EGD(EsophagoGastroDuodenoscopy)

Simulator
LM-103
Instruction Manual
Thank you for purchasing this EGD Simulator.

Please read this instruction manual carefully to ensure correct use of the product,and store it in a safe place for easy access.

KOKEN CO., LTD.
1-4-14 Koraku, Bunkyo-ku, Tokyo 112-0004 JAPANURL:http://www.kokenmpc.co.jp
E-mail:customer@kokenmpc.co.jp©2013-2020 KOKEN CO., LTD. C-1-1008-1-01-05

Handling and Safety Precautions
These precautions should be strictly observed in order to ensure safe,
long-term use of the product.
The following precautions should be observed particularly strictly:○ About “EGD Simulator LM-103”
1. This simulator is made of specialized silicone rubber, which achieves a similar texture as thehuman body, and may break when inappropriate force is used. Please handle it with the samecare as when handling human beings.
2. Every time before this simulator is used, apply an adequate amount of endoscopic lubricating
jelly in stock to the inside of the simulator. Please refer to P.7 “3-1 Application of lubricating
jelly” for further details. When adequate lubricating jelly is not applied, the endoscope may
become stuck inside the simulator, causing damage.
3. Do not place anything directly on the body of the simulator, because the simulator may
become deformed.
4. Please refrain from using organic solvents such as thinners or benzene, since the simulator
may be deformed and the color may fade.
5. Do not use oil-based ink or paint, because these will soak into the simulator and cannot bedeleted.
6. When transporting the simulator in the black case, close all the clasps.
7. This product is intended for use in standard operating environments. Do not use it in heavy
industrial settings.
8. This model uses urethane foam for some of its parts, and may be susceptible to damage frompests that are attracted to urethane foam (such as insects in the ant family).
When storing this model, ensure that thorough measures are taken to prevent pest damage
before storing. The company will not be involved with or held liable for pest damage that
occurs during storage.

Options sold separately○ Concerning the “Simulated polyp (for polypectomy) LM-103A”
1. Please take care to follow the directions below so as to avoid mold growth or degeneration of the
Simulated Polyp.
		1-1. Please avoid storing the Simulated Polyp (for polypectomy) at a location with direct sunlight or ahigh temperature and always store in a refrigerator (between 2 and 10ºC, do not freeze). If it is stored
at a temperature of over 30ºC, it may change in shape or degrade, rendering it unusable.

1		

1-2. Please use the Simulated Polyp as early as possible after it has been unsealed. KOKEN is not 		
responsible for quality of Simulated Polyps that have already been unsealed.

		

1-3. When taking out the Simulated Polyp, please use clean tweezers etc.

		1-4. If a Simulated Polyp has been taken out of the container, please do not put it back in the 		container.

		

1-5. Do not leave a Simulated Polyp (for polypectomy) out of the container for a long period of time.
The surface will become dry and hard, and it will not be possible to use it any longer.

		

1-6. Always store in the storage liquid. Storing it in other liquids will cause degeneration of the polyp.
Be careful not to spill the storage liquid or throw it away before using all the Simulated Polyps (forpolypectomy).

2. When resecting a Simulated Polyp (for polypectomy), always use a disposable electrode.
3. Be sure that no storage liquid gets in your eyes or mouth.

Maintenance of the model after use.
1. Each time after using this simulator, wash the lubricating jelly inside the gastrointestinal tract 		
with cold or hot water.
2. Wipe dirt from the black case (excluding the sponge parts) using a soft cloth such as gauze 		soaked in water or mild detergent diluted with water.
* Never use solvents like thinners or benzene.
3. When this simulator is exposed to direct sunlight or ultraviolet rays for a prolonged period of 		time, it may be deformed or the color may fade. When not in use, attach to its proper place 		on the base of the case, put the lid on, and store in a level place without direct sunlight or 		
ultraviolet rays.

