Design of an Inexpensive Physical Endoscopic Simulator to Facilitate Teaching the Fundamentals of Endoscopic Surgery Skills

Neil King, MD, Anastasia Kunac, MD, FACS, Gregory J Gallina, MD, FASCRS, Erik Johnsen, BS, Aziz Merchant, MD, FACS. Rutgers- The State University of New Jersey (All Campuses)

Background: Surgical simulation allows skills acquisition, shortens learning time for technical procedures, and may reduce patient complications.  Colonoscopy is a technical skill mandated by ABS of surgeons and endoscopy training is well suited to a simulation environment. Virtual reality endoscopy systems which have been adopted for national level testing and training are cost-prohibitive for many training programs.  We therefore sought to develop an inexpensive physical endoscopic simulator to facilitate Fundamentals of Endoscopic Surgery (FES) skills training. We hypothesized that we could build a feasible model for teaching basic colonoscopic skills for less than $500.00.

Methods: We constructed a physical colonoscopy simulator from locally available commercial materials. Data on construction times, material cost, and materials used were captured. We then tested the feasibility of the model with respect to the performance of the five Fundamentals of Endoscopic Surgery tasks by  surgical residents and attending physicians. Participants were given an orientation to the five FES tasks before attempting the simulator. Participants were given two attempts to complete the five tasks. Data were collected on time to completion of the colonoscopy, loop reduction, and polyp snare, as well as demographic data.  Participants also filled out a survey after using the simulator to assess the “realism” of the model.  .

Results: The initial physical simulator was built at a cost of $73, and took approximately 2.5 months to effectively troubleshoot and construct.  The model measures 30”x36” and weighs 8.5 pounds. and with appropriate instructions and materials can be built in less than 90 minutes. We are able to simulate the five skills tested on the FES practical exam on our model.  Our feasibility study has enrolled 15 participants: 100% of participants were able to complete all five tasks with a mean time to completion of simulated colonoscopy of 8:24 min [SD 2:36min] . Participants ranked the ease of performing the five tasks using our model and found the loop reduction and the retroflexion tasks the most difficult.

Conclusion: We have developed and constructed a low cost colonoscopy simulator. We have demonstrated that the five described FES skills can be performed on our simulator by both expert and novice endoscopists. Given that the simulator is inexpensive and easily reproducible, we believe our simulator can be be used as a cost effective method to teach basic endoscopic skills in other surgical residency training programs. 

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