Force Application During Colonoscopy as a Marker of Competence: Development of a Novel Training Device
Abstract
Colonoscopy is a technically challenging procedure to learn. The colonoscope is prone to forming loops in the colon, which can lead patient discomfort and even perforation. We hypothesized that expert endoscopists use techniques to avoid loop formation, and identify and straighten loops earlier, and thus exert less force.
Using a physical colon simulator model, electromagnetic tracking markers were used to follow the motion of the colon as the scope was advanced. Attending physicians exerted significantly lower mean colonic displacement than trainees.
To allow portability to any simulator, and even the clinical setting, we designed and tested the construct validity of a force-sensing sleeve for the colonoscope. It utilizes piezoresistive sensors applied in a helical orientation along the length of the colonoscope.
Force application is a marker of endoscopic competence. Our colonoscope sleeve has potential for educational and clinical use, alerting endoscopists to dangerous force application, improving patient comfort and safety.