1. The contents of this instruction manual are subject to change without notice.
2. This instruction manual may not be reproduced in part or in its entirety without permission.
3. Please contact us in the event that any errors or omissions are found in the contents of the instruction
manual.
4. This product should be used only as described in this instruction manual. In particular, the productshould not be used in any way that contravenes the precautions noted in the instruction manual.

2

Table of Contents

1.

Outline and Features

2.

Components

3.

Handling the Simulator
3-1 Application of lubricating jelly
3-2 Attachment of the separately sold option Simulated polyp(for polypectomy) LM-103A
3-3 Care for the Simulator

4.

Simulator configuration table

5.

Specifications3

1. Outline and Features
OutlineThis product is a simulator in which an endoscope can be inserted into the upper gastrointestinal
tract to perform examination.
Both transoral and transnasal insertion are available, and as an accessory, recreation of an ulcer andan observational polyp is included.
As a separately sold option, a polyp can be attached to practice polyp resection and control of
bleeding from it.

Features1. Specialized silicone rubber is used as the material, and inserting the endoscope feels like
inserting it into an actual human body. The color inside is also close to that of the humanbody.
2. Since the oral and nasal cavities have been reproduced, both transoral and transnasal
insertion can be practiced.
3. For the transnasal insertion, the difficulty setting of insertion can be changed by placing
the nasal septum pieces to deviate to the right or the left side. The insertion technique andvisibility can be changed.
4. Practicing endoscopic examination of the esophagus, stomach, and duodenum is possible.
It is also possible to practice cannulation of the papilla during endoscopic retrograde
cholangiopancreatography (ERCP).
5 Gastric ulcers and early gastric cancer can be observed in the stomach. Four types of polyps
of Yamada classification types I to IV can also be attached for observation.
6. As a separately sold option, a polyp can be attached to practice polyp resection and controlof bleeding from it. After resecting it, one can practice the clipping method to stop the
bleeding.
7. An ulcer is reproduced in the duodenum.

42. Names of pieces and configuration diagram

1
2
3
4
5
6
7
8
9
10
11
12
13
14

Name of Components

Hypopharynx piece
Esophagus piece
StomachHalf head piece
Main head piece
Duodenum piece
Nasal septum (deviated to the left)
Nasal septum (deviated to the right)
Simulated polyp (for polypectomy) conduction cable
Stand
Simulated polyp ﬁxture
Simulated polyps (for observation):Yamada classiﬁcation types I to IV
Hard case (for the head side)
Hard case (for the body side)5

