Training program using a traction device improves trainees’ learning curve of colorectal endoscopic submucosal dissection

Mitsuyoshi, Yuki; Ichikawa, Daisuke; Ohya, Tomohiko R.; Ishihoka, Mitsuaki; Yasue, Chihiro; Chino, Akiko; Igarashi, Masahiro; Nakashima, Akitoshi; Saito, Shôichi; Fujisaki, Junko; Saruta, Masayuki

doi:10.1007/s00464-021-08799-y

Cited by 9 publications

(13 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although colorectal ESD results in superior treatment outcomes compared to those of endoscopic mucosal resection (EMR), such as higher en bloc resection rates, it is difficult to standardize the training system because of poor maneuverability and the risk of intraoperative perforation 7 . To date, the introduction of and training methods for colorectal ESD for trainees are still being discussed, and workshops and hands-on seminars are being actively conducted 3 , 4 . On average, the amount of endoscopic experience of the operator at the time of human ESD initiation is 7.7 years (standard deviation [SD], 4.1), and it is generally initiated in the gastric antrum (90%) 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Colorectal ESD has a high rate of intraoperative perforation (2.6%) compared to other procedures, thus rendering its introduction to trainees difficult 2 . The appropriate introduction of and training for colorectal ESD for trainees is still undergoing discussion 3 . Additionally, the criteria for performing colorectal ESD vary among institutions and have not yet been established; however, the performance colorectal ESD is often allowed after gaining experience performing animal and upper gastrointestinal ESD 4 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness of a multi-loop traction device for colorectal endoscopic submucosal dissection performed by trainees: a pilot study

Jinushi

Tashima

Terada

et al. 2022

Sci Rep

View full text Add to dashboard Cite

Colorectal endoscopic submucosal dissection (ESD) is a difficult procedure, and its introduction to trainees has been debated. Although the criteria for performing colorectal ESD vary among institutions, it is often allowed after gaining experience performing surgeries in animals and upper gastrointestinal ESD. This pilot study aimed to compare the treatment outcomes of ESD performed by trainees using the multi-loop traction device (MLTD group) and those of conventional ESD performed by experts (control group). It also aimed to determine whether the MLTD can be used to safely introduce colorectal ESD to trainees. We included 26 colorectal ESD patients (13 in the MLTD group and 13 in the control group) treated at our hospital from October to December 2021. There were no significant differences in the procedure time (50 min vs. 30 min), dissection speed (19.9 mm2/min vs. 28.7 mm2/min), and intraoperative perforation (0% vs. 0%) of the two groups. Furthermore, the rate of ESD self-completion in the MLTD group was 100%. Therefore, the use of the MLTD allowed the safe introduction of colorectal ESD, even among endoscopists with no experience performing colorectal ESD. Consequently, the use of the MLTD may replace animal and upper gastrointestinal ESD when introducing colorectal ESD to trainees.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of a multi-loop traction device for colorectal endoscopic submucosal dissection performed by trainees: a pilot study

Jinushi

Tashima

Terada

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Cumulative sum (CUSUM) analysis was used to quantitatively evaluate the learning curve based on a previously published method. 13 The ESDs were ordered chronologically; CUSUM was the running total of the differences between the individual data points and the average for all data points. A curve approximating the obtained plot was drawn; R 2 was used to evaluate the goodness of fit.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted endoscopic submucosal dissection contributes to efficient and safe learning for novices: Prospective pilot cross‐over ex vivo study (with video)

