Читать книгу Successful Training in Gastrointestinal Endoscopy - Группа авторов - Страница 25

Both research and training courses have employed endoscopy performed on live anesthetized pigs and dogs [39–42]. Using live animals provides the best possible tactile “feel” of real tissue and endoscope movements with conditions most closely resembling those that occur during human endoscopy. Specifically, this includes the presence of luminal fluid, motility, and the ability to cause real bleeding and perforation (Video 1.5). Such courses have been conducted to teach therapeutic techniques, most notably ERCP and EUS [41]. At present, live animal courses are the only means of nonhuman simulation of sphincter of Oddi manometry [42].

Although clearly advantageous for the above reasons, live animal courses also present some substantial drawbacks. Among these are that animals are very expensive to maintain and there are significant ethical considerations in using animals for training. These ethical considerations are magnified by the fact that ex vivo alternatives now exist for teaching most techniques and do not require sacrificing any animals solely for this purpose. In contrast to the multiple uses possible on other simulator types, once certain procedures, such as sphincterotomy, are performed, it is difficult or impossible for others to practice the same techniques on the same animal.

For these and other reasons, training on live animals, while potentially more realistic than on inanimate simulators, appears now to be on the wane in the evolution of endoscopic training techniques. It appears likely that live animal courses will be limited to advanced procedures such as sphincter of Oddi manometry, for which no comparable inanimate model exists, and advanced training in ESD and NOTES^®. For the latter techniques, many of the skill sets would still be best taught in inanimate tissue models, saving the live animal work for later training in which real physiological conditions and the potential for complication management is required. Live animal endoscopy laboratories remain well suited for clinical investigation. Finally, testing of new accessories and development of new techniques on live animals will likely continue, but much of the groundwork for these tests will have been already completed on inanimate simulators.