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Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT)

Erlernen der flexiblen Endoskopie, insbesondere der endoskopischen Vakuumtherapie (EVT)

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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.

Zusammenfassung

Hintergrund

Anastomoseninsuffizienzen und Perforationen im Gastrointestinaltrakt stellen schwerwiegende Komplikationen dar, die mit hoher Komplikationsrate und Letalität einhergehen. Bisherige Therapieoptionen (v. a. Reoperationen) verlaufen oft unbefriedigend. Als vielversprechende Alternative kommt mehr und mehr die endoskopische Vakuumtherapie (EVT) zum Einsatz.

Problem

Die EVT erfordert hohe Kompetenz in der interventionellen flexiblen Endoskopie, die primär nicht jedem Chirurgen zur Verfügung steht. Hier sind spezielle Trainingsprogramme erforderlich.

Methoden

Ausgehend von dieser Notwendigkeit wurde das lange bewährte Tübinger Trainingssystem für flexible Endoskopie für die besonderen Erfordernisse von Chirurgen modifiziert und aktuell durch ein spezielles Trainingsmodul für die EVT erweitert.

Ergebnisse

Neben den theoretischen Grundlagen steht vor allem das Erlernen der handwerklichen „skills“ der flexiblen Endoskopie im Vordergrund. Dazu wurde ein 2‑stufiges Verfahren entwickelt: 1. Erlernen der Handhabung des flexiblen Endoskops und der Orientierung im Raum anhand eines didaktisch optimierten abstrakten Phantoms (Tübinger Orientophant). 2. Erlernen und Training der EVT anhand eines neu entwickelten patientenanalogen Trainingsmodells (Tübinger Spongiophant) mit verschiedenen Insuffizienzen und Abszesshöhlen im oberen und unteren Gastrointestinaltrakt. Dabei kann schrittweise das Vorgehen genau wie beim Patienten trainiert werden, wobei der Schwamm mit verschiedenen Methoden (Overtube, Nachschleppverfahren etc.) „hands-on“ (praktisch) appliziert werden kann. Auch der Umgang mit Fehlern und Komplikationen kann ideal hands-on wiederholt geübt werden.

Diskussion

Auswertungen der ersten Kursserien zeigen, dass Chirurgen bei diesem Vorgehen sehr schnell endoskopische Kompetenz erreichen und das neue Verfahren beherrschen lernen. Die Struktur eines solchen Kurses muss allerdings entsprechend langjähriger Erfahrungen didaktisch optimal gestaltet werden. Von gesundheitspolitischer Seite sollten solche Kurse mehr unterstützt werden, um die Patientenversorgung zu verbessern und die Patientensicherheit zu erhöhen.

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Authors and Affiliations

  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

    K. E. Grund, U. Schweizer, A. Zipfel & B. Duckworth-Mothes

  2. Surgical Endoscopy, Experimental Endoscopy, Research and Training, Centre for Medical Research, Eberhard Karls University of Tübingen, Waldhörnlestr. 22, 72072, Tübingen, Germany

    B. Duckworth-Mothes

Authors
  1. K. E. Grund
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  2. U. Schweizer
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  3. A. Zipfel
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  4. B. Duckworth-Mothes
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Corresponding author

Correspondence to K. E. Grund.

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Conflict of interest

K. E. Grund, U. Schweizer, A. Zipfel, and B. Duckworth-Mothes declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

Additional information

This article was originally published in German in Der Chirurg 2018, 89:077–983. https://doi.org/10.1007/s00104-018-0736-9

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Grund, K.E., Schweizer, U., Zipfel, A. et al. Learning of flexible endoscopy, particularly endoscopic vacuum therapy (EVT). Chirurg 93, 56–63 (2022). https://doi.org/10.1007/s00104-021-01497-4

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  • DOI: https://doi.org/10.1007/s00104-021-01497-4

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