INTERVENTIONAL TRAINING MODEL FOR FLEXIBLE ENDOSCOPY IN POSTOPERATIVELY ALTERED ANATOMY OF THE UPPER GI TRACT

Aims Many surgeries in the upper gastrointestinal tract, especially the steadily growing number of bariatric procedures, often result in a fundamentally altered anatomy. Insufficient knowledge of the altered anatomy leads to an increased risk in follow-up endoscopy, for example due to cholelithiasis after bariatric surgery. A realistic, patient-like training model is not yet available, but could improve the quality of diagnostic and, above all, therapeutic endoscopy in patients with postoperatively altered anatomy.

Methods First, the altered anatomy was completely reconstructed with digital 3D programs using patient-analog data. Materials from textile research were used as well as rigid and flexible 3D printing materials for tissue replication. Furthermore, already developed and patented artificial tissues, plastics such as latex, acrylic, silicone and various elastomers were used to reproduce animal-free, realistic and interventional organ structures of the upper gastrointestinal tract.

Results A modular hands-on training phantom was created, which shows a situation after partial gastric resection with Roux-en-Y reconstruction. Further anatomical variants (gastric bypass, Billroth II, reconstruction after Whipple surgery) are currently being developed. Interventionally, an ERCP can be trained under fluoroscopy with papilla and bile duct intervention with different access techniques (e.g. device assisted enteroscopy) as well as the treatment of a duodenal stump insufficiency with a VAC sponge.

Conclusions The training of flexible endoscopy for patients with postoperatively altered anatomy is possible with newly developed phantoms. An evaluation of the phantom is performed on volunteers with different levels of experience.