3. Handling the Simulator
3.

Usage

ǒ ǎ 3r©ĩ

○3.Before
using
this thissimulator,
apply
lubricating
Use any
any endoscopic
endoscopic
 Usage
Beforeusing
simulator,
apply
lubricating jelly
jelly toto eacheach piece.
piece. Use
3.
UsageŠǀưǅƙŴÃƆƅƖ&Ɔ8ƶǊƮƆ´³ƫǄǊƙHZŶƁŰŽŵũŢ´³ƫǄǊƉŬquž
lubricating jelly in stock.
lubricating jelly in stock.
 ƈýĕÃ´³ƫǄǊƙŴÃŰŽŵũŢĩ
Beforeusing using
this simulator,
apply apply
lubricating
jelly toeach
Use any Before
this simulator,
lubricatingjelly
to piece.
each piece.
Use endoscopic
any endoscopic
Application
ofinlubricating
jelly
lubricating
jelly
stock.
3-1ĩ3-1
Applicationoflubricating
jelly
lubricating
jelly
in stock.
Ĳ Ĭ İ ĩ ĩ ´³ƫ Ǆ Ǌ HZ©ĩ
RemovetheVelcrobeltandtakethe
RemoveVelcrotake
offoffthejelly
halfhalf
headheadpiece.piece.
3-1
Applicationof belt
lubricatingjelly
3-1 theApplication
ofand
lubricatingģďƙENŶƁũƖƼƨƭơƹǅƱƙKŶšģď-Ġƙ3ƕKŶƁŰŽŵũŢĩ
ĩ
Removethe Velcro
belt andtake
offtaketheoffhalfthehead
Removethe Velcro
beltand
halfpiece.
head piece.
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩRemove the cardiac connector that connects the stomach to the esophagus pieces.
Remove the cardiac connector that connects the stomach to the esophagus pieces.
äƃĥčď?ƙzÞŶƁũƖAėďƤƵơƬƙKŶƁŰŽŵũŢĩ
Removethe cardiac
connector
that connects
the stomach
to the esophagus
Removethe cardiac
connector
that connects
the stomach
to the esophagus
pieces.pieces.
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
Cardiac connectorĩ
Cardiacconnector
ĩ
CardiacAėďƤƵơƬĩ
connectorĩ
Remove the nasal septum and the hypopharynx piece, and apply lubrication jelly to the nasal andĩoral cavities of the main and half head pieces.
Removethe nasal septum and the hypopharynx piece, and apply lubrication jelly to the nasal
ĨĜď?š>ģď?ƙ3ƕKŶšģďƃģď-ĠƈĨé1Ɗ4éƆ´³ƫǄǊƙHZŶƁŰ
Removethenasal septum
the hypopharynx
and apply
lubrication
the andnasal andRemovethe nasal
septumand theand
hypopharynx
piece, piece,
and apply
lubrication
jelly tojelly
the tonasal
Hypopharynx
piece
Nasalhead
septumpieces.
andoralcavitiesof thethemainmainand
and
half
ŽŵũŢĩ
oral
cavities
of
half
head
pieces.
oral cavities of the main and half head pieces.
pieceĩHypopharynx
>ģď?ĩ
Nasal septum
piece piece
Nasal septumĩ HypopharynxĨĜď?ĩ
piece piece
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
- 66 -

6- 6 - - 6 -The nasal
nasal septum
as as
both
a right
and andleft deviation
type. Selectone, and
apply
the
The
septumpiece
pieceis isavailable
availablebotha right
left deviation
type. Selectone,andlubricating jelly. Then attach it to the main head piece.
apply the lubricating jelly. Then attach it to the main head piece.
Rightdeviation

Leftdeviation

7-7-

After applying
applying the
hypopharynx
piece,
attachit to thehead piece.
Afterthelubricating
lubricatingjelly
jellytotothethehypopharynx
piece,
attachit tomain
the mainhead piece.

Put thepiece
backthemainmainheadhead andand secure
with
Velcrotape.
Putthehalf
halfhead
head
piece
onon
the
securethem
them
with
Velcrotape. Velcro tape on
the parietal region of the head should be fixed with a piece of Velcro on the back of the head.

Apply lubricating jelly to the inside of the esophagus piece.

Insert lubricating jelly into the esophagus piece from the hypopharyngeal and cardiac ends, andspread the lubricating jelly to cover the entire inner side of the esophageal piece by kneading it fromthe outside.
* When kneading it, be careful not to dig your nails into the piece. It may be damaged.

-8-8Apply lubricating jelly to the inside of the esophagus piece.

Apply lubricating
lubricating jelly
thetheinsideof the esophagus
piece.
Insertjellytointo
esophagus
piece fromthe hypopharyngeal and cardiac ends,

Insertlubricating
jelly into thejelly
esophagus
from thehypopharyngeal
and cardiac ends,
and spreadthe lubricating
to coverpiece
the entire
innerside of the esophageal
piece andbyspread the lubricating jelly to cover the entire inner side of the esophageal piece by kneading it fromkneading
theoutside.it from the outside.

*When
your nails
nails into
intothethepiece.
piece.ItItmay
maybe
bedamaged.
damaged.
* Whenkneading
kneadingit,
it,bebecarefulcareful not
not toto digdig yourAfterthehypopharynx
hypopharynx
piece,
secureit withVelcroAfter attachingattaching itittotothe
piece,
secureit withVelcrotape.tape.

