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Surgical Simulation of Bronchoscopy: Transbronchial Needle Aspiration
(TBNA)
In the TBNA module, the user learns to correctly use a cytology needle
to biopsy a lymph node. Four cases, which include pertinent information
to guide decision-making before and during the procedure, present progressively
difficult anatomies and pathologies. This step-wise learning method can
help users attain broader experience in less time. The module’s
didactic content covers basic anatomy, patient selection, tools, techniques,
and complications of TBNA. CT images provide context for learning diagnostic
skills and a "Virtual Attending" feature advises the user on
correct technique and warns of potential harm to the patient.
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 that are recorded include total procedure time; number of needle
punctures; number of successful aspirations and vessel punctures; details
of potential scope damage; and details of potential sample contamination,
including the number of times scope suction was used prior to completion
of aspirations and the number of times the needle was withdrawn from a
node before suction was broken.
Training Objectives
Upon completion of the TBNA Module users will be able to:
- Discuss the indications, contraindictions, and complications of TBNA
- Identify the approximate locations of the 11 mediastinal lymph node
stations
- Discuss the use of the cytology needle for TBNA
- Describe the correct technique for performing TBNA, including obtaining
a nodal sample
- Perform a simulated transbronchial needle
aspiration
Realistic Environment Aides
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
Transbronchial Needle Aspiration module includes several teaching tools
to help users accurately navigate through the tracheobronchial tree, correctly
locate biopsy sites, and safely use the cytology needle:
- Force feedback duplicates the feel of bronchoscope navigation and
cytology needle use
- Needle penetration deforms tissue and causes bleeding
- Patients exhibit physiological changes based on users’ actions
- Interactive anatomical maps show the location of lymph nodes relative
to the tracheobronchial tree
- Transparency feature allows users to visualize pathology shape and
location
- Instructional videos detail each step of a successful TBNA
- Photos of actual TBNA cytology specimens illustrate a variety of possible
aspirate samples
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