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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

 Comparison of the operative time (s) for MASTER ESD between endoscopist and non-endoscopist study groups.
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FI243-4:  Comparison of the operative time (s) for MASTER ESD between endoscopist and non-endoscopist study groups.

Mentions: All participants were able to complete the ESD procedures and there were no perforations during the procedure. When the operative times were compared between the three groups, there was no difference in the time for first grasping of mucosa, time to expose the submucosa, time for submucosal dissection, and total time for the procedure (Fig. 3). There was a trend towards longer operative time for the non-clinician novice to complete the submucosal dissection though the difference was not statistically significant. The average operative time for MASTER ESD was 121.7 ± 57.7 s for the ESD expert group, 202.7 ± 149.5 s for the ESD non-expert group, and 561.0 ± 495.6 s for the novice group (P = 0.242) (Fig. 4). When all the clinicians were grouped to compare with the non-clinicians, we found that there was a trend towards a longer total dissection time (P = 0.085; 95 %CI = – 70.8 to 868.5) and submucosal dissection time (P = 0.078; 95 %CI = – 48.5 to 705.8) for the non-clinician group as compared to clinician group, however these differences were not significant.


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)

 Comparison of the operative time (s) for MASTER ESD between endoscopist and non-endoscopist study groups.
© Copyright Policy
Related In: Results  -  Collection

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

FI243-4:  Comparison of the operative time (s) for MASTER ESD between endoscopist and non-endoscopist study groups.
Mentions: All participants were able to complete the ESD procedures and there were no perforations during the procedure. When the operative times were compared between the three groups, there was no difference in the time for first grasping of mucosa, time to expose the submucosa, time for submucosal dissection, and total time for the procedure (Fig. 3). There was a trend towards longer operative time for the non-clinician novice to complete the submucosal dissection though the difference was not statistically significant. The average operative time for MASTER ESD was 121.7 ± 57.7 s for the ESD expert group, 202.7 ± 149.5 s for the ESD non-expert group, and 561.0 ± 495.6 s for the novice group (P = 0.242) (Fig. 4). When all the clinicians were grouped to compare with the non-clinicians, we found that there was a trend towards a longer total dissection time (P = 0.085; 95 %CI = – 70.8 to 868.5) and submucosal dissection time (P = 0.078; 95 %CI = – 48.5 to 705.8) for the non-clinician group as compared to clinician group, however these differences were not significant.

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