-8-

To remove
remove theremovethe thepyloricconnector
that connects
the stomach
the duodenumTo
thestomach,stomach,removepyloricconnector
that connects
the tostomachto thepiece after pulling the pyloric connector up and removing the stomach and duodenum piece fromduodenum
piece
after pulling the pyloric connector up and removing the stomach andthe pyloric fixing
rod.
duodenum piece from the pyloric fixing rod.

Pyloric connector
Pyloric fixing rod

9ĩĩĩ remove the stomach, remove the pyloric connector that connects the stomach to theTo
To remove the stomach, remove the pyloric connector that connects the stomach to the duodenumĩpiece after pulling the pyloric connector up and removing the stomach and duodenum piece fromduodenum
piece
after pulling thepyloric
pyloricconnector
connector
and removing
thetostomachandTo pyloric
remove fixing
thestomach,thatupconnects
the stomach
the duodenumäƈ3ƕKŶƉšäƃ,
vêď?ƙzÞŶƁũƖ\ėďƤƵơƬƙaůŲäƃ,
therod. remove thepiece after pulling the pyloric connector up and removing the stomach and duodenum piece fromduodenumpiecefrom thepyloric fixing rod.
vêď?ƙ\ėďENǇƭƲŭƔ3ƕKŶżgš\ėďƤƵơƬƙKŶƁŰŽŵũŢĩ
Totheremove
stomach,pyloricthe
fixingrod. remove the pyloric connector that connects the stomach to the duodenumĩpiece after pulling the pyloric connector up and removing the stomach and duodenum piece fromĩthe pyloric fixing rod.
ĩĩĩĩ
ĩ Pyloric connector
Pyloric connector
ĩPyloric fixing rodĩ \ėďƤƵơƬĩ
Pyloric connector
Pyloric fixing rod\ėďENǇƭƲĩ
ĩ
Pyloric fixing rod
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
äƈƆ´³ƫǄǊƙHZŶƁŰŽŵũŢĩ
AėďƤƵơƬš\ėďƤƵơƬŭƔäďƆ´³ƫǄǊƙƗšKŭƔ{ƎäƆ´³ƫǄǊƙHZŶƁŰŽŵũŢĩ
ś {Ə ĝƉ š ¦Ŷ Ɓ »ƙ ÔƁ ƅ ũ Ƃ Ű Ž ŵ ũ Ţ øƆ Ɠ ƕ Î}ƈ /BƆ ƅ ƕ ƍ Ÿ Ţ ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
-9-9ĩ
-9ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
10

10

Apply lubricating jelly to the entire inside of the stomach.
Apply lubricating jelly to the entire inside of the stomach.
Insertlubricating
lubricatingjelly
jellytointo
stomachfromcardiac and pyloric connectors, and spread it
Applythetheentireinside ofthethestomach.
Insert lubricating jelly into the stomach from the cardiac and pyloric connectors, and spread it to theInsertlubricating
into
stomachfromthebycardiac
connectors,
to theentire
inner
side
ofthe
the
mainbystomachitoutside.
from theoutside.and spread it to theentireinnerside
ofjellythemainstomachkneading
itkneading
fromandthe pyloric
entire inner side of the main stomach by kneading it from the outside.
to digdig your
your nails
nails into
into thethepiece.
piece.ItItmay
maybe
bedamaged.
damaged.
**WhenWhenkneading
kneading it,
it, bebe careful
careful not
not to* When kneading it, be careful not to dig your nails into the piece. It may be damaged.

