Endoscopic submucosal dissection training: evaluation of an ex vivo training model with continuous perfusion (ETM-CP) for hands-on teaching and training in China

Abstract

Background The existing ex vivo models of endoscopic submucosal dissection (ESD) cannot simulate intraoperative hemorrhage well. We aimed to establish an ESD training method by applying an ex vivo training model with continuous perfusion (ETM-CP). Methods Four training sessions were conducted for 25 novices under the guidance of 2 experts. Eventually, 10 novices completed ESD operations on a total of 89 patients after the training. The resection effectiveness, resection speed, complication rate, and novice performance before and after the training were compared. The data regarding the effects of the training and the model were gathered through a questionnaire survey. Results In terms of the simulation effect of the model, ETM-CP was evaluated as similar to the live pig in all aspects (P > 0.05). The questionnaire analysis revealed that the ESD theoretical knowledge, skill operation, and self-confidence of novices were improved after the training (P < 0.05). The resection time per unit area had a correlation with the number of training periods (rs = – 0.232). For novice performance, the resection time per unit area was shortened (P < 0.05). There was no difference in patient performance between the novice group and the expert group after the training in terms of en bloc resection, R0 resection, complication rate, endoscopic resection bleeding (ERB) score, muscularis propria injury (MPI) score, and resection time per unit area (P > 0.05). Conclusion The ETM-CP is effective for ESD training.

Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters

“…Similar effects have been demonstrated for different procedures including foreign body removal [79], endoscopic submucosal dissection [32], and peroral endoscopic myectomy [33]. An additional advantage is that even difficult procedures [32,33,79], or parts of them [31], can be trained before they are first used in patient care, and, thus, the early phase of the learning curve can be avoided in the patient [33].…”

“…Trainees and even advanced and experienced endoscopists felt that they gained additional experience and proficiency from using ex vivo simulators, especially if they were using them in a structured manner [79]. Similar effects have been demonstrated for different procedures including foreign body removal [79], endoscopic submucosal dissection [32], and peroral endoscopic myectomy [33]. An additional advantage is that even difficult procedures [32,33,79], or parts of them [31], can be trained before they are first used in patient care, and, thus, the early phase of the learning curve can be avoided in the patient [33].…”

“…Modelling the biomechanics of the living organism is crucial for the acceptance of ex vivo simulators [35]. They have been evaluated and thoroughly tested, including a randomized controlled trial, and found to be helpful in gaining experience, training, and even proficiency, irrespective of the level of experience at the start of the training [32,78]. Trainees and even advanced and experienced endoscopists felt that they gained additional experience and proficiency from using ex vivo simulators, especially if they were using them in a structured manner [79].…”

“…Such a training opportunity contributes towards better training and aid in gaining experience that is required to adequately perform difficult tasks within a procedure [31]. Porcine-based endoscopy simulators have been created for endoscopic submucosal dissection [32], peroral endoscopic myectomy [33], anastomotic strictures in Crohn's disease [34], and colonoscopy [35]. Successful use of these simulators, however, requires that they adequately model the human patient and be consistent models, i.e., in a way that they always have similar tissue parameters and tissue properties.…”

Teachers should apply the principle of reduction for more sustainable surgical simulation practice: the example of training pharyngolaryngeal surgery in a porcine model

“…: heart ( 7 ), eyes ( 8 )], to train for complex procedures [e.g. : liver transplantation ( 9 ), craniostenosis treatment ( 10 ), endoscopic submucosal dissection ( 11 ), and to design ( 12 )] or to train for the use of medical devices mainly in the field of robotic surgery ( 10 , 13 , 14 ). Given 1/difficulty of accessing food resources around the world ( 15 ), and 2/the environmental impact of pig production ( 16 ), we need to question the relevance of using such models for surgical learning.…”