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Tonishi T, Ishibashi F, Okusa K, Mochida K, Suzuki S. Effects of a training system that tracks the operator’s gaze pattern during endoscopic submucosal dissection on hemostasis. World J Gastrointest Endosc 2025; 17:104315. [DOI: 10.4253/wjge.v17.i3.104315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 02/16/2025] [Accepted: 02/27/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint. Understanding the operator’s viewpoint may facilitate the skills.
AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection (ESD) on hemostasis.
METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD, displaying the viewpoint as a circle. In phase 1, videos of three trainees’ viewpoints were recorded. After reviewing these, trainees were recorded again in phase 2. The videos from both phases were retrospectively reviewed, and short clips were created to evaluate the hemostasis skills. Outcome measures included the time to recognize the bleeding point, the time to complete hemostasis, and the number of coagulation attempts.
RESULTS Eight cases treated with ESD were reviewed, and 10 video clips of hemostasis were created. The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1 (8.3 ± 4.1 seconds vs 23.1 ± 19.2 seconds; P = 0.049). The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different (15.4 ± 6.8 seconds vs 31.9 ± 21.7 seconds; P = 0.056). Significantly fewer coagulation attempts were performed during phase 2 (1.8 ± 0.7 vs 3.2 ± 1.0; P = 0.004).
CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts. Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.
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Affiliation(s)
- Takao Tonishi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba 272-0827, Japan
- International University of Health and Welfare Graduate School of Medicine, Chiba 286-8686, Japan
| | - Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba 272-0827, Japan
- International University of Health and Welfare Graduate School of Medicine, Chiba 286-8686, Japan
| | - Kosuke Okusa
- Department of Data Science for Business Innovation, Chuo University, Tokyo 112-0003, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba 272-0827, Japan
- International University of Health and Welfare Graduate School of Medicine, Chiba 286-8686, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba 272-0827, Japan
- International University of Health and Welfare Graduate School of Medicine, Chiba 286-8686, Japan
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Xia J, Wang W, Guo J, Wu J, Wan X. A pilot study on endoscopic delivery of injectable bioadhesive for esophageal repair in a porcine model. Biomed Mater 2024; 19:055023. [PMID: 39025105 DOI: 10.1088/1748-605x/ad6546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/18/2024] [Indexed: 07/20/2024]
Abstract
Endoscopic submucosal dissection (ESD) is the gold-standard surgical procedure for superficial esophageal cancer. A significant and challenging complication of this technique is post-ESD esophageal stricture. In this study, the feasibility of endoscopic catheter delivery of bioadhesive to esophageal lesions in a porcine model was tested. Injectable bioadhesive was composed of oxidized dextran (ODA) and chitosan hydrochloride (CS), its physicochemical properties, injectability, antibacterial activity, and cytocompatibility were investigated beforein vivotest. ODA-CS bioadhesive was delivered to the wound bed of the esophageal tissue using a custom-made catheter device after ESD in a porcine model. Our results show that the ODA-CS bioadhesive is of good injectability, tissue adhesive strength, antibacterial capacity, and blood compatibility.In vivodelivery was achieved by endoscopic spraying of ODA and CS in separate catheters fixed on the endoscopic probe. ODA and CS can be mixed well to allow in situ bioadhesive formation and firmly adhere to the esophageal wound surface. After two weeks, the bioadhesive maintained structural integrity and adhered to the surface of esophageal wounds. However, histological analysis reveals that the ODA-CS bioadhesive did not show improvement in attenuating inflammatory response after ESD. This pilot study demonstrates the feasibility of ODA-CS bioadhesive for shielding esophageal wounds after ESD, whereas efforts need to improve its anti-inflammatory activity to reduce fibrosis for stricture prevention.
