KOKEN LM-103 User manual

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 JAPAN
URL:http://www.kokenmpc.co.jp
E-mail:[email protected]
©2013-2020 KOKEN CO., LTD. C-1-1008-1-01-05

1
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 the
human body, and may break when inappropriate force is used. Please handle it with the same
care 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 be
deleted.
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 from
pests 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 a
high 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.

2
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 (for
polypectomy).
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 product
should not be used in any way that contravenes the precautions noted in the instruction manual.

3
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congurationtable
5. Specications

4
1. Outline and Features
Outline
This 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 and
an observational polyp is included.
As a separately sold option, a polyp can be attached to practice polyp resection and control of
bleeding from it.
Features
1. 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 human
body.
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 and
visibility 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 classication 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 control
of bleeding from it. After resecting it, one can practice the clipping method to stop the
bleeding.
7. An ulcer is reproduced in the duodenum.

5
2. Names of pieces and con guration diagram


 NameofComponents
1 Hypopharynxpiece
2 Esophaguspiece
3 Stomach
4 Halfheadpiece
5 Mainheadpiece
6 Duodenumpiece
7 Nasalseptum(deviatedtotheleft)
8 Nasalseptum(deviatedtotheright)
9 Simulatedpolyp(forpolypectomy)conductioncable
10 Stand  
11 Simulatedpolypfixture 
13 Hardcase(fortheheadside)
12 Simulatedpolyps(forobservation):YamadaclassificationtypesItoIV
14 Hardcase(forthebodyside)


6
3. Handling the Simulator
○ Before using this simulator, apply lubricating jelly to each piece. Use any endoscopic
lubricating jelly in stock.
3-1Applicationoflubricatingjelly
Remove the Velcro belt and take o󱐯 the half head piece.
Remove the cardiac connector that connects the stomach to the esophagus pieces.
Remove the nasal septum and the hypopharynx piece, and apply lubrication jelly to the nasal
and oral cavities of the main and half head pieces.
- 6 -
3. Usage
Before using this simulator, apply lubricating jelly to each piece. Use any endoscopic
lubricating jelly in stock.
3-1 Application of lubricating jelly
Remove the Velcro belt and take off the half head piece.
Remove the cardiac connector that connects the stomach to the esophagus pieces.
Remove the nasal septum and the hypopharynx piece, and apply lubrication jelly to the nasal and
oral cavities of the main and half head pieces.
Cardiac connector
Nasal septum
piece
Hypopharynx piece
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3. Usage
Before using this simulator, apply lubricating jelly to each piece. Use any endoscopic
lubricating jelly in stock.
3-1 Application of lubricating jelly
Remove the Velcro belt and take off the half head piece.
Remove the cardiac connector that connects the stomach to the esophagus pieces.
Remove the nasal septum and the hypopharynx piece, and apply lubrication jelly to the nasal and
oral cavities of the main and half head pieces.
Cardiac connector
Nasal septum
piece
Hypopharynx piece
- 6 -
3. Usage
Before using this simulator, apply lubricating jelly to each piece. Use any endoscopic
lubricating jelly in stock.
3-1 Application of lubricating jelly
Remove the Velcro belt and take off the half head piece.
Remove the cardiac connector that connects the stomach to the esophagus pieces.
Remove the nasal septum and the hypopharynx piece, and apply lubrication jelly to the nasal and
oral cavities of the main and half head pieces.
Cardiac connector
Nasal septum
piece
Hypopharynx piece

7
The nasal septum piece is available as both a right and left deviation type. Select one, and
apply the lubricating jelly. Then attach it to the main head piece.
- 7 -
The nasal septum piece is available as both a right and left deviation type. Select one, and apply the
lubricating jelly. Then attach it to the main head piece.
Right
deviation
Left
deviation
- 7 -
The nasal septum piece is available as both a right and left deviation type. Select one, and apply the
lubricating jelly. Then attach it to the main head piece.
Right
deviation
Left
deviation

8
After applying the lubricating jelly to the hypopharynx piece, attach it to the main head piece.
Put the half head piece on the main head and secure them with Velcro tape. Velcro tape on
the parietal region of the head should be xed with a piece of Velcro on the back of the head.
- 8 -
After applying the lubricating jelly to the hypopharynx piece, attach it to the main head piece.
Put the half head piece back on the main head and secure them with Velcro tape.
Apply lubricating jelly to the inside of the esophagus piece.
Insert lubricating jelly into the esophagus piece from the hypopharyngeal and cardiac ends, and
spread the lubricating jelly to cover the entire inner side of the esophageal piece by kneading it from
the outside.
* When kneading it, be careful not to dig your nails into the piece. It may be damaged.

