Laparoscopic Surgery

EndoSim developed a realistic simulation model of common laparoscopic procedures using ex-vivo explants. A domed lid includes a rubber membrane that allows insertion of laparoscopic ports and instruments. The ex-vivo specimens used in the EASIER 1 or 2 model consist of porcine tissue or bovine tissue harvested at USDA inspected slaughterhouses as a byproduct of the meat production industry. The ex-vivo tissue promotes a realistic laparoscopic experience using commercially available laparoscopic devices. Of highest importance, is the haptic feedback of real tissue simulation models that provide a comparable training environment as in a real patient.

Natural Orifice Translumenal Endoscopic Surgery (NOTES)

For the simulation of NOTES, a complete porcine peritoneal cavity explant is used in the EASIER model for the simulation of endoluminal and transluminal surgical procedures.

This model is useful for the training of basic NOTES procedures, such as establishing transgastric and transcolonic access, peritoneal exploration, and tissue biopsy. For the more advanced ‘digestivist’, the EASIER can facilitate organ resection (cholecystectomy, distal pancreatectomy, liver lobe resection, hysterectomy, oophorectomy) or gastrointestinal anastomosis techniques (gastrojejunostomy, partial gastrectomy, colectomy). Multiple gastrotomies or colotomies can be performed in a single model. To facilitate multiple participants during gastrotomy or colotomy, each procedure ends by closing the perforation with a variety of closure devices.

In addition to the endoscopic view, surgical procedures can be observed through the clear acrylic cover. By removing the lid, a direct assessment of tissue incision, resection, and clip application can be undertaken by gross inspection of the the surgical site.

In contrast to using live animals for NOTES training, the use of ex-vivo specimens obtained from the meat industry, does not involve ethical concerns and is not subject to IRB approval.

For the simulation of laparoscopy or hybrid NOTES procedures a special cover with laparoscopic ports is used instead of the clear lid. This permits the use of commercially available laparoscopic instruments.

Skin Suture Pad

Skin samples from real porcine skin can be used to practice suturing such as closing cuts and lacerations with simple and advanced interrupted suturing, subcuticular suturing, continuous suturing, skin stapling or application of adhesive strips.

Surgical Real Tissue Ex-vivo Models

Porcine full abdominal explant

Esophagus, stomach, duodenum, pancreas, ileum, liver, gallbladder, and kidneys

• Laparoscopic cholecystectomy

• Laparoscopic appendectomy

• Laparoscopic Roux-en-Y gastric bypass

• Laparoscopic Sleeve gastrectomy

• NOTES

EMR/ESD

Porcine ex-vivo esophagus-stomach-duodenum specimen

• Diagnostic EGD

• Endoscopic Mucosa Resection (EMR)

• Endoscopic Submucosal Dissection (ESD)

• Variceal band ligation

POEM

• POEM

Balloon Enteroscopy

Porcine ex-vivo esophagus, stomach, duodenum and 6 feet of small bowel (ileum)

• Single balloon enteroscopy

• Double balloon enteroscopy

Stomach Defect

Porcine ex-vivo esophagus-stomach-duodenum specimen with target perforations

• Perforation closure

UGI Hemostasis

Porcine ex-vivo esophagus-stomach-duodenum specimen with 6-8 bleeding vessels sutured into the anterior stomach wall

• Hemostasis in the upper GI tract:

• Injection

• Cautery

• Clipping

• Suturing

Twisted Sleeve

Porcine ex-vivo esophagus-stomach-duodenum specimen with altered anatomy resembling the status post laparoscopic sleeve gastrectomy

• Twisted sleeve model realistically simulates a gastric volvulus as a complication of laparoscopic sleeve gastrectomy

Zenker’s

Cartridge task trainer with ex-vivo model of an artificial pharyngoesophageal diverticulum with a pharyngeal pouch

• Zenker diverticulotomy

Roux-en-Y Gastric Bypass

Porcine ex-vivo esophagus-stomach-duodenum specimen with altered anatomy resembling the status post laparoscopic Roux-en-Y gastric bypass

• ERCP in Roux-en-Y Gastric Bypass Anatomy

Porcine Colorectal Specimen

Porcine colon and rectum with mesentery, urinary bladder, vagina, ovaries, salpinx

• Laparoscopic colectomy

• Laparoscopic hemicolectomy

Bovine Colorectal Specimen

Bovine colon and rectum with mesentery, urinary bladder, vagina, ovaries, salpinx

• Laparoscopic colectomy

• Laparoscopic hemicolectomy

Bovine Colon Polyp specimen

Bovine ex-vivo colon specimen with 6-8 bleeding vessels

• Endoscopic Polypectomy in the colon

Proctoscopy

Cartridge model of a porcine ex-vivo anus and rectum

• Proctoscopy

• Hemorrhoid ligation

• Anal sphincter repair

Bovine colon EMR/ESD specimen

Bovine ex-vivo colon specimen

• EMR/ESD in the colon and rectum

Colonic stenosis

Porcine ex-vivo colon specimen with simulated stenosis

• Colon dilation and stent placement

LGI Hemostasis

Porcine ex-vivo colon specimen with 6-8 bleeding vessels

• Hemostasis in the colon or rectum

Porcine Colon Polyp specimen

Porcine ex-vivo colon specimen with 6-8 bleeding vessels

• Polypectomy in the colon

Bovine Colon Polyp specimen

Bovine ex-vivo colon specimen with 6-8 bleeding vessels

• Polypectomy in the colon