K E Grund1, U Schweizer2, A Zipfel2, B Duckworth-Mothes2,3. 1. Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany. chir.endo@uni-tuebingen.de. 2. Surgical Endoscopy, University Hospital for General, Visceral and Transplant Surgery, Centre for Medical Research, Experimental Surgical Endoscopy, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany. 3. Surgical Endoscopy, Experimental Endoscopy, Research and Training, Centre for Medical Research, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany.
Abstract
BACKGROUND: Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative. PROBLEM: The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. METHODS: Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT. RESULTS: In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. DISCUSSION: Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.
BACKGROUND: Anastomotic insufficiency and perforations in the gastrointestinal tract are severe complications associated with a high complication rate and mortality. Conventional treatment options (particularly re-operations) are often unsatisfactory. Endoscopic vacuum therapy (EVT) is increasingly being used as a promising alternative. PROBLEM: The use of EVT requires a high level of competence in interventional flexible endoscopy, which is primarily not available to every surgeon. Special training programs are required here. METHODS: Based on this need the long-proven Tuebingen training system for flexible endoscopy was modified to meet the special requirements of surgeons and is currently being extended by a special training module for EVT. RESULTS: In addition to the theoretical principles, the training is focused on learning the manual skills for flexible endoscopy. A 2-stage process was developed for this purpose: 1) to become familiar with handling of the flexible endoscope and to learn spatial orientation by means of a didactically optimized abstract phantom ("Tuebingen Orientophant") and 2) learning and training of EVT using a newly developed patient-analogous training model with various insufficiencies and abscess cavities in the upper and lower gastrointestinal tract ("Tuebinger Spongiophant"). The procedure can be trained hands-on step by step exactly as with the patient, whereby the sponge can be applied using different methods, such as overtube and dragging procedures. The consequences of mistakes and complication management can also ideally be trained hands-on using the phantom. DISCUSSION: Evaluations of the first course series show that surgeons achieve endoscopic competence very quickly and learn to master the new procedure. The structure of such a course must, however, be designed according to long-term experience in an optimal didactic manner. Decision-makers in healthcare policy should give much more support to such courses in order to improve patient care and to increase patient safety.
Authors: Diogo Turiani Hourneaux de Moura; Bruna Furia Buzetti Hourneaux de Moura; Michael A Manfredi; Kelly E Hathorn; Ahmad N Bazarbashi; Igor Braga Ribeiro; Eduardo Guimarães Hourneaux de Moura; Christopher C Thompson Journal: World J Gastrointest Endosc Date: 2019-05-16
Authors: Michael A Manfredi; Susannah J Clark; Steven J Staffa; Peter D Ngo; C Jason Smithers; Thomas E Hamilton; Russell W Jennings Journal: J Pediatr Gastroenterol Nutr Date: 2018-12 Impact factor: 2.839