Surgical Simulation: Introduction to Esophagogastroduodenoscopy (EGD)

The Introduction to EGD module provides instruction and practice in performing esophagogastroduodenoscopy. This procedure involves navigating the upper gastrointestinal tract, including the esophagus, stomach, and duodenum, examining the respective lining, and taking cytology samples of normal mucosa and suspicious lesions. The module allows users to track and manage some of the complications that might be encountered in a real procedure. Six progressively difficult cases expand learning by presenting variations in anatomy and pathology.

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 involved in EGD.

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 and time to intubate the upper esophageal sphincter and pylorus; complications such as perforation, oversedation, and tracheal intubation; inspection metrics such as inspection of the fundus, major papilla, and angularis incisura; use of pharmacological agents; patient discomfort metrics; and captured endoscopic images.

Training Objectives

• 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

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 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.