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[¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 25]

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[2017-4-19. ¾Öµ¶ÀÚ ÆíÁö]

±³¼ö´Ô ¾È³çÇϼ¼¿ä. ±³¼ö´Ô²²¼­ ¸¸µé¾î ÁֽŠEndoTODAY·Î ¿­½ÉÈ÷ °øºÎÇÏ°í ÀÖ´Â ¾Öµ¶ÀÚÀÔ´Ï´Ù. Àú´Â ¼ÒÈ­±â Æç·Î¿ì¸¦ ½ÃÀÛÇÑÁö ÀÌÁ¦ ¸· 2´Þ Á¤µµ µÈ ¿ÕÃʺ¸ÀÔ´Ï´Ù.

4³âÂ÷ ¶§ ¼ÒÈ­±â³»°ú ºÐ°ú ½ÅûÀ» ¾ÈÇϸ鼭 ³»°ú ¼ö·ÃÀ» 4³â°£ ¹Þ¾ÒÁö¸¸ ³»½Ã°æÀº Àӻ󰭻縦 óÀ½ ½ÃÀÛÇϸ鼭 °ÅÀÇ Ã³À½ ¸¸Á®º¸±â ½ÃÀÛÇÏ¿´½À´Ï´Ù. EndoTODAY¸¦ ±¸µ¶ÇÑÁöµµ ¾ÆÁ÷ 2´ÞÀÌ Ã¤ ¾È µÈ °Å °°½À´Ï´Ù.

¾îÁ¦ ¿ì¿¬È÷ ³»½Ã°æÇÐȸ ÇѾç´ë Áý´ãȸ ÈÄ ½Ä´ç¿¡¼­ Àλçµå¸± ±âȸ°¡ ÀÖ¾ú°í, µ¿·á ÀDZ¹¿øµéÀÌ À§ ¸ðÇü¿¡ ´ëÇØ ¸»¾¸µå¸®´Â ¹Ù¶÷¿¡ ¸Å¿ì ÇãÁ¢ÇÏÁö¸¸ Á¦°¡ ¸¸µç À§³»½Ã°æ ¸ðÇü »çÁø ¹× ³»½Ã°æ ½ÃÇà »çÁøÀ» º¸³»µå¸³´Ï´Ù. Á¦°¡ ¼ö·ÃÇÏ´Â º´¿ø¿¡´Â À§, ´ëÀå ¸ðÇüÀÌ ¾ø¾ú±â¿¡ ¸¶¶¥È÷ ¿¬½ÀÇÒ ¹æ¹ýµµ ¾ø°í Çؼ­... ^^;;

»ç½Ç Ãʹݿ¡´Â À§³»½Ã°æÀ» observation ÇÒ ¶§ ½Äµµ¿Í À§, ½ÊÀÌÁöÀåÀÌ ¾î¶² ¸ð¾çÀ¸·Î ÀÖÀ»Áö Á¶Â÷ 3Â÷¿øÀûÀ¸·Î »ý°¢À» ¸øÇߴµ¥, ¸ðÇüÀ» ¸¸µé¸é¼­ ÇغÎÇÐÀû ±¸Á¶¸¦ ´Ù½Ã Çѹø »ý°¢Çغ» °Í °°½À´Ï´Ù. ³»½Ã°æÀº ÀÇ°øÆÀ¿¡¼­ ¼ö¸® ºÒ°¡´ÉÇÏ´Ù°í ÇÑ ³»½Ã°æÀ¸·Î ¿¬½ÀÇϸ鼭 ÃÔ¿µÇÑ »çÁøÀÔ´Ï´Ù. Àú °°Àº °æ¿ì´Â ½ÇÁ¦ »ç¶÷ À§¿¡¼­ J ÅÏÀ» ÇÏ´Â °Ô ºÎ´ã½º·¯¿ü´Âµ¥, ¸ðÇü¿¡¼­ ¿¬½ÀÀ» Çغ¸°í ½Ã¹Ä·¹ÀÌ¼Ç ÇÏ´Â °Í¿¡ µµ¿òÀÌ µÇ¾ú´ø °Í °°½À´Ï´Ù.

