Journal of Surgical Simulation 2018; 5: 24 - 30

Published: 15 July 2018


Original article

Optimal simulation and tissue platforms for acquiring surgical endoscopy skills to perform per oral endoscopic myotomy (POEM)

Andrew Wang, R. Dan Lawson and Gordon G. Wisbach
Corresponding author: This work was presented as a poster at the 9th Annual American College of Surgeons Accredited Education Institutes Consortium Meeting, March 7–8, 2016, Chicago, IL, USA. Email:


Background: Per oral endoscopic myotomy (POEM) represents a natural orifice transluminal endoscopic surgery (NOTES) approach to the treatment of achalasia and some esophageal motility disorders. Promising preliminary results necessitate the development of a training system for this procedure. No dedicated measure of competency or standard training has been established. Training that optimizes the use of simulation and tissue platforms to learn the surgical endoscopic skills needed to perform the POEM procedure is required for its development.

Methods: Our team consists of an interventional endoscopist and an advanced minimally invasive surgeon, experienced with NOTES procedures, as part of a Combined Endoscopy Center at a major medical facility. The task force focused on establishing POEM training platforms at a fully accredited American College of Surgeons simulation center, vivarium, and bioskills center. After a thorough assessment, an optimal curriculum was established using inanimate and animate platforms.

Results: Our recommended curriculum is as follows. Fundamentals of Endoscopic Surgery (FES) certification establishes a foundation in flexible esophagoscopy. The recommended training platforms include: (1) simulation (inanimate) for FES and instrument familiarization, (2) a porcine ex vivo Erlangen model for endoscopic submucosal dissection followed by submucosal endoscopy with mucosal flap, including blunt balloon dissection, (3) porcine non-survival: submucosal myotomy and mucosal flap closure followed by necropsy, (4) porcine survival: complete procedure followed by necropsy, (5) simulation (inanimate) and video format for management of intra-operative adverse events, including bleeding, hemodynamic capnothorax, and full-thickness incision.

Conclusion: POEM requires specific knowledge and technical skills spanning gastroenterology and surgery. We provide training that optimizes the use of simulation and tissue platforms for trainee acquisition of the advanced surgical endoscopy skills necessary to perform POEM.



achalasia; per oral endoscopic myotomy; POEM; surgical endoscopy; natural orifice transluminal endoscopic surgery; NOTES;