Attach the cardiac connector. Join the ease points of the connector to connect them.
Attachcardiacconnector.
Jointhetheeaseeasepointsof theto connect
them. them.
Attachthethecardiacconnector.
Joinpointsof connector
the connector
to connect
Ease point
Ease point

11- 10 - 10 -Apply lubricating jelly to the inside of the duodenum piece.
Apply lubricating jelly to the inside of the duodenum piece.
Insert lubricating jelly into the duodenum piece and apply lubricating jelly to the entire inner
Insert lubricating jelly into the duodenum piece and apply lubricating jelly to the entire inner side ofsideof thelubricating
duodenumpiece
by kneading
itoutside.
fromthe outside.
jelly
to theinsidetheduodenumpiece.
the Apply
duodenumpiece bykneading
it fromofthe
Apply lubricating jelly to the inside of the duodenum piece.
Insertlubricating
jelly
into theduodenumpiece
andintoapply
lubricatingjelly
toentire inner side of*Whenkneading
it,it,
benot
totodig
nails
piece.
It maybedamaged.
Whenkneading
becarefulcarefulnotdigyouryour
nails
intothethepiece.
may
bethe
damaged.
Insert* lubricating
jelly into
lubricating
jelly toItthe
entireinner side ofthe duodenum
piecethebyduodenum
kneading itpiecefromandtheapplyoutside.
the duodenum piece by kneading it from the outside.
* When kneading it, be careful not to dig your nails into the piece. It may be damaged.
* When kneading it, be careful not to dig your nails into the piece. It may be damaged.
Apply lubricating jelly to the inside of the duodenum piece.

Insert lubricating jelly into the duodenum piece and apply lubricating jelly to the entire inner side ofthe duodenum piece by kneading it from the outside.
* When kneading it, be careful not to dig your nails into the piece. It may be damaged.

ĩĩĩ Attach the pyloric connector. Join the ease points of the connectors to connect them. Then insert theĩ pyloric fixing rod into the hole for fixation of the pyloric connector.
Attach the pyloric connector. Join the ease points of the connectors to connect them.
\ėďƤƵơƬƙzÞŶƁŰŽŵũŢzÞƈĝƉšƤƵơƬƈ9ũ.ƙ9ƘźƁzÞŶƁŰŽŵũŢŻ
Attach the pyloric connector. Join the ease points of the connectors to connect them. Then insert the
Attachthepyloricconnector.
Join
ofoftheto connect
them.
Thenrodinsert theTheninsertthepyloric
fixingrodeaseinto
the holeforfixationthepyloricconnector.
Pyloric
fixingpyloric
fixingrod into
the thehole
for points
fixation
theconnectors
pyloricof
connector.
ƈgš\ėďƤƵơƬƈÓƆ\ėďENǇƭƲƙYŶĈƚƂŰŽŵũŢĩ
pyloric fixing rod into the hole for fixation of the pyloric connector.
ĩ
Pyloric fixing rod\ėďENǇƭƲĩ
幽門部固定ロッĩPyloric fixing rodĩドAttach the pyloric connector. Join the ease points of the connectors to connect them. Then insert theĩpyloric fixing rod into the hole forEase
point of the pyloric connector.
fixationĩEase point
Pyloric fixing rod
ĩ
Ease
point
9ũ.ĩ
合
い
ĩ
印
ĩ
ĩ
ĩ
Ease pointĩĩ
Hole for fixationĩĩ
Hole for fixation
ĩ Hole for fixationĩĩĩHole for fixation3ƕűÃÓĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
ĩ
12 - 11 ĩĩ- 11 -

Select 1 of the 4 types of simulated polyp (for observation) , and insert it into the hole at thebottom of the stomach.

I

II

III

IV

(Yamada classification type I
to IV)

Main stomach
epidermis

Setting for the simulated polyp (for observation)

Use the hard case (for the body side) as necessary. When not covered, the general locationof the endoscope can be seen from the outside of the simulator with the endoscope light.
When covered, the endoscopic light cannot be seen from the outside, and training close to
the clinical setting is possible.

