Medical
Surgical Simulation: Lower GI System
The surgical simulation Endoscopy AccuTouch® System with lower GI modules provides a wide range of training scenarios through its software modules listed below.
The simulator with lower GI modules was introduced in 1999, and since that time hundreds of customers have integrated the simulator into their training programs. Some of their experiences are documented below under Case Studies.
Many clinical studies related to the surgical simulator’s training effectiveness have also been performed and published in leading medical journals. A few of them are listed below under Clincial Studies.
A return on investment study was performed for this simulator by Frost & Sullivan. See the ROI tab for more information.
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Medical & Surgical Simulation: Introduction to Flexible Sigmoidoscopy
In the Introduction to Flexible Sigmoidoscopy module, the user is introduced to the anatomy and procedure of gastrointestinal endoscopy training through educational aids including:
- 3D animations
- Video tutorials
- Illustrations of the endoscopic, embryologic, and gross anatomy of the colon
A pathology atlas depicts lesions that may be encountered during an examination, and clinical pearls help users find the lumen and overcome paradoxical motion. In addition, this surgical simulation module provides:
- A realistic surgical environment
- Objective, automated evaluations
- Training for proficient technique
Read more about Flexible Sigmoidoscopy
Realistic Surgical Simulation Training
The Endoscopy AccuTouch System delivers realistic, procedure-based content for cognitive and motor skills training. Introduction to Flexible Sigmoidoscopy provides practice in using a flexible signmoidoscope to conduct a thorough examination of the colon and includes several teaching tools:
- The flexible sigmoidoscope looks, feels, and handles like a real scope, allowing users to perfect their technique.
- The simulation contains realistic features such as red-out when the scope tip presses against the mucosa and paradoxical motion when in a loop.
- The patient reacts vocally to the user’s actions, complaining of pain when appropriate.
- The external view helps users orient by showing the real-time position of the scope tip in the gross anatomy.
- Buttons on the sigmoidoscope allow the user to capture images of detected lesions for later review.
- Case histories provide pertinent information on the simulated patient.
- The Virtual Attending feature provides instructional feedback to students during the procedure.
- Anatomy displayed during the procedures is derived from actual patient data and reacts like real tissue in real time.
- The colon expands with air insufflation and collapses with suction.
Evaluation Report Offers User-Specific Documentation
A thorough evaluation report is automatically generated every time a user completes a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency. Items recorded include:
- Time to complete the procedure
- Depth of scope insertion
- Percent of colonic mucosa visualized
- Patient comfort
- Whether retroflexion was performed
- Use of educational tools
Training Objectives for Mastery
Upon completion of the module, users will be able to:
- Discuss the indications, contraindications, and complications of flexible sigmoidoscopy, and the skills necessary to perform a sigmoidoscopic examination
- Identify and describe the pertinent anatomy
- Describe the goal of a sigmoidoscopic examination and how to prepare the patient for the procedure
- Demonstrate the correct technique for holding, operating, and manipulating the flexible signmoidoscope in a simulated environment
- Understand the procedural steps required to perform a complete sigmoidoscopic examination
- Describe the types of lesions that may be found during an examination
Medical & Surgical Simulation: Introduction to Colonoscopy
The Endoscopy AccuTouch Surgical Simulation System's Introduction to Colonoscopy module supplies realistic events and interactions, such as:
- Red-out when the scope tip presses against the mucosa
- Stool on the lens
- Paradoxical motion when in a loop
The module uses a colonoscope that looks, feels, and handles like a real one, and provides:
- A realistic surgical environment
- Objective, automated evaluations
- Experiences that help develop proficiency
Didactic content covers embryologic, gross, and endoscopic anatomy. Step-by-step video tutorials show how to operate the colonoscope, conduct a complete examination, and complete procedural preparation, from patient education through colon prep and premedication.
Realistic Surgical Simulation Training
Introduction to Colonoscopy helps users learn basic scope handling techniques for gastrointestinal endoscopy, including how to negotiate loops and navigate through the entire colon. It includes several teaching tools:
- Patients react vocally to the user’s actions, complaining of pain when appropriate.
- Abdominal compression can be applied by the virtual assistant to the region where loop formation is suspected.
- Patient positioning can be changed to aid in navigating flexures or loops.
- Clinical tips are included for finding lumen and overcoming paradoxical motion.
- Maneuvers for negotiating loops, including N-loops, alpha loops, and reversed alpha loops, are presented in split-screen animation format.
- A Virtual Attending feature provides instructional feedback to the user during the procedure.
