Feasibility of Adaptating the Fundamentals of Laparoscopic Surgery Trainer Box to Endoscopic Skills Training Tool

Oscar M Crespin, MD1, Allan Okrainec, MD1, Andrea Kwong1, Ilay Habaz1, Maria C Jimenez, MD1, Jeff Mosko, MD1, Timothy D Jackson, MD1, Louis W Liu, MD1, Lee L Swamstron, MD2, Eran Shlomovitz, MD1. 1University of Toronto/University Health Network, 2Oregon Health Sciences University

Introduction: The SAGES Research Delphi Study prioritized the need to train surgeons and surgical trainees in flexible endoscopy. The Fundamentals of Laparoscopic Surgery (FLS) training box is a well-recognized and validated tool, already accessible to surgical trainees to hone their laparoscopic skills. Seeking a highly available, reusable, low-cost, and hands-on modality trainer we aimed to adapt the FLS training box and tasks for the development of endoscopic skills supplemental to Fundamentals of Endoscopic Surgery (FES).

Methods and Procedures: With ongoing consultation from five experienced surgeons and gastroenterologists, the setup of the training system and adaptation of FLS tasks were optimized for endoscopy. Adaptations focussed on utilizing as many of the existing components of the FLS training tool to maintain simplicity while allowing for the testing and practice of clinically relevant endoscopic skills.

Results: A front attachment panel with different opening options was designed to select the most ergonomic insertion point for an endoscope into the FLS training box (Figure A). A shaft provides additional support and limits movement of the endoscope at the point of insertion, forcing the utilization of the tip of the scope to perform the task  (Figure B). A platform on the inner surface of the panel permits performance of retroflexion tasks (Figure C). The endoscopic tower, originally excluded to minimize complexity of the setup, was eventually included to more realistically represent endoscopic visualization (Figure D).  Five endoscopic tasks were designed with most utilizing existing components from FLS (Table 1 and figures E, C, G, H).

Conclusions: An adaptation of the FLS training box has been developed for endoscopic skills with a focus on maintaining simplicity, reusability, and low-cost. Following validation, this adaptation may act as a training supplementation to the FES program. 

Table 1
Endoscopic TaskAdapted FLS ComponentsSimulation Intentions
Forward View Peg Transfer (Figure E)Pegboard, Triangular RingsBiopsies, General Scope Handling Skills
Retroflexed Peg Transfer (Figure C)Pegboard, Triangular RingsRectum and GEJ Intervention
Puncturing (Figure F)Precision CuttingNeedle Injection, Tattooing
Snaring (Figure G) Foam OrganPolyp Snaring/EMR
Clipping (Figure H)Suturing Board, Penrose DrainsMuscosal Closure



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