The Feasibility of Using Simulated Targets in the Stomachs of Live Pigs for Full Endoscopic Submucosal Dissection Training

Abstract

Background/AimsIn endoscopic submucosal dissection (ESD) training, only a flat target lesion can usually be simulated in the normal mucosa. This study aimed to evaluate the feasibility of simulated targets in the stomachs of live pigs for complete training.MethodsSix trained endoscopists with hands-on experience with ex vivo, isolated pig stomachs were enrolled in this pilot study. An endoscopic banding device was used to create a polyp that was snared, leaving an ulcerated lesion. This simulated target model was used to perform ESD in pigs. The en bloc resection rate, procedure time, complications, quality of resection, and participants’ opinions on the simulated targets were compared with the conventional model.ResultsEn bloc resections were achieved in all six simulated targets and six conventional models. The mean size of the resected specimens was 32.2 mm (range, 20 to 39 mm) in the simulated target group and 23.5 mm (range, 11 to 40 mm) in the conventional group. The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking.ConclusionsGood identification of the lesion and ease of periphery marking in the target model may improve resection quality.

Efficacy of a three‐day training course in endoscopic submucosal dissection using a live porcine model: a prospective evaluation

“…Our model would have to be improved. As already described, creating simulated ulcerated target lesions, closer to those found in real life, can be a good way to add difficulty and to realise a new step in preclinical training 18 . After all, it is clear that this type of session is not sufficient in terms of efficiency but above all safety.…”

A novel artificial tissue simulator for endoscopic submucosal resection training – a pilot study

“…Currently, prior to training, the novice has never performed any of the techniques necessary for the performance of ESD such as lesion marking, mucosal pre-cutting, submucosal dissection, and hemostasis of the submucosal vessels. Animal models, both ex vivo and in vivo [ 8 – 10 ], are expensive, inconvenient, and time consuming. The expense of hands-on training with live animals may limit the ability of some training programs to provide ESD training.…”

“…The expense of hands-on training with live animals may limit the ability of some training programs to provide ESD training. One animal training session may cost nearly $300 (US) per trainee [ 10 ]. Additionally, the animal must be sacrificed afterward.…”

“…We believe that there is a gap between what trainees learn from an instructional video and the skills required to perform ESD in an animal model; the novice has never performed the unique and novel skills required for the ESD procedure, such as mucosal marking, mucosal pre-cutting, circumferential incision, and submucosal dissection. Training on animal models, both ex vivo or in vivo [ 8 – 10 ], is expensive, inconvenient, and requires time-consuming preparation. We have previously developed realistic artificial tissue models to provide a more complete ESD training experience [ 11 ].…”

Fidelity of computer‐based simulators for fellows training in Taiwan

“…Since the mid‐1990s, the simulator had been widely used in much hands‐on training programs . Studies have demonstrated the benefits of computer simulation for training in endoscopy, with reductions in the need for instructor assistance and patient discomfort and acceleration of new skills .…”