A new endoscopic/laparoscopic interdisciplinary training and education (ELITE) system for NOTES

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