Yang

et al. 2022

Digestive Endoscopy

View full text Add to dashboard Cite

Objectives:The lack of effective countertraction to expose the submucosal layer contributes to the technical complication and adverse events in endoscopic submucosal dissection (ESD). We aimed to evaluate the efficacy and safety of a novel endoscopic robot (flexible auxiliary single-arm transluminal endoscopic robot [FASTER]) for ESD learning for novices.Methods: This was a prospective, cross-over designed pilot study in ex vivo porcine stomach. Four ESD novices were randomized to either FASTER-assisted ESD first (FC) group or a conventional ESD first (CF) group, performed 40 gastric ESDs using each technique, then crossed over to another technique. The performance and learning curve were compared between the two groups.Results: In the first phase, novices in the FC group demonstrated significantly better performance with shorter procedure time (25.6 AE 7.8 vs. 38.9 AE 13.4 min; P < 0.001) and submucosal dissection time (13.9 AE 5.5 vs. 23.1 AE 11.0 min; P < 0.001), higher direct-vision dissection ratio (84.0 AE 7.9% vs. 43.5 AE 20.7%; P < 0.001), and lower muscular injury (2.5 vs. 40.0%; P < 0.001) and task load (4 vs. 5; P < 0.001). Fewer ESDs were required to gain early proficiency in the FC group. When crossed to the second phase, procedure time in the FC group was prolonged but the muscular injury rate did not increase significantly. In total, endoscopists in the FC group tended to have a lower task load (4 vs. 5; P = 0.008) and less muscular injury (10.0 vs. 21.3%; P = 0.05). Conclusion:Flexible auxiliary single-arm transluminal endoscopic robot-assisted learning reduces the technical difficulty of ESD for novices and the safety profile can sustain in following conventional ESD. These results indicated that FASTER has potential implications for ESD training in clinical practice.

show abstract

“…Although colorectal ESD has superior treatment outcomes, such as en bloc resection proportion, compared to endoscopic mucosal resection (EMR), it is di cult to standardize the training system due to poor maneuverability and risk of intraoperative perforation [7] . To date, the introduction and training methods of colorectal ESD in trainees are still being discussed, and workshops and hands-on seminars are being actively held [3,4] . On an average, endoscopic experience at the time of human ESD initiation is 7.7 years (SD 4.1), and is generally initiated in the gastric antrum (90%) [4] .…”

Section: Discussionmentioning

confidence: 99%

“…Colorectal ESD has a high rate of intraoperative perforation (2.6%) compared to other organs, rendering it di cult to introduce to trainees [2] . The introduction and training for colorectal ESD in trainees is still under discussion [3] . In addition, the criteria for starting colorectal ESD vary among institutions and have not yet been established; however, colorectal ESD is often initiated after gaining experience in animal and upper gastrointestinal ESD [4] .…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of multi-loop traction device for colorectal endoscopic submucosal dissection in trainees: a pilot study

Jinushi

Tashima

Terada

et al. 2022

Preprint

View full text Add to dashboard Cite

Colorectal endoscopic submucosal dissection (ESD) is a difficult procedure, and its introduction in trainees have been debated. Although the criteria for starting colorectal ESD vary among institutions, it is often initiated after gaining experience in animal and upper gastrointestinal ESD. This pilot study aimed to compare the treatment outcomes of the trainees using the multi-loop traction device (MLTD group) and the experts’ conventional-ESD (control group), and determine whether MLTD can be used for safe introduction of colorectal ESD in trainees. We included 26 colorectal ESD patients (13 in the MLTD group and 13 in the control group) treated at our hospital from October to December 2021 in the analysis. There were no significant differences in procedure time (50 min vs. 30 min), dissection speed (19.9 mm2/min vs. 28.7 mm2/min,), and intraoperative perforation (0 % vs. 0 %) between the two groups. Furthermore, the proportion of ESD self-completion in the MLTD group was 100%. Thus, MLTD was used for safe introduction of colorectal ESD even among endoscopists with no experience in colorectal ESD. Subsequently, MLTD may replace animal and upper gastrointestinal ESD in the introduction of colorectal ESD in trainees. Further studies using larger sample sizes need to be conducted.

show abstract

Training program using a traction device improves trainees’ learning curve of colorectal endoscopic submucosal dissection

Cited by 9 publications

References 20 publications

Effectiveness of a multi-loop traction device for colorectal endoscopic submucosal dissection performed by trainees: a pilot study

Effectiveness of a multi-loop traction device for colorectal endoscopic submucosal dissection performed by trainees: a pilot study

Robot‐assisted endoscopic submucosal dissection contributes to efficient and safe learning for novices: Prospective pilot cross‐over ex vivo study (with video)

Effectiveness of multi-loop traction device for colorectal endoscopic submucosal dissection in trainees: a pilot study

Contact Info

Product

Resources

About