For endoluminal and laparoscopic training and education, sufficient training models
are available. Neither of these, however, are suitable for NOTES. We developed a new
simulation model including a highly immersive endoluminal and intraabdominal environment
to perform both combined laparoscopic/endoscopic rendezvous procedures as well as
NOTES interventions.
Material and methods: The anatomical mockup of a human trunc including the head and stumps of the arms
and legs contains the entire gastrointestinal tract. The stumps of the legs are fixed
in lithotomy position to provide access to the anus. Flab valves are integrated into
the esophagus and the rectum to retain the insufflated gas.
The abdominal cavity – based upon a former CLA prototype (Coburger Lehrmittelanstalt,
Coburg, Germany) is gas-tight with an extendable abdominal wall. Transmural insertion
of Veress needles or trocars is possible without gas loss. The texture of the GI-tract
and of the gallbladder can be mechanically dissected and approximated by standard
flexible instruments.
Results: The comprehensive spectrum of current translumenal endoscopic surgery could successfully
be performed via the transgastric or transsigmoid (ISSA) approach. Since no electrocautery
can be applied, dissecting with scissors was required. Reliable closure of canalicular
structures could be achieved by clips and stapling devices.
Conclusion: The newly created simulation model for NOTES appears to be useful for training and
education of NOTES procedures. The only restriction is that electrocautery cannot
be applied.
Supported in part by Bavarian Research Foundation
Keywords: NOTES, Training, Simulation, Hybrid Procedures, Laparoscopy