9
After attaching it to the hypopharynx piece, secure it with Velcro tape.
To remove the stomach, remove the pyloric connector that connects the stomach to the
duodenum piece after pulling the pyloric connector up and removing the stomach and
duodenum piece from the pyloric xing rod.
- 9 -
After attaching it to the hypopharynx piece, secure it with Velcro tape.
To remove the stomach, remove the pyloric connector that connects the stomach to the duodenum
piece after pulling the pyloric connector up and removing the stomach and duodenum piece from
the pyloric fixing rod.
Pyloric connector
Pyloric
fixing rod
Apply lubricating jelly to the inside of the esophagus piece.
Insert lubricating jelly into the esophagus piece from the hypopharyngeal and cardiac ends,
and spread the lubricating jelly to cover the entire inner side of the esophageal piece by
kneading it from the outside.
*When kneading it, be careful not to dig your nails into the piece. It may be damaged.
- 8 -
After applying the lubricating jelly to the hypopharynx piece, attach it to the main head piece.
Put the half head piece back on the main head and secure them with Velcro tape.
Apply lubricating jelly to the inside of the esophagus piece.
Insert lubricating jelly into the esophagus piece from the hypopharyngeal and cardiac ends, and
spread the lubricating jelly to cover the entire inner side of the esophageal piece by kneading it from
the outside.
* When kneading it, be careful not to dig your nails into the piece. It may be damaged.

10
To remove the stomach, remove the pyloric connector that connects the stomach to the
duodenum piece after pulling the pyloric connector up and removing the stomach and
duodenum piece from the pyloric xing rod.
10
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After attaching it to the hypopharynx piece, secure it with Velcro tape.
To remove the stomach, remove the pyloric connector that connects the stomach to the duodenum
piece after pulling the pyloric connector up and removing the stomach and duodenum piece from
the pyloric fixing rod.
Pyloric connector
Pyloric
fixing rod
- 9 -
After attaching it to the hypopharynx piece, secure it with Velcro tape.
To remove the stomach, remove the pyloric connector that connects the stomach to the duodenum
piece after pulling the pyloric connector up and removing the stomach and duodenum piece from
the pyloric fixing rod.
Pyloric connector
Pyloric
fixing rod
- 9 -
After attaching it to the hypopharynx piece, secure it with Velcro tape.
To remove the stomach, remove the pyloric connector that connects the stomach to the duodenum
piece after pulling the pyloric connector up and removing the stomach and duodenum piece from
the pyloric fixing rod.
Pyloric connector
Pyloric fixing rod

11
Apply lubricating jelly to the entire inside of the stomach.
Insert lubricating jelly into the stomach from the cardiac and pyloric connectors, and spread it
to the entire inner side of the main stomach by kneading it from the outside.
*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.
- 10 -
Apply lubricating jelly to the entire inside of the stomach.
Insert lubricating jelly into the stomach from the cardiac and pyloric connectors, and spread it to the
entire inner side of the main stomach by kneading it from the outside.
* 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.
Ease point
- 10 -
Apply lubricating jelly to the entire inside of the stomach.
Insert lubricating jelly into the stomach from the cardiac and pyloric connectors, and spread it to the
entire inner side of the main stomach by kneading it from the outside.
* 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.
Ease point