Çöó½ºÆ½ ¿ìÀ¯Åë °ú ÀÎÅͳÝÀ¸·Î ÁÖ¹®ÇÑ PVC È£½º (¹è¼Ûºñ Æ÷ÇÔ ¸¸¿ø) , Å×ÀÌÇÁ , Ä® , º»ÀÎÀÇ ÀΰǺñ°¡ ÀüºÎ ÀÔ´Ï´Ù.

Ãʱâ Áغñ¹° ÀÔ´Ï´Ù.

½ÇÁ¦ ¸ðÇü¹°À̱¸¿ä. ÀÌ¹Ì À§³»½Ã°æ ½ºÄÚÇÁ°¡ EGJ À» ³Ñ¾úÀ» ¶§ »çÁøÀÔ´Ï´Ù. Çöó½ºÆ½ Áß°£¿¡ incision À» ³Ö¾î¼­ °ñÆÇÁö¸¦ ³Ö¾ú°í, À̸¦ ¼Ò¸¸ ¹× angleÀ̶ó°í »ý°¢ÇÏ°í ¸¸µé¾î º¸¾Ò½À´Ï´Ù. Å×ÀÌÇÁ´Â PVC È£½º¿¡ ±¼°î½ÃŲ ºÎºÐÀ» °íÁ¤½ÃÅ°±â À§ÇØ »ç¿ëÇÑ °ÍÀÔ´Ï´Ù.. ºñ±³Àû Åõ¸íÅëÀÌ¶ó¼­ Á¦°¡ ½ºÄÚÇÁ¸¦ Á¶ÀÛÇÏ¿´À» ¶§ È­¸éÀ¸·Îµµ ÀÎÁöÇÏ°í ½ÇÁ¦·Î ¾î´À ¹æÇâÀ¸·Î ¿òÁ÷ÀÌ´Â Áö ÀÌÇØÇϱⰡ ÆíÇß½À´Ï´Ù.

½ÇÁ¦·Î´Â ¸ðÇüÀÌ °¡º­¿ö¼­ ´Ù¸¥ »ç¶÷ÀÌ ¸ðÇüÀ» Àâ¾ÆÁà¾ß ÇÕ´Ï´Ù.

½Äµµ Áß°£¿¡ vocal cord µµ ±×·Á ³Ö¾ú±¸¿ä.

EGJ À» ³Ñ¾î¼­ body ¹æÇâÀ¸·Î ½ºÄßÀ» °¡¿îµ¥·Î ¸ÂÃá »çÁøÀÔ´Ï´Ù.

J ÅÏÀ¸·Î cardia¸¦ º» »çÁøÀÔ´Ï´Ù. °íÀå³­ ½ºÄßÀ̶ó cardia ¸¦ °üÂûÇϴµ¥ ÇÑ°è°¡ ÀÖ¾ú½À´Ï´Ù.

UÅÏÀ¸·Î °üÂûÇÑ cardia ¿Í fundus ¸¦ °üÂûÇÑ »çÁøÀÔ´Ï´Ù.

Pyloric channel À» ³Ñ¾î°¡±â Àü »çÁøÀÔ´Ï´Ù.

Ç×»ó °Ç°­ÇϽðí, ¹Ù»Ú½Å ¿ÍÁß¿¡ °¨»çÇÕ´Ï´Ù.

[2017-4-20. ÀÌÁØÇà ´äº¯]

¹Ý°©½À´Ï´Ù. ³»½Ã°æÇÐȸ Áý´ãȸ ÈÄ ¼ÒÁÖ ÇÑ ÀÜ ÇÒ ¼ö À־ ÇູÇß°í, ¶Ç ¼±»ý´ÔÀÇ ³ë·ÂÀÌ ´À²¸Áö´Â home-made endoscopy simulator¸¦ º¼ ¼ö À־ Áñ°Ì½À´Ï´Ù. °í»ý ¸¹À¸¼Ì½À´Ï´Ù.

