Yuhsin V Wu, MD, Steve J Schomisch, Phd, Cassandra N Cipriano, Jeffrey L Ponsky, MD, Jeffrey M Marks, MD
University Hospitals Case Medical Center
Introduction: The future of surgery is constantly evolving. With advancements in endoscopic techniques and equipment, more surgical procedures are becoming purely endoscopic or hybrid. In addition, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) will soon launch Fundamentals of Endoscopic Surgery (FES) for surgery residents. In order to keep up with this trend, surgeons need an effective training model to learn and practice therapeutic endoscopic procedures. We have devised a simple, reproducible, and cost-effective endoscopic model that can train future surgical endoscopists in band ligation, saline lift polypectomy, lesion tattooing, thermal and non-thermal methods of hemostasis, endoscopic mucosal resection, percutaneous gastrostomy tube placement (PEG), foreign body removal, esophageal and pyloric dilations.
Methods: To start, an explanted porcine esophagus and stomach is stabilized on a modified peg board. The esophageal orifice is cannulated with a custom over-tube and the duodenal segment ligated. Using an upper endoscope, an endoscopic band ligator is used to practice endoscopic band ligation. As a result, multiple gastric pseudopolyps are created. Once the “polyps” are created, the participant will now practice saline lift polypectomy techniques and tattooing of the “lesion” site. The resected pseudopolyp site now resembles a gastric ulcer. The participant will then practice obtaining hemostasis utilizing thermal (cautery, APC) and non-thermal techniques (epinephrine injections, clipping). Additionally, marbles, coins, paper clips, safety pins, and jacks may be placed into the explant to practice foreign body removal. A stricture can be simulated at the explant’s lower esophageal sphincter and pylorus. This allows the participant to practice balloon dilations. A PEG tube may also be placed using pull, push, or introducer technique.
| Supply (quantity) | Cost |
| Explanted Esophagus&Stomach (1) | $25 |
| Basic Surgical Supplies | $50 |
| *Over-tube (1) | $150 |
| Multi-band Ligator (6 bands) | $236 |
| *Injection Needle (1) | $20 |
| *Polyp Snare (1) | $34 |
| *EMR Cap (1) | $24 |
| *Thermal Hemostasis Catheter w/inj needle (1) | $240 |
| Endoscopic Clips (5) | $341 |
| Roth Net (1) | $75 |
| *Esophageal Balloon Dilator (1) | $116 |
| Inital PEG kit (1) | $99 |
| Total | $1410 |
| * re-usable | |
Results: This model is capable of teaching 9 therapeutic endoscopic procedures without the need for special laboratory space, live animals, or human cadavers. Techniques learned also carry over for lower gastrointestinal procedures. Our training supplies were generously supported through an educational grant. However, if calculated at standard purchasing costs, each module would cost approximately $1410 excluding the cost of the endoscopic tower and scope (Table 1 lists the cost of supplies). Of note, many pieces of equipment are reusable (indicated by *). To date, this model has successfully trained 1200 surgical residents, 640 MIS fellows, and 240 attending surgeons.
Conclusion: Explanted gastroesophageal endoscopic model is an easily reproducible and cost effective model suitable for training all levels of trainees in therapeutic endoscopic techniques.
Session: Poster Presentation
Program Number: P169