Evaluation Report Offers User-Specific Documentation
A thorough evaluation report is automatically generated every time a user completes a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency. Items recorded include:
- Time to complete the procedure
- Depth of scope insertion
- Colonic perforations
- Patient comfort
- Whether retroflexion was performed
- Percent of colonic mucosa visualized
- Degree of pain experienced by the patient
- Whether excessive sedation was used
- Details on scope handling and visualization parameters
Training Objectives for Proficiency
Upon completion of the Introduction to Colonoscopy Module, users will be able to:
- Describe the anatomy of the colon pertinent to colonoscopy
- Demonstrate the operation of the colonoscope
- Perform a simulated colonoscopy examination
- Describe common colorectal lesions encountered during colonoscopy
- Discuss tips and techniques for overcoming common problems
Medical & Surgical Simulation: Colonoscopy Biopsy
The Endoscopy AccuTouch Surgical Simulation System's Biopsy module focuses on using forceps in the working channel of the endoscope to interact with the mucosa and lesions. Interaction between the forceps and mucosa shows tissue deformation and accurately reflects tissue resistance and the amount of pressure exerted by the tool when taking a sample. Intubation of the terminal ileum is also possible. The module includes:
- Extensive multimedia didactic content
- Objective, automated evaluations
- Training for proficient technique
- A realistic surgical environment
Read more about Colonoscopy Biopsy
Extensive Multimedia Didactic Content
Extensive multimedia didactic content expands the learning experience. Video tutorials demonstrate:
- The function of the working channel
- Use of irrigation to better visualize the colonic wall
- How to take biopsies
Indications, contraindications, and complications of biopsy are detailed, and a comprehensive pathology atlas depicts actual lesions and polyps that may be encountered during an examination.
Evaluation Report Offers User-Specific Documentation
A thorough evaluation report is automatically generated every time a user completes a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency. Items recorded include:
- Time to complete the procedure
- Depth of scope insertion
- Colonic perforations
- Patient comfort
- Whether retroflexion was performed
- Percent of colonic mucosa visualized
- Degree of pain experienced by the patient
- Whether excessive sedation was used
- Details on scope handling and visualization parameters
- Number of successful biopsies, including their type and location
Training Objectives for Proficiency
Upon completion of the Colonoscopy: Biopsy Module, users will be able to:
- Identify pathologies, interact with the colon model, and perform a biopsy in a simulated environment
- Understand the basic differences and usage between the types of forceps available
- Appreciate the basic colonoscopy navigational techniques that make biopsying in certain areas of the colon easier
- Demonstrate, in a simulated environment, some of the uses of the working channel
- Discuss tips and techniques for overcoming common problems specific to biopsy
Realistic Surgical Simulation Environment
The Endoscopy AccuTouch System delivers realistic, procedure-based content for cognitive and motor skills training for this gastrointestinal endoscopy procedure. Colonoscopy: Biopsy provides several teaching tools:
- Forceps can be used anywhere in the simulated colon and can biopsy any part of the mucosa repeatedly.
- Irrigation allows the user to loosen stool or glandular secretions from the mucosa surface and typically improves the amount of mucosa visualized during the simulated procedure.
- Skills of navigation and intubation of the simulated terminal ileum can be practiced using either direct or retroflexion techniques.
- A submucoscal tenting animation demonstrates how an overzealous endoscopist may grasp too much tissue, which may lead to complications.
- Clinical tips illustrate innately difficult biopsy locations and how scope angulation is required in order to take a biopsy.
- Optimal distance for taking a biopsy sample is demonstrated through 3-D animation.
- A Virtual Attending feature provides instructional feedback throughout the procedure.
Medical & Surgical Simulation: Basic Polypectomy
The Basic Polypectomy module allows users to identify, capture, transect, and remove simulated polyps. Polypectomy surgical simulation equipment includes:
- Snares & Mini snares
- Hot forceps
- Electrocautery tips
- An electrosurgical unit
Complications include uncontrolled bleeding when the polyp head is guillotined, electrocautery-induced perforation, and vasovagal reactions.
The module provides:
- Extensive multimedia didactic content
- A realistic surgical environment
- Objective, automated evaluations
- Experiences for developing proficiency
Extensive Multimedia Didactic Content
Multimedia didactic content supports cognitive learning and includes:
- Videos that demonstrate fundamentals and proper technique
- A comprehensive pathology atlas that depicts actual polyps and carcinomas that may be encountered
- Illustrated information on appropriate preparation and use of polypectomy equipment
Realistic Surgical Simulation Training
The Colonoscopy: Basic Polypectomy module provides several teaching tools for learning polypectomy:
- Polyps react and deform as the snare and forceps interact with the tissue, leaving appropriate visual clues, such as bleeding and burn marks.
- Examples of resistance the user will feel include: using the forceps to grasp tissue, tugging on the snare encircling a polyp, and pulling a retrieved polyp head through the working channel.
- Patient verbal feedback indicates the level of patient discomfort during the procedure.
- Complications such as uncontrolled bleeding when the polyp head is guillotined, electrocautery-induced perforation, and vasovagal reactions help prepare the endoscopist for an actual procedure.