³»½Ã°æÀ» ȯÀÚ¿¡°Ô ½ÃÇàÇϱâ Àü simulator¸¦ ÀÌ¿ëÇÑ ÈÆ·ÃÀº Å©°Ô µµ¿òÀÌ µË´Ï´Ù. ±×·¯³ª ¿­¾ÇÇÑ ±¹³» ÀÇ·á ȯ°æÀ¸·Î ÀÎÇÏ¿© simulator ÈÆ·ÃÀÌ ºÎÁ·ÇÑ ÇüÆíÀε¥, ÀÌ·¸°Ô ½º½º·Î µµ±¸¸¦ ¸¸µé¾î ¿¬½ÀÇÏ½Å´Ù´Ï Á¤¸» ´ë´ÜÇÑ ÀÏÀÔ´Ï´Ù. Å« °¨µ¿À» ¹Þ¾Ò½À´Ï´Ù.

2017³â 4¿ù 8ÀÏ ÇÑÀÏ Ç︮ÄÚ¹ÚÅÍ ÇÐȸ¿¡¼­ ¾Æ»êº´¿ø ÀÌÁøÇõ ±³¼ö´ÔÀÇ 3D-printed training simulator¸¦ ÀÌ¿ëÇÑ Á¶Á÷°Ë»ç ¿¬½À moduleÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù.

ÃÖ÷´Ü simulator¸¦ °³¹ßÇÏ°í °è½Ã´Â ÀÌÁøÇõ ±³¼ö´Ôµµ óÀ½¿¡´Â ¾ÆÁÖ ´Ü¼øÇÑ ¾ÆÀ̵ð¾î¿Í crudeÇÑ µµ±¸¿¡¼­ Ãâ¹ßÇϼ̽À´Ï´Ù. Çöó½ºÆ½ ¹Ú½ºÀÇ ÇÑ ÂÊ¿¡ ±¸¸ÛÀ» ³»°í ³»ºÎ¿¡ °í¹« °°Àº °ÍÀ» ºÙ¿©¼­ ³»½Ã°æ Á¶Á÷°Ë»ç ÈÆ·ÃÀ» Çß´Ù°í ÇÕ´Ï´Ù. »çÁøÀ» ±¸ÇÒ ¼ö ¾ø¾î¼­ Á¦°¡ ÇÐȸ¿¡¼­ º¸¾Ò´ø ÀÌÁøÇõ ±³¼ö´ÔÀÇ ½½¶óÀ̵带 ¶°¿Ã¸®¸ç ±×¸²À» ±×·Áº¸¾Ò½À´Ï´Ù. (º¸Ãæ: ³í¹®À¸·Î ¹ßÇ¥µÈ °ÍÀ» µÚ´Ê°Ô ¾Ë¾Ò½À´Ï´Ù. Ahn JY. Gut Liver 2016)

Á¦ ¿¬±¸½Ç Ã¥²ÈÀÌ¿¡´Â ³°Àº Çöó½ºÆ½ ¹Ú½º Çϳª°¡ ÀÖ½À´Ï´Ù. µÅÁö stomachÀ» ÀÌ¿ëÇÑ ESD ¿¬½À¿¡ »ç¿ëÇÏ´ø ±¸½Ä simulator ¹Ú½ºÀÔ´Ï´Ù. ¿À·£ Ãß¾ïÀ¸·Î ¹ö¸®Áö ¾Ê°í º¸°üÇÏ°í ÀÖ½À´Ï´Ù.

