An Inexpensive, Portable Physical Endoscopic Simulator: Description and Initial Evaluation

Background: Surgeons and gastroenterologists in training benefit from simulation-based endoscopy education, yet the price of most training endoscopy simulators is prohibitive. We set out to create and evaluate a low-cost endoscopic simulator and box model trainer for learning fundamental endoscopic skills. Methods: After adding a wireless network-enabled camera (total cost, $20) to a discarded clinical endoscope, we paired this with an easily constructed box trainer (cost $32) to generate an endoscopic simulator system (YazanoScope) for simulation training. Participants (general surgery interns, research fellows, and medical and college students) used the YazanoScope to train to mastery on 5 FES tasks. Outcomes included skill assessments on a computer simulator and trainees' perceptions comparing the physical model to the computer simulator. Results: Forty trainees participated. The median (range) training time was 110 (60-180) min. Only 10% of trainees were able to reach the cecum at baseline compared to 100% after training. The mean (SD) time was 253 (154) s at baseline (including completers and non-completers) and 249 (89) after training (P = 0.88). On a retention test 2 wk later, 21 of 22 (96%) completed the computer simulator assessment (endoscope tip reached the cecum). Mean time was 214 (67) s (P = 0.32 compared with immediate posttraining). All 40 trainees believed the YazanoScope provided better haptic feedback than the computer simulator. Conclusions: Training with this inexpensive, portable endoscopic simulator (YazanoScope) was associated with increased procedure completion with no change in procedure time. All participants favored the haptic feedback of the $52 YazanoScope over a computer simulator.