Ex Vivo Bovine Model: A Diagnostic and Therapeutic Endoscopy Training Model

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Ex Vivo Bovine Model: A Diagnostic and Therapeutic Endoscopy Training Model

By Richard Whelan 6 Videos FEATURING Richard Whelan

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March 12, 2019

Introduction: Flexible endoscopy is an integral part of General and Colorectal
Surgery. The American Board ...
read more ↘ of Surgery (ABS) now mandates endoscopy training and
successful completion of the Fundamentals of Endoscopic Surgery program. As a result
simulators have become a ubiquitous tool for pre-clinical training. While simulators are
useful for learning scope insertion and maneuvering skills, they fall short in actual
tissue handling via endoscopic instrumentation. We developed an ex vivo bovine model
to be used as an adjunct to endoscopy simulators. Once insertion and maneuvering
skills have been acquired, trainees will use this model to learn basic diagnostic and
therapeutic endoscopy skills. These include clinically essential skills such as biopsy,
tattooing, and polypectomy.
Method: A bovine colon obtained from a slaughterhouse is cleaned, and the proximal
end is everted to expose the mucosa. Targets for biopsy and saline lift are created
using a heated nail head. Polyps are made using a hemorrhoid bander. Once the lesions
are created, the end is inverted and sealed using a clip. The colon is insufflated, and
the trainees proceed to biopsy 6 targets, lift 6 targets, and snare 4 polyps. The
difficulty level can be increased by placing the colon in different configurations.
Results/Conclusion: The ex vivo bovine model provides realistic visual and tactile
feedback. Further, it mimics clinical endoscopy in terms of tissue handling, scope
manipulation using torque and tip deflection, insufflation, lens cleaning, as well as
through the channel instrumentation. These advantages enable optimal pre-clinical
training in basic diagnostic and therapeutic endoscopy after scope insertion and
maneuvering skills have been acquired. Early experience in this ongoing study
indicates that proficiency with the model can be obtained in 5 sessions. Gaining
proficiency with the ex vivo bovine model allows trainees to develop more advanced
skills during their subsequent clinical exposure to endoscopy.
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