Medical & Surgical Simulation: Upper GI

Multimedia Didactic Content

The module’s didactic content includes indications, contraindications, and complications of performing EGD and an illustration of the gross anatomy with corresponding definitions and/or detailed descriptions of the specific anatomy.

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
• Time to intubate the upper esophageal sphincter and pylorus
• Complications such as perforation, over sedation, and tracheal intubation
• Inspection metrics such as inspection of the fundus, major papilla, and angularis incisura
• Use of pharmacological agents
• Patient discomfort metrics
• Captured endoscopic images

Surgical Simulation Training Tools

The EGD module provides several teaching tools:

• Force feedback replicates the feel of navigating the endoscope and manipulating the working channel tools.
• The patient’s vital signs respond in a physiologically realistic manner to the administration of pharmacologic agents.
• Verbal feedback indicates the level of patient discomfort during the case and if the trachea was intubated.
• The built-in Virtual Attending gives real-time instruction during the procedure.
• An external view helps the user’s orientation by showing the position of the scope as the user navigates through the upper gastrointestinal tract.

Realistic Training Environment

Upon completion of this module, users will be able to:

• Navigate an endoscope through the upper gastrointestinal tract including intubation of both esophageal sphincters and the pylorus.
• Validate techniques for positioning the endoscope within the 3D model to properly inspect the mucosa, which includes retroflexing the scope tip to inspect all areas of the stomach.
• Identify pathology and acquire cytology samples of the pathology and nearby mucosa using forceps and/or a brush.
• Discuss the indications, contraindications, and complications involved in diagnostic EGD.
• Discuss tips and techniques for over coming common challenges specific to EGD.

Extensive Multimedia Didactic Content

Multimedia didactic materials provide an extensive background to help understand and visualize the procedure and its objectives:

• Videos demonstrate ERCP techniques, such as cannulation of the major and minor papilla.
• A comprehensive pathology atlas depicts both endoscopic and fluoroscopic pathologies.
• Interactive anatomy lessons include manipulating a 3D model to visualize anatomy at different angles.
• Information includes use of the endoscopic elevator, radiation, contrast injection, and orientation for selective cannulization

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
• Time to intubate pylorus
• Time to cannulate the major papilla
• Occurrence of complications such as perforation, over sedation, and over dilation of ducts by contrast
• Fluoroscopic metrics such as total fluoroscopy time, total amount of contrast injected, and amount of contrast injected into the pancreatic duct
• Use of pharmacological agents
• Patient discomfort metrics
• Captured endoscopic images and radiographs.

High-fidelity Surgical Training Tools

The ERCP module provides several tools for learning how to navigate the duodenoscope through the upper GI tract, selectively cannulate the biliary and pancreatic ducts, and obtain cholangiopancreatograms:

• Complications occur such as perforation, over-sedation, and pancreatic duct injury.
• Each computerized patient audibly responds to the endoscopist's actions by expressing discomfort or pain.
• Realistic action allows practicing techniques for intubating the esophagus, passing through the pylorus, and obtaining the proper scope angle for successful cannulation.
• The scope allows injecting contrast under fluoroscopy and obtaining radiographs from a variety of angles.
• The patient responds in a physiologically realistic manner to the administration of pharmacologic agents.
• Transparent views through the duodenum show the orientation of the biliary and pancreatic ducts.
• Animations explain the short-scope and long-scope positions and the influence these positions have on cannulating the papilla.
• A Virtual Attending provides real-time instruction during the procedure.
• Textual tips provide information for overcoming difficult cannulations.

Realistic Training Environment

Upon completion of this module, users will be able to:

• Demonstrate techniques for orienting the duodenoscope and selective cannulating the respective ducts in a simulated environment.
• Understand why ERCP requires a side-viewing scope with an elevator.
• Identify pathology and understand why contrast and fluoroscopy are needed to visualize duct variations.
• Discuss the indications, contraindications and complications of ERCP.
• Describe the common anatomic and pathologic variations of the biliary and pancreatic ducts.
• Understand the safe use of fluoroscopy in ERCP and some of its potential complications.
• Discuss tips and techniques for overcoming common challenges specific to ERCP.