A novel simulation for transanal endoscopic operation training.

BACKGROUND Transanal endoscopic microsurgery (TEM) and transanal endoscopic operation (TEO) have been widely adopted since first being described by Buess et al in 1985. A specially designed rectoscope is used with laparoscopic imaging and angulated instrumentation to allow precise dissection of rectal lesions under a magnified view. We describe a novel ex vivo simulator for TEO/TEM training. TECHNIQUE A porcine rectal specimen was used to simulate the human rectum. A standardised liquid polyp mix is injected into the submucosal layer of the bowel. This solidifies at room temperature, allowing it to remain in situ, providing a realistic rectal lesion when visualised through the transanal endoscopic equipment (Fig 1). The stages of polyp removal can be practised including circumferential excision margin marking, polyp excision and suturing of the rectal defect. This simulation has been trialled by delegates on a laboratory-based TEO course (Fig 2).