LAUSR

At present, the design of most endoscopic training simulators is not based on actual gastric morphology [1–3]. We therefore developed a simulator for endoscopic therapy training that was based on the morphology of an actual stomach. Starting from computed tomographic images of a stomach, a standard gastric morphological structure was made using computer modeling and 3D printing technology (▶Fig. 1 a–c). To simulate the position of the human stomach during gastroscopy, a container was designed to support and hold the simulator in a fixed position (▶Fig. 1d). Compared to traditional simulators, which are not designed on the basis of real gastric morphology, our simulator preserves the original structure of the stomach as much as possible, especially in regard to the fundus and the angular incisure (▶Fig. 2 a). This allows trainees to experience clinical gastroscopy in a way that is as realistic as possible. Accurate control of the endoscope is the most important skill for performing various endoscopic procedures. Therefore, two kinds of training modules have been designed, which use, respectively, (1) sequentially numbered hollow cylinders (nos. 1–13) (▶Fig. 1 e), and (2) adhesive target paper and a writing pen. The hollow cylinders are distributed over the inner wall of the simulator, each representing a standard gastric location, e. g., no. 1 for the posterior wall of the gastric fundus. As the orifices of the hollow cylinders are perpendicular to the gastric wall with which they are in contact, their angles of inclination vary. The following functions are served: (1) Accurate indication of the various locations in the gastric anatomical structure. The trainees can determine the correct gastric anatomical location of the observed part in the endoscopic field according to the numbers observed during training, which helps them to master the anatomical morphology of a real stomach. (2) Training in specialized endoscopic skills with different instruments, such as precise insertion or simulated snare polypectomy (▶Fig. 2b).