handle the controls and to relate the tip location to the anatomic image in the monitor.…”

Section: Discussionmentioning

confidence: 99%

Validation of a Realistic Simulator for Veterinary Gastrointestinal Endoscopy Training

Usón‐Gargallo¹,

Usón-Casaús²,

Pérez-Merino³

et al. 2014

Journal of Veterinary Medical Education

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This article reports on the face, content, and construct validity of a new realistic composite simulator (Simuldog) used to provide training in canine gastrointestinal flexible endoscopy. The basic endoscopic procedures performed on the simulator were esophagogastroduodenoscopy (EGD), gastric biopsy (GB), and gastric foreign body removal (FBR). Construct validity was assessed by comparing the performance of novices (final-year veterinary students and recent graduates without endoscopic experience, n=30) versus experienced subjects (doctors in veterinary medicine who had performed more than 50 clinical upper gastrointestinal endoscopic procedures as a surgeon, n=15). Tasks were scored based on completion time, and specific rating scales were developed to assess performance. Internal consistency and inter-rater agreement were assessed. Face and content validity were determined using a 5-point Likert-type scale questionnaire. The novices needed considerably more time than the experts to perform EGD, GB, and FBR, and their performance scores were significantly lower (p<.010). Inter-rater agreement and the internal validity of the rating scales were good. Face validity was excellent, and both groups agreed that the endoscopy scenarios were very realistic. The experts highly valued the usefulness of Simuldog for veterinary training and as a tool for assessing endoscopic skills. Simuldog is the first validated model specifically developed to be used as a training tool for endoscopy techniques in small animals.

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Section: Discussionmentioning

confidence: 99%

Validation of a Realistic Simulator for Veterinary Gastrointestinal Endoscopy Training

Usón‐Gargallo¹,

Usón-Casaús²,

Pérez-Merino³

et al. 2014

Journal of Veterinary Medical Education

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“…Consequently, assessment of tissue quality, pulsation, and tension become quite difficult. 32 Other barriers to the current endoscopes include the inability to apply traction, lack of multiplanar instrumentation, and working channels that limit the size of instruments. These complexities associated with NOTES result in longer and more mentally tasking workloads for the operators and make NOTES far more challenging than traditional imaged-based procedures.…”

Section: Discussionmentioning

confidence: 99%

“…These complexities associated with NOTES result in longer and more mentally tasking workloads for the operators and make NOTES far more challenging than traditional imaged-based procedures. 32 The MICS robot was developed while taking these limitations into account. The benefits of this platform over other laparoscopic and robotic systems include the stability of the system, its low profile, multiquadrant accessibility, and the need for only a 12-mm enterotomy or incision.…”

Section: Discussionmentioning

confidence: 99%

“…As such, training becomes a challenge. 32 Because of the joystick control of the current robotic system for maneuverability and feedback, the steep learning curve of flexible endoscopy is potentially avoided, as are the inherent disadvantages of flexible endosocopes. Therefore, further development of the technology may allow for quick adaptation by a NOTES surgeon.…”

Section: Discussionmentioning

confidence: 99%

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A Novel, New Robotic Platform for Natural Orifice Distal Pancreatectomy

et al. 2014

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Laparoendoscopic technology has revolutionized the practice of surgery; however, surgeons have not widely accepted laparoscopic techniques for pancreatic surgeries due to the complexity of the operation. Natural orifice transluminal endoscopic surgery (NOTES) offers a great new potential for pancreatic procedures, with early data showing benefits of reduced visible scarring and the potential for decreased wound infections, hernias, pain, and postoperative complications. However, there are significant limitations to the currently used flexible endoscopy tools, including a diminished visual field, spatial orientation and tissue manipulation issues, and 2-dimensional visual feedback. We have adopted a novel snake-like robot, the minimally invasive cardiac surgery (MICS) robot, which addresses these issues. In the current pilot study, the MICS robot was evaluated for transrectal distal pancreas exploration and resection in 2 nonsurvival porcine models. Abdominal navigation and accessing the pancreas was investigated in the first pig, and based on its success, pancreas resection was studied in pig 2. The MICS robot was successful in accessing and visualizing the right upper, left upper, and left lower quadrants of the abdomen in pig 1 and was able to perform a successful complex NOTES procedure with distal pancreas resection in pig 2, with only minimal laparoscopic retraction assistance. In conclusion, preliminary results showing the MICS robot in natural orifice distal pancreatectomy are positive. Enhancements to optics and instrumentation will help further increase the usability in pancreatic interventions. Future indications may include transgastric NOTES approaches, endoluminal procedures, and single-port applications.

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“…Simulations of numerous endoscopic procedures have been developed, including diagnostic and therapeutic upper and lower endoscopy, [1][2][3][4] ERCP, 5-10 EUS, [11][12] and natural orifice transluminal endoscopic surgery. [13][14] Various modalities of simulators exist, including mechanical models, [7][8]15 live animal 16 and ex vivo tissue models, [3][4]6,12,14,[17][18] and computer-based virtual reality models. 9,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]41,[49][50][51][52][53] Each type of simulator has specific advantages and drawbacks.…”

mentioning

confidence: 99%