12
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 of 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.
Attach the pyloric connector. Join the ease points of the connectors to connect them.
Then insert the pyloric xing rod into the hole for xation of the pyloric connector.
- 11 -
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 of
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.
Attach the pyloric connector. Join the ease points of the connectors to connect them. Then insert the
pyloric fixing rod into the hole for fixation of the pyloric connector.
Ease point
Hole for fixation
Pyloric fixing rod
12
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- 11 -
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 of
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.
Attach the pyloric connector. Join the ease points of the connectors to connect them. Then insert the
pyloric fixing rod into the hole for fixation of the pyloric connector.
Ease point
Hole for fixation
Pyloric fixing rod
合い
印
- 11 -
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 of
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.
Attach the pyloric connector. Join the ease points of the connectors to connect them. Then insert the
pyloric fixing rod into the hole for fixation of the pyloric connector.
Ease point
Hole for fixation
Pyloric fixing rod
幽門部固定ロッ
ド
- 11 -
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 of
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.
Attach the pyloric connector. Join the ease points of the connectors to connect them. Then insert the
pyloric fixing rod into the hole for fixation of the pyloric connector.
Ease point
Hole for fixation
Pyloric fixing rod

13
Select 1 of the 4 types of simulated polyp (for observation) , and insert it into the hole at the
bottom of the stomach.
Use the hard case (for the body side) as necessary. When not covered, the general location
of 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.
(Yamada classification type I
to IV)
I II III IV
Settingforthesimulatedpolyp(forobservation)
Mainstomach
epidermis

14
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.
Stick the return electrode you are holding, so that it covers the plate of the simulated polyp (for
polypectomy) conduction cable.
* If using a dual-type return electrode, stick it so that both sides touch the plate.
Velcrotape
Plate side of the simulated polyp
(for polypectomy) conduction cable

15
○ Attachment of the simulated polyp (for polypectomy)
Place the simulated polyp  xture on top of the baffl e plate of the stand.
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.
ジャマ板
Baffl e plate

16
Secure the simulated polyp and the stomach by wrapping them with Velcro tape.
Connect the cord to the return electrode. When it is covered with a hard case (for the body
side), pull the cord from the cutout in the stand.
*The cord is not included.
Practicing resection is possible under the same output of the high-frequency ablation
instrument as with the human body.
Ring of the conduction cable
Setting of the Simulated polyp (for polypectomy)
Epidermis of the stomach
Simulated polyp  xture
切り欠き
Cutout

17
3-3Caringforthesimulator
Clean the EGD simulator each time after it was used. Cleaning should be done by the
following steps.
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
damaged.
- 15 -
3-3 Care after use
Clean the EGD simulator each time after it was used. Cleaning should be done by the following
steps.
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
damaged.
Main head
Half head
Nasal septum piece Hypopharynx piece
Esophageal piece Stomach
Duodenum piece

18
Let the water that remains after washing dry out su󱐰ciently in a place where the pieces are
not exposed to direct sunlight.
After the pieces have dried, attach the main head to the stand, and then set each piece.
- 16 -
Let the water that remains after washing dry out sufficiently in a place where the pieces are not
exposed to direct sunlight
After the pieces have dried, attach the main head to the stand, and then set each piece.
Attach by fitting the hole at the bottom of the
main head to the rod sticking from the stand.
- 16 -
Let the water that remains after washing dry out sufficiently in a place where the pieces are not
exposed to direct sunlight
After the pieces have dried, attach the main head to the stand, and then set each piece.
Attach by fitting the hole at the bottom of the
main head to the rod sticking from the stand.

19
4. Simulator conguration table
5. Specications

Productname Quantity
Stomach 1pc
Halfhead 1pc
Mainhead 1pc
Hypopharynxpiece 1pc
Esophaguspiece 1pc
Duodenumpiece 1pc
Nasalseptum(deviatedtotheleft) 1pc
Nasalseptum(deviatedtotheright) 1pc
Simulatedpolyp(forpolypectomy)conductioncable 1pc
1pc

Stand 

Simulatedpolyps(forobservation):YamadaclassificationtypesItoIV  1set

Simulatedpolypfixture  1pc
Hardcase(fortheheadside) 1pc
 1pc
Hardcase(forthebodyside) 1pc
Productname
Productnumber

Simulatedpolyp (forpolypectomy):5count 
LM-103A



Productname Length Width Height Weight
EGDSimulator Approx. Approx. Approx. Approx.27cm
80cm 29cm 8kg
Only a Yamada classification
type IV shape is included
Separately sold options
* The product must be refrigerated (2ºC to 10ºC, do not freeze).