- Sedative and counter sedative selections affect patients' vital signs and pain threshold.
- A Virtual Attending feature provides information on pathology type and procedural technique.
- External view and Find Scope Tip features aid in recognizing scope location.
- Animations illustrate concepts, complications, and situations difficult to teach, including submucosal tenting, submucosal burn, contralateral burn, and transection considerations.
- Videos demonstrate the usefulness of air insufflation and suction to distinguish hyperplastic polyps from other small polyps.
Evaluation Report Offers User-Specific Documentation
A thorough evaluation report is automatically generated every time a user completes a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency. Items recorded include:
- Time to complete the procedure
- Depth of scope insertion
- Colonic perforations
- Patient comfort
- Whether retroflexion was performed
- Percent of colonic mucosa visualized
- Degree of pain experienced by the patient
- Whether excessive sedation was used
- Type of pathology identified
- Location ofvthe pathology
- Whether the polyp head was transected
- Whether uncontrolled bleeding occurred
- If the polyp was retrieved Electrocautery metrics
Training Objectives for Developing Proficiency
Upon completion of this module, users will be able to:
- Use basic techniques to capture, transect, and retrieve simulated polyps
- Recognize the utility of certain tools and understand why they are better suited for certain types of polyps
- Recognize the benefits of electrocautery and the damage it can do in the simulated colon if performed improperly
- Appreciate some of the complications inherent to polypectomy
- Discuss tips and techniques for overcoming common problems specific to polypectomy
University of Aberdeen Clinical Skills Centre
Medical Simulation Promotes Training Excellence
Challenge
Educate both novice and experienced physicians Provide a cost-effective platform for learning several procedures Allow skills maintenance
Solution – More Complete Training with Immersion’s Endoscopy AccuTouch System
- Enables physicians to identify and address common complications, become familiar with the devices used during the procedure
- Independently determines skill levels using automated performance metrics
- Patented force feedback technology offers as close to a real feel for the procedure as possible
Outcome – Faster Learning on a Variety of Procedures
- Used the same machine for training on upper and lower GI and brochoscopy procedures
- Purchased Immersion Medical’s vascular access system to train nursing students in intravenous insertion
- Helped to speed learning
- Helped physicians refresh skills
Philadelphia GI Training Group
Simulator Provides Faster Proficiency, Reduced Risk, and Increased Efficiency for Colonoscopy Training
Challenge
- Decrease time to proficiency
- Minimize patient discomfort
- Reduce procedural time and risk
Solution – A Better Way to Teach with Immersion’s Endoscopy AccuTouch System
- Attending physicians can review progress of each novice clinician
- Trainees can access a virtual attending physician for context-sensitive help
- Allows practice on various techniques
- Perform without stress and without risk of patient complications
Outcome – Randomized Survey Results
- Simulator group achieved superior skill scores during the first and second months
- Six-month evaluation showed significantly faster time to cecal intubation
- Fellows gained confidence and a better understanding of how the colon might react in certain circumstances
- Enabled attending physicians to be more efficient without adding 30 percent training overhead to complete procedures
Rush University Medical Center
Simulation Improves Training, Patient Safety, Program Efficiency, and Recruiting
Challenge
- Reduce frustration of gastroenterology fellows
- Enable more rapid progress
- Allow easier skills assessment
- Improve performance on human cases
Solution – A Shorter Learning Curve with Immersion’s Endoscopy AccuTouch System
- Combines didactic and hands-on training
- Helps develop knowledge and skills by presenting progressively difficult anatomy and pathology
- Allows fellows to perform 30 or 40 simulated cases per week
- Fosters more individualized education
- Mimics the feel of a real colonoscopy
Outcome – A Five-year Study
- Reduced number of cases to achieve clinical competency in sigmoidoscopy from 30 to 15
- Allowed first-year fellows to make it to the cecum during their first case
- Enabled trainees to complete sophisticated maneuvers and apply behaviors they learned on the simulator without instruction from the attending physician
- Lowered patient discomfort
- Reduced procedural time
- Helped recruit fellows
ROI
An independent six-month study to determine the payback period for Immersion Medical simulators has concluded with
- A report (PDF) on the elements that contribute to ROI
Download the report now. - Median ROI periods
About the Study
- The study was possible because Immersion Medical simulators have been in use by hospitals and training programs for a sufficient period of time to allow an in-depth evaluation of their performance.
- Detailed interviews and surveys of 237 attending staff physicians, residency directors, nursing directors, nurses, risk managers, and CFOs or controllers in hospitals, universities, and community colleges across the U.S. were used.
- The Health Research and Educational Trust (HRET), the research affiliate of the American Hospital Association, provided access to the study's control group - 145 medical personnel who did not use Immersion Medical simulators.
- The study was performed by Frost & Sullivan, a world leader in growth consulting and competitive intelligence; corporate strategy and best practices; training; and technology, market, economic, and customer research.