133-2 Attachment of the separately sold option Simulated polyp (for polypectomy) LM-103A* Always store the simulated polyp (for polypectomy) in the refrigerator (2ºC to 10ºC, do
not freeze).
The disposable return electrode is not included.
The storage liquid has a unique odor due to ingredients included to maintain the
conductive property of the preservative and the polyp.
Keep the storage liquid out of the eyes and mouth.
○ Attachment of the return electrode
Stick the plate side of the simulated polyp(for polypectomy) conduction cable to the Velcro
tape on the stand.

Velcro tape

Plate side of the simulated polyp(for polypectomy) conduction cable

Stick the return electrode you are holding, so that it covers the plate of the simulated polyp (forpolypectomy) conduction cable.
* If using a dual-type return electrode, stick it so that both sides touch the plate.

14

○ Attachment of the simulated polyp (for polypectomy)
Place the simulated polyp fixture on top of the baﬄe plate of the stand.

Bafﬂe plate
ジャマ板

Insert the simulated polyp (for polypectomy) into the ring side of the simulated polyp(for polypectomy) conduction cable.

Insert the simulated polyp (for polypectomy) into the hole at the bottom of the stomach.

15

Secure the simulated polyp and the stomach by wrapping them with Velcro tape.

Ring of the conduction cable

Epidermis of the stomach

Simulated polyp fixture

Setting of the Simulated polyp (for polypectomy)

Connect the cord to the return electrode. When it is covered with a hard case (for the bodyside), pull the cord from the cutout in the stand.
*The cord is not included.

Cutout切り欠き

Practicing resection is possible under the same output of the high-frequency ablation
instrument as with the human body.

16

3-3 Caring for the simulator
Clean
EGD
simulatoreach time after it was used. Cleaning should be done by the
3-3 the
Care
after
use

Clean theEGD simulator each time after it was used. Cleaning should be done by the following
following
steps.
steps.
		 Remove each piece from the stand. Rinse each piece with cold or hot water.
Remove each piece from the stand. Rinse each piece with cold or hot water.
		 *When washing by hand, be careful not to dig your nails into the pieces. They may be 		* When washing by hand, be careful not to dig your nails into the pieces. They may bedamaged.
damaged.

Half head

Main head

Nasal septum piece

Hypopharynx piece

Esophageal piece

StomachDuodenum piece17- 15 -

		 Let the water that remains after washing dry out sufficiently in a place where the pieces are
Let the water that remains after washing dry out sufficiently in a place where the pieces are not
not exposed
tosunlight
direct sunlight.
exposedto direct
Let the water that remains after washing dry out sufficiently in a place where the pieces are notexposed to direct sunlight		After the pieces have dried, attach the main head to the stand, and then set each piece.

		 After
Afterthethepiecespieceshave
dried,
attachtheheadmaintohead
to theandthenset each piece.
have
dried,
attachthe mainthe stand,andstand,then seteach
piece.
Attach by fitting the hole at the bottom of themain head to the rod sticking from the stand.
Attach by fitting the hole at the bottom of themain head to the rod sticking from the stand.

- 16 - 16 -18

4. Simulator configuration table
Product nameStomachHalf head
Main head
Hypopharynx piece
Esophagus piece
Duodenum piece
Nasal septum (deviated to the left)
Nasal septum (deviated to the right)
Simulated polyp (for polypectomy) conduction cable
Stand
Simulated polyps(for observation): Yamada classiﬁcation types I to IV
Simulated polyp ﬁxture
Hard case (for the head side)
Hard case (for the body side)

Quantity
1 pc
1 pc
1 pc
1 pc
1 pc
1 pc
1 pc
1 pc
1 pc
1 pc
1 set
1 pc
1 pc
1 pc

Separately sold options
Product nameProduct number

Simulated polyp (for polypectomy) : 5countLM-103A* The product must be refrigerated (2ºC to 10ºC, do not freeze).

Only a Yamada classification
type IV shape is included

5. Specifications
Product name
EGD Simulator

LengthApprox.27cm

Width
HeightApprox. 80cm Approx. 29cm

19

WeightApprox.8kg