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The feasibility of using simulated targets in the stomachs of live pigs for full endoscopic submucosal dissection training.

Wang HY, Shih SC, Hung CY, Liu CY, Shieh TY, Chen MJ - Gut Liver (2014)

Bottom Line: The en bloc resection rate, procedure time, complications, quality of resection, and participants' opinions on the simulated targets were compared with the conventional model.The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking.Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan ; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan ; Clinical Skills Training Center, Department of Medical Education, Mackay Memorial Hospital, Taipei, Taiwan ; Department of Medicine, Mackay Medical College, New Taipei, Taiwan.

ABSTRACT

Background/aims: In 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.

Methods: Six 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.

Results: En 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.

Conclusions: Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.

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Related in: MedlinePlus

Specimen samples using the conventional model. Poor quality resections have an irregular shape (E), an inadequate safety margin (B, C, D), or a cut in the lesion (E). (A) and (F) are considered as quality and complete resections.
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f2-gnl-08-619: Specimen samples using the conventional model. Poor quality resections have an irregular shape (E), an inadequate safety margin (B, C, D), or a cut in the lesion (E). (A) and (F) are considered as quality and complete resections.

Mentions: The maneuvers for ESD were similar to the standard protocol in humans (Fig. 1C–F). In the present study, a water-jet gastroscope (GIF-Q260; Olympus Optical Co., Ltd.) was used. An ESG-100 (Olympus Optical Co., Ltd.) electrosurgical generator was used in all the procedures, and the settings were changed according to the procedure being performed. For the initial marking, “force coagulation I” mode was used at power level of 50. During submucosal dissection, “pulse cut slow” mode was used at power level of 80. For coagulation with the coagulation grasper, “soft coagulation” mode was used at power level of 80. Normal saline mixed with epinephrine and indigo carmine was use for submucosal injection. To improve the endoscopic view and manipulation in submucosal dissection, a distal attachment cap (D-201-10704; Olympus Optical Co., Ltd.) was mounted on the tip of gastroscope. A coagrasper (FD-410LR; Olympus Optical Co., Ltd.) was used when visible vessels or active bleeding was identified. The specimen was then resected, pinned on a cork, and measured. Fig. 2 shows the specimens using the conventional model and Fig. 3 shows specimens using the target model.


The feasibility of using simulated targets in the stomachs of live pigs for full endoscopic submucosal dissection training.

Wang HY, Shih SC, Hung CY, Liu CY, Shieh TY, Chen MJ - Gut Liver (2014)

Specimen samples using the conventional model. Poor quality resections have an irregular shape (E), an inadequate safety margin (B, C, D), or a cut in the lesion (E). (A) and (F) are considered as quality and complete resections.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215447&req=5

f2-gnl-08-619: Specimen samples using the conventional model. Poor quality resections have an irregular shape (E), an inadequate safety margin (B, C, D), or a cut in the lesion (E). (A) and (F) are considered as quality and complete resections.
Mentions: The maneuvers for ESD were similar to the standard protocol in humans (Fig. 1C–F). In the present study, a water-jet gastroscope (GIF-Q260; Olympus Optical Co., Ltd.) was used. An ESG-100 (Olympus Optical Co., Ltd.) electrosurgical generator was used in all the procedures, and the settings were changed according to the procedure being performed. For the initial marking, “force coagulation I” mode was used at power level of 50. During submucosal dissection, “pulse cut slow” mode was used at power level of 80. For coagulation with the coagulation grasper, “soft coagulation” mode was used at power level of 80. Normal saline mixed with epinephrine and indigo carmine was use for submucosal injection. To improve the endoscopic view and manipulation in submucosal dissection, a distal attachment cap (D-201-10704; Olympus Optical Co., Ltd.) was mounted on the tip of gastroscope. A coagrasper (FD-410LR; Olympus Optical Co., Ltd.) was used when visible vessels or active bleeding was identified. The specimen was then resected, pinned on a cork, and measured. Fig. 2 shows the specimens using the conventional model and Fig. 3 shows specimens using the target model.

Bottom Line: The en bloc resection rate, procedure time, complications, quality of resection, and participants' opinions on the simulated targets were compared with the conventional model.The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking.Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan ; Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan ; Clinical Skills Training Center, Department of Medical Education, Mackay Memorial Hospital, Taipei, Taiwan ; Department of Medicine, Mackay Medical College, New Taipei, Taiwan.

ABSTRACT

Background/aims: In 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.

Methods: Six 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.

Results: En 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.

Conclusions: Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.

Show MeSH
Related in: MedlinePlus