Surgical Simulation of Bronchoscopy: BAL and Endobronchial Sampling

The sampling tools for this surgical simulation module include a needle, forceps, and brush, all entering via the working channel of a realistic bronchoscope. The interaction of the tools with pathology enhances the realism through deformation of tissue and realistic bleeding. The patient breathes, coughs, and exhibits changes in vital signs based on users' actions.

The two bronchoalveolar lavage (BAL) and four endobronchial sampling case histories, including x-ray and CT images, provide pertinent information to guide decision-making. The cases present progressively challenging anatomy and pathology for a wide range of experience.

A thorough evaluation report is automatically generated every time a user proceeds through 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, percent of bronchial segments entered, order of the bronchi visualized, number of scope collisions with the airway wall, aliquots of lidocaine and saline used, and details of the tracheobronchial inspection.

Training Objectives

Upon completion of the BAL and Endobronchial Sampling module, the user will be able to:

• Discuss the procedural steps performed during BAL
• Understand the correct positioning of the bronchoscope
  necessary for a BAL
• Describe pathological conditions that require a BAL
• Discuss the use of forceps, needles, and brushes for
  sampling endobronchial lesions
• Describe the procedural steps performed to obtain an
  endobronchial sample
• Understand the correct positioning of the bronchoscope
  necessary for a biopsy
• Describe common complications that can occur when
  sampling endobronchial lesions with a forceps, needle,
  or brush

Realistic Educational Aids

The Endoscopy AccuTouch® System delivers realistic, procedure-based content for cognitive and motor skills training. The system
consists of a PC, an interface device with interchangeable
anatomy, proxy endoscopes, and software modules for a wide range of training scenarios. The Bronchoaleolar L avage (BAL) and Endobronchial Sampling module includes several teaching tools:

• Road signs, superimposed over the display can be switched on to provide international nomenclature for the pulmonary anatomy, allowing users to orient themselves and solidify their understanding of anatomy and terminology.
• An external view helps the user visualize the location of the scope.
• A Virtual Assistant foot pedal allows for solo operation of the simulator.
• A video capture button allows for pictures of the pathology to be taken and stored.