2008³â ESD animal model training

¿©ÇÏÆ° home-made endoscopy simulator´Â Á¤¸» ´ë´ÜÇÑ ÀÏÀÔ´Ï´Ù. ´õ¿í Á¤ÁøÇϽñ⠹ٶø´Ï´Ù.


[2017-4-20. ¾Öµ¶ÀÚ (Á¤°æ¿ø ±³¼ö´Ô) ÆíÁö]

¼±»ý´Ô. ÀÌÁøÇõ ±³¼ö´Ô²²¼­ ¸¸µå¼Ì´ø Çöó½ºÆ½ ¹Ú½º simulator´Â ³í¹®À¸·Î ¹ßÇ¥µÇ¾ú±â¿¡ ¾Ë·Áµå¸³´Ï´Ù (Ahn JY. Gut Liver 2016).

View of the interior of the container without its lid and a schematic diagram. (A) The photograph shows the interior of the food container without its lid. (B) The design schematic. The numbers are in order of biopsy progression and indicate the following: the greater curvature (GC)/anterior wall (AW) of the lower body (LB) (1st site, arrow), the AW of the antrum (2nd site, arrow), the AW of the LB (3rd site, arrow), the lesser curvature (LC)/posterior wall (PW) of the LB (4th site, arrow), the PW of the mid-body (MB) (5th site, arrow), the LC of the MB (6th site, arrow), and the cardia (7th site, arrow). The corresponding locations of the biopsy sites (¡Ü), polyvinylchloride (PVC) bottle cap (gray spot), and the hole for the scope shaft (¡Û) are shown.

View of the completed biopsy simulation and magnified views of its components. (A) View of the completed biopsy simulation. (B) Interior view of the hole in the container wall for the passage of the scope shaft. (C) View of the distal end of the polyvinylchloride (PVC) hose with the container removed. Also visible is the silk sheet fastened by the bracket and hose. (D) View of the PVC bottle cap. (E) View of the small round magnetic foam tape with a snap fastener in situ in one of the seven biopsy sites.

Typical sequence of the maneuver for picking up the snap fastener with the biopsy forceps and putting it into the polyvinylchloride (PVC) bottle cap. (A) Approach to the snap fastener. (B) Grasping and detaching the snap fastener. (C) Moving the snap fastener to the PVC bottle cap.

[2017-4-20. ÀÌÁØÇà ´äº¯]

¾îÁ¦ ¾î¶² fellow ¼±»ý´ÔÀÇ home-made endoscopy simulator¸¦ ¼Ò°³ÇÑ ¹Ù ÀÖ½À´Ï´Ù. Á¦°¡ ¾Æ»êº´¿ø ÀÌÁøÇõ ±³¼ö´ÔÀÇ biopsy training¿ë box simulator¿¡ ´ëÇÏ¿© concept ½ºÄÉÄ¡¸¦ º¸¿©µå·È½À´Ï´Ù.

±×·±µ¥... ÀÌ¹Ì ³í¹®À¸·Î ³ª¿ÍÀÖ´Ù´Â Á¦º¸°¡ ÀÖ¾ú½À´Ï´Ù. Á˼ÛÇÕ´Ï´Ù. °øºÎ ºÎÁ· Å¿ÀÔ´Ï´Ù...... ³ë¾ÈÀ¸·Î Ã¥À» º¸¸é ´«ÀÌ ¾ÆÆļ­ ³í¹® Àб⸦ Á¶±Ý ÁÙ¿´´õ´Ï ±Ý¹æ Ƽ°¡ ³³´Ï´Ù.^^

Á¤°æ¿ø ±³¼ö´Ô. °¨»çÇÕ´Ï´Ù. ´çÀå µ¸º¸±â ¸ÂÃß°Ú½À´Ï´Ù.


[References]

1) EndoTODAY ¾Öµ¶ÀÚ Áõ·Ê ÆíÁö

2) ¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 35 - Homemade endoscopy simulator (¼­¿ï´ë °¡Á¤ÀÇÇаú)

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.