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Research article
Inanimate figure tracing and ex vivo pig stomach models to teach endoscope control and ESD: Description of models and preliminary results.
HMC Shantha Kumara
Lenox Hill Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9106-797X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
ESD is the gold standard treatment for large sessile adenomas yet US adoption rates are low. In ESD, tissue is cut only when the scope tip, with hot knife extended, is moving; this requires different skills than needed for snare polypectomy (scope tip held still). Scope tip control and ESD training methods are needed. A program including an inanimate figure tracing model (FTM; Model1), ex vivo pig stomach model (PSM; Model2) and bovine colon model was devised. This paper concerns preliminary results for models 1 and 2.
Methods
A straight hollow plastic tube with a window cutout 15cm from its end was used for both models (slotted sponge = “anus”). For the FTM a paper with a line figure is placed in the window. After endoscope insertion and positioning the figure is traced with a catheter "pen"; 8 tracings (4 figure types) and 1 pig ESD were done per session. In the PSM a piece of pig stomach and Bovie pad was placed over the window. After “lifting” the mucosa ESD resection of a "polyp" was done. Time/accuracy were tracked for both models as were bowel wall injuries in the PSM.
Results
A total of 30 FTM sessions and PSM cases were done (2 trainees). Completion times and accuracy improved over 8 FTM sessions for less experienced trainee A but not for trainee B. A total of 29/30 PSM cases were completed. The number of deep muscle injuries decreased with time, however, case length correlated with tissue quality and not number of cases. Lifting and tissue conductivity problems were noted in poor quality tissue.
Conclusions
Despite model related issues, both models are feasible and allow trainees to learn scope tip control and ESD; clearly, more study is needed. A smaller diameter tube and use of fresh stomach are advised.
Keywords
ESD, endoscopic training, ex vivo pig stomach model, inanimate training models
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Dr Ronak Bahuva
commented on 05 February, 2020
This is a very nice model which can help physicians, especially Gastroenterologists to acquire skills necessary for such important endoscopic procedures. Endoscopic procedures are the future, and we really need more studies and training models like this especially in USA
View 1 reply
Neil Sarkar, MD
commented on 06 February, 2020
How readily available is this animal model? It seems like a great tool and I have seen other abstracts utilizing this model, but am unsure of what goes into setting up such a training model. The scope tip tracing training seems very useful for coordination
View 1 reply
Abhinit Shah
replied on 07 February, 2020
Thanks for your comment Dr Sarkar. The animal model is one that our research team has come up with and built it ourselves. There are our abstracts and videos online which explain how we created the training model, but it can also be easily emulated by looking at the figures on this manuscript. The model is not available on the market as of yet. We introduced the figure tracing model to GI specialists and other surgeons, and is being very well received by them and said it has helped them refine their skills.
Dr Harsha Shah
commented on 06 February, 2020
This very descriptive study utilizing a unique model is a welcome step in training new crop of surgeons in Endo-Laparoscopic procedures. As far as the importance of ESD is concerned, there is a huge benefit of taking out a polyp without making a skin incision, instead of taking a part of the colon out. To say the very least, this training model if included in resident education, will make them very well versed in using the colonoscope. Good Job!
View 1 reply
Abhinit Shah
replied on 07 February, 2020
Thank you very much for your words Dr Shah. Our aim is to do the best to produce surgeons with very wide range of skill sets.
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This is a preprint. It has not completed peer review.
Research article
Inanimate figure tracing and ex vivo pig stomach models to teach endoscope control and ESD: Description of models and preliminary results.
HMC Shantha Kumara
Lenox Hill Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9106-797X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 03 Jan, 2020
Community comments: 6
Metrics
Comments: 6
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
ESD is the gold standard treatment for large sessile adenomas yet US adoption rates are low. In ESD, tissue is cut only when the scope tip, with hot knife extended, is moving; this requires different skills than needed for snare polypectomy (scope tip held still). Scope tip control and ESD training methods are needed. A program including an inanimate figure tracing model (FTM; Model1), ex vivo pig stomach model (PSM; Model2) and bovine colon model was devised. This paper concerns preliminary results for models 1 and 2.
Methods
A straight hollow plastic tube with a window cutout 15cm from its end was used for both models (slotted sponge = “anus”). For the FTM a paper with a line figure is placed in the window. After endoscope insertion and positioning the figure is traced with a catheter "pen"; 8 tracings (4 figure types) and 1 pig ESD were done per session. In the PSM a piece of pig stomach and Bovie pad was placed over the window. After “lifting” the mucosa ESD resection of a "polyp" was done. Time/accuracy were tracked for both models as were bowel wall injuries in the PSM.
Results
A total of 30 FTM sessions and PSM cases were done (2 trainees). Completion times and accuracy improved over 8 FTM sessions for less experienced trainee A but not for trainee B. A total of 29/30 PSM cases were completed. The number of deep muscle injuries decreased with time, however, case length correlated with tissue quality and not number of cases. Lifting and tissue conductivity problems were noted in poor quality tissue.
Conclusions
Despite model related issues, both models are feasible and allow trainees to learn scope tip control and ESD; clearly, more study is needed. A smaller diameter tube and use of fresh stomach are advised.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
Dr Ronak Bahuva
commented on 05 February, 2020
This is a very nice model which can help physicians, especially Gastroenterologists to acquire skills necessary for such important endoscopic procedures. Endoscopic procedures are the future, and we really need more studies and training models like this especially in USA
View 1 reply
Abhinit Shah
replied on 07 February, 2020
Thanks Dr Bahuva! I agree that Endoscopic procedures are the future.
Neil Sarkar, MD
commented on 06 February, 2020
How readily available is this animal model? It seems like a great tool and I have seen other abstracts utilizing this model, but am unsure of what goes into setting up such a training model. The scope tip tracing training seems very useful for coordination
View 1 reply
Abhinit Shah
replied on 07 February, 2020
Thanks for your comment Dr Sarkar. The animal model is one that our research team has come up with and built it ourselves. There are our abstracts and videos online which explain how we created the training model, but it can also be easily emulated by looking at the figures on this manuscript. The model is not available on the market as of yet. We introduced the figure tracing model to GI specialists and other surgeons, and is being very well received by them and said it has helped them refine their skills.
Dr Harsha Shah
commented on 06 February, 2020
This very descriptive study utilizing a unique model is a welcome step in training new crop of surgeons in Endo-Laparoscopic procedures. As far as the importance of ESD is concerned, there is a huge benefit of taking out a polyp without making a skin incision, instead of taking a part of the colon out. To say the very least, this training model if included in resident education, will make them very well versed in using the colonoscope. Good Job!
View 1 reply
Abhinit Shah
replied on 07 February, 2020
Thank you very much for your words Dr Shah. Our aim is to do the best to produce surgeons with very wide range of skill sets.
Abhinit Shah
replied on 07 February, 2020
Thanks Dr Bahuva! I agree that Endoscopic procedures are the future.