Simulation training technique for performing percutaneous endoscopic gastrostomy

The OBJECTIVE was to create a simulator for practicing manual skills of performing percutaneous endoscopic gastrostomy (PEG).
METHODS AND MATERIALS. A patient simulator has been developed. It has a mouth, oropharynx, removable esophagus, stomach, and anterior abdominal wall that allows performing all stages of the operation. To objectify tension force of the gastrostomy tube during fixation and transmitting the proper manual sensations, a measuring device – bezmen was used. Initially, we used a single-use gastrostomy kit Freka PEG, FR 20 for the simulation. It increased the cost of the simulation. Therefore, instead of disposable kits, the Pezzer catheter No. 24 with a developed metal coneshaped tip was used as a gastrostomy tube (patent RU 2669483, 11.10.2018). Simulation was performed with reusable surgical instruments. At the final stage, an additional external pressure plate and a connector with a cover were used.
RESULTS. The developed method of simulation training for PEG imposition allows performing all stages of endoscopic gastrostomy imposition. The simplicity of manufacturing and the possibility of replacing worn elements allows multiple implementation of the method. Using reusable instruments and a Pezzer catheter with a designed reusable tip increases the cost-effectiveness of training. The use of a measuring device allows to convey the necessary sensations of tension of the gastrostomy tube during fixation with an external pressure plate, corresponding to the sensations in real clinical simulation.
CONCLUSION. The developed method of training for PEG imposition with the simulator allows to effectively work out manual skills and reduce the risk of iatrogenic complications during surgery on the patient.

1. Gavshchuk M. V., Gostimskii A. V., Bagaturiya G. O., Lisovskii O. V., Zavyalova A. N., Karpatskii I. V., Kosulin A. V., Gostimskii I. A., Alad’eva E. E. Import substitution possibilities in palliative medicine. Pediatrician (St. Petersburg). 2018;9(1):72–76. (In Russ.).

2. Gostimskii A. V., Gavshchuk M. V., Zavyalova A. N., Barsukova I. M., Naidenov A. A., Karpatskii I. V., Petrosyan A. A., Lisovskii O. V. Features nutrition support and nursing of patients with gastrostomy. Medicine: theory and practice. 2018;3(2):3–10. (In Russ.).

3. Gaivoronsky I. V. Normal human anatomy: textbook for medical universities. 9­е ed. revised and corrected. SPb., Spetslit, 2016. Vol. 1:558. (In Russ.).

4. Hee Kyong Na, Ji Yong Ahn, Gin Hyug Lee, Jeong Hoon Lee, Do Hoon Kim, Kee Wook Jung, Kee Don Choi, Ho June Song, Hwoon­Yong Jung. The efficacy of a novel percutaneous endoscopic gastrostomy simulator using three­dimensional printing technologies. Journal of Gastroenterology and Hepatology. 2019 Mar;34(3):561–566.