A mechanical model for ERCP training

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

The major limitation to the training of therapeutic endoscopist is the lack of practice opportunity. Hands on training is at a premium. Different practice methods including animal models and computer simulators are used. Computer models are expensive, often lack tactile sensation and may not use the real instrument or accessories. Animal models have their own limitations. A mechanical model has been developed for ERCP training. Method: Using simple tubing for plumbing and electrical circuitry, we constructed a mechanical model for ERCP training. Unique features of this model included a papilla made of special cuttable material and a transparent plastic bile duct, where stricture can be created and stones placed inside for extraction. We used a self recoil catheter and guidewire system for cannulation and optical sensors to monitor the success of cannulation. An external camera is used in place of fluoroscopy to monitor the events inside the bile duct. The model is used with standard ERCP equipment including duodendoscope, monitors and diathermy unit. The model permits the trainee to practice orientation and correct positioning of the endoscope for cannulation. Successful cannulation is monitored endoscopically, by the optical sensors and the external camera when deep CBD cannulation is achieved. Papillotomy can be performed using a standard papillotome and diathermy unit at the usual setting. Subsequent stone extraction can be performed with basket or balloon, and biliary stenting performed using standard accessories. A large replaceable bile duct permits mechanical lithotripsy of large stones. Results: the average time taken for the trainee to orientate the endoscope and perform successful cannulation is 5 to 10 minutes. Papillotomy can be performed in 10 minutes and biliary stenting within 15 minutes. Conclusion: This mechanical model allows the trainee to practice therapeutic ERCP procedures and gain experience and familiarity with the real instrument and accessories; it also facilitates coordination between the endoscopist and assistant. It minimizes the anxiety of the inexperienced trainee during the learning process and the frustration of the trainer over a prolonged procedures with the risk of oversedation. Prospective studies are being set up to determine the potential benefit of this training e.g. shorten procedure time, higher success rate and reduced fluoroscopy time in ERCP procedures.

Original languageEnglish (US)
Pages (from-to)317
Number of pages1
JournalGastrointestinal Endoscopy
Volume43
Issue number4
StatePublished - 1996

ASJC Scopus subject areas

  • Gastroenterology

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