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Affiliation(s)
- Jie Xia
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, People's Republic of China
| | - Wenxin Wang
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, People's Republic of China
| | - Jinghui Guo
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, People's Republic of China
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, Department of Biomedical Engineering, Donghua University, Shanghai 201620, People's Republic of China
| | - Xinjian Wan
- Digestive Endoscopic Center, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, People's Republic of China
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De Cristofaro E, Masgnaux LJ, Saurin JC, Jacques J, Napoléon B, Rivory J, Pioche M. Multipolar adaptive traction makes endoscopic submucosal dissection feasible for large neoplastic area of the fundus in patient with familial adenomatous polyposis. Endoscopy 2023; 55:E963-E964. [PMID: 37604442 PMCID: PMC10442201 DOI: 10.1055/a-2135-8682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Elena De Cristofaro
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Louis-Jean Masgnaux
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | | | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Harlow C, Sivananthan A, Ayaru L, Patel K, Darzi A, Patel N. Endoscopic submucosal dissection: an update on tools and accessories. Ther Adv Gastrointest Endosc 2020; 13:2631774520957220. [PMID: 33089213 PMCID: PMC7545765 DOI: 10.1177/2631774520957220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove larger polyps or early non-metastatic lesions. It has long been used in Asia, but is now fast growing in popularity in the West. There are multiple challenges faced by ESD practitioners. While the practice of ESD in gastric lesions is relatively well established, the oesophagus with its narrow lumen and challenging workspace, and the colon with its tortuous course and folds are more challenging frontiers. The nature of performing a procedure endoscopically means that conventional methods offer no mechanism for providing counter-traction while performing dissection, impeding visibility and increasing the rate of complications. There are a multitude of tools available to those performing ESD for the different stages of the procedure. This article reviews the accessories currently used in regular ESD practice including the knives used to cut and dissect lesions, the cap and hood devices used to improve visibility and safety, injection fluids to lift the submucosal plane, haemostatic devices, generators, and finally, emerging traction apparatus. There is some evidence behind the use of these tools, however, ESD remains the domain of a small number of practitioners and the practice relies heavily on expert experience. Evolution of the ESD toolbox will make the procedure more accessible to more endoscopists, which in turn will drive the development of a more substantial evidence base to evaluate efficacy and safety of the multitude of tools.
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Affiliation(s)
| | - Arun Sivananthan
- Imperial College Healthcare NHS Trust, London, UK; Institute of Global Health Innovation, London, UK
| | | | - Kinesh Patel
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust; Institute of Global Health Innovation, London, UK
| | - Nisha Patel
- Imperial College Healthcare NHS Trust, Institute of Global Health Innovation, St Mary’s Hospital Campus, 10th Floor, QEQM Wing, South Wharf Road, Paddington, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London, UK
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Jiang W, Zhou Y, Wang C, Peng L, Yang Y, Liu H. Navigation strategy for robotic soft endoscope intervention. Int J Med Robot 2019; 16:e2056. [PMID: 31713946 DOI: 10.1002/rcs.2056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current soft endoscope intervention mainly depends on the skills of endoscopists, especially for the orientation of the endoscope within the human tortuous lumen. This dependence causes inefficient and time-consuming surgery. METHODS A human-robot cooperation navigation strategy is proposed to perform the intervention of soft endoscope. The navigation strategy firstly detects the cavity center by processing the image of endoscope, then an auto-orienting strategy is presented to automatically adjust the endoscope pointing to the detected cavity center. RESULTS Human phantom experiments are carried out to validate the effectiveness and feasibility of the navigation strategy. The results show that the cavity center is accurately extracted with whether the cavity is occluded or not and the auto-orienting strategy could well point the endoscope around the cavity center. CONCLUSION The proposed human-robot cooperation navigation strategy releases endoscopists from the time-consuming operations and improves the safety and automation of intervention procedures.
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Affiliation(s)
- Wei Jiang
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China.,Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang, China.,University of Chinese Academy of Sciences, Beijing, China.,Key Laboratory of Minimally Invasive Surgical Robot, Liaoning Province, Shenyang, China
| | - Yuanyuan Zhou
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China.,Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang, China.,University of Chinese Academy of Sciences, Beijing, China.,Key Laboratory of Minimally Invasive Surgical Robot, Liaoning Province, Shenyang, China
| | - Chongyang Wang
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China.,Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang, China.,Key Laboratory of Minimally Invasive Surgical Robot, Liaoning Province, Shenyang, China
| | - Lihua Peng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Hao Liu
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang, China.,Institutes for Robotics and Intelligent Manufacturing, Chinese Academy of Sciences, Shenyang, China.,Key Laboratory of Minimally Invasive Surgical Robot, Liaoning Province, Shenyang, China
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