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Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope.

Chiu PW, Phee SJ, Bhandari P, Sumiyama K, Ohya T, Wong J, Poon CC, Tajiri H, Nakajima K, Ho KY - Endosc Int Open (2015)

Bottom Line: There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242).When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085).There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER.

View Article: PubMed Central - PubMed

Affiliation: CUHK Jockey Club Minimally Invasive Surgical Skills Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background and study aims: One of the challenges in performing endoscopic submucosal dissection (ESD) is the lack of counter traction during submucosal dissection. MASTER (Master and Slave Transluminal Endoscopic Robot) was designed to allow performance of complex endoluminal procedures using two arms with excellent control. This study aimed to compare the performance of ESD between endoscopists and novices using MASTER.

Methods: This is a prospective study comparing the differences in performing ESD using MASTER in an ex vivo porcine stomach model among individuals with or without experience in surgery and endoscopy. Multiple standardized lesions of 20 mm(2) were pre-marked on an ex vivo porcine stomach. Each participant received basic training in controlling MASTER before the ESD procedure. The operative time and size of specimen obtained by each participant were noted.

Results: Nine individuals (three ESD expert endoscopists, three ESD non-expert endoscopists, and three non-clinician novices) participated in the experiment. All participants completed the ESD procedure for en bloc resection of standardized lesions using EndoMASTER without perforation. The mean times (mean ± SD) taken by ESD expert endoscopists, ESD non-expert endoscopists, and novices to complete Robotic ESD were 122 ± 58 s, 203 ± 150 s, and 561 ± 496 s, respectively. There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242). When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085).

Conclusions: There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER. The use of MASTER enabled the novice without endoscopy experience to complete the ESD procedure.

No MeSH data available.


Related in: MedlinePlus

External view demonstrating submucosal dissection using the MASTER robotic endoscope. b Endoscopic view showing lifting of mucosa and submucosal dissection using the MASTER robotic endoscope.
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FI243-2: External view demonstrating submucosal dissection using the MASTER robotic endoscope. b Endoscopic view showing lifting of mucosa and submucosal dissection using the MASTER robotic endoscope.

Mentions: All of the procedures were performed using the MASTER endoscopic robot which was held by a single endoscopist (KYH) experienced in handling the MASTER robot (Fig. 1). In order to standardize the size of the lesion for the trial, we created a standard 20 mm circular cardboard disc which was then used to create standard 20 mm circular lesions with diathermy markings (ERBE 300 D, ERBE, Germany) in an ex vivo porcine stomach. After submucosal injection of normal saline mixed with indigo carmine, a circumferential mucosal incision was made using an IT2 knife (Olympus Co Ltd, Japan) (Fig. 1). The study started after completion of the circumferential mucosal incision. All participants completed the ESD procedure using the MASTER robot (Fig. 2). The steps for performance of ESD were standardized as: 1. Grasping of the mucosa using the right arm of the MASTER; 2. Elevation of the mucosa after grasping to expose the submucosal plane; 3. Submucosal dissection using the left arm with the diathermy hook; and 4. Repeating the procedure until complete dissection of the gastric lesion had been achieved.


Enhancing proficiency in performing endoscopic submucosal dissection (ESD) by using a prototype robotic endoscope.

Chiu PW, Phee SJ, Bhandari P, Sumiyama K, Ohya T, Wong J, Poon CC, Tajiri H, Nakajima K, Ho KY - Endosc Int Open (2015)

External view demonstrating submucosal dissection using the MASTER robotic endoscope. b Endoscopic view showing lifting of mucosa and submucosal dissection using the MASTER robotic endoscope.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4612240&req=5

FI243-2: External view demonstrating submucosal dissection using the MASTER robotic endoscope. b Endoscopic view showing lifting of mucosa and submucosal dissection using the MASTER robotic endoscope.
Mentions: All of the procedures were performed using the MASTER endoscopic robot which was held by a single endoscopist (KYH) experienced in handling the MASTER robot (Fig. 1). In order to standardize the size of the lesion for the trial, we created a standard 20 mm circular cardboard disc which was then used to create standard 20 mm circular lesions with diathermy markings (ERBE 300 D, ERBE, Germany) in an ex vivo porcine stomach. After submucosal injection of normal saline mixed with indigo carmine, a circumferential mucosal incision was made using an IT2 knife (Olympus Co Ltd, Japan) (Fig. 1). The study started after completion of the circumferential mucosal incision. All participants completed the ESD procedure using the MASTER robot (Fig. 2). The steps for performance of ESD were standardized as: 1. Grasping of the mucosa using the right arm of the MASTER; 2. Elevation of the mucosa after grasping to expose the submucosal plane; 3. Submucosal dissection using the left arm with the diathermy hook; and 4. Repeating the procedure until complete dissection of the gastric lesion had been achieved.

Bottom Line: There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242).When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085).There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER.

View Article: PubMed Central - PubMed

Affiliation: CUHK Jockey Club Minimally Invasive Surgical Skills Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background and study aims: One of the challenges in performing endoscopic submucosal dissection (ESD) is the lack of counter traction during submucosal dissection. MASTER (Master and Slave Transluminal Endoscopic Robot) was designed to allow performance of complex endoluminal procedures using two arms with excellent control. This study aimed to compare the performance of ESD between endoscopists and novices using MASTER.

Methods: This is a prospective study comparing the differences in performing ESD using MASTER in an ex vivo porcine stomach model among individuals with or without experience in surgery and endoscopy. Multiple standardized lesions of 20 mm(2) were pre-marked on an ex vivo porcine stomach. Each participant received basic training in controlling MASTER before the ESD procedure. The operative time and size of specimen obtained by each participant were noted.

Results: Nine individuals (three ESD expert endoscopists, three ESD non-expert endoscopists, and three non-clinician novices) participated in the experiment. All participants completed the ESD procedure for en bloc resection of standardized lesions using EndoMASTER without perforation. The mean times (mean ± SD) taken by ESD expert endoscopists, ESD non-expert endoscopists, and novices to complete Robotic ESD were 122 ± 58 s, 203 ± 150 s, and 561 ± 496 s, respectively. There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242). When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085).

Conclusions: There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER. The use of MASTER enabled the novice without endoscopy experience to complete the ESD procedure.

No MeSH data available.


Related in: MedlinePlus