Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 16, 2025; 17(3): 104315
Published online Mar 16, 2025. doi: 10.4253/wjge.v17.i3.104315
Effects of a training system that tracks the operator’s gaze pattern during endoscopic submucosal dissection on hemostasis
Takao Tonishi, Fumiaki Ishibashi, Kosuke Okusa, Kentaro Mochida, Sho Suzuki
Takao Tonishi, Fumiaki Ishibashi, Kentaro Mochida, Sho Suzuki, Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba 272-0827, Japan
Takao Tonishi, Fumiaki Ishibashi, Kentaro Mochida, Sho Suzuki, 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
Author contributions: Tonishi T, Ishibashi F, Mochida K, and Suzuki S conducted the data compilation; Ishibashi F and Suzuki S conceived the manuscript; Tonishi T and Ishibashi F contributed formal analyses, surveys, and writing of the original manuscript; Ishibashi F conducted the funding and project management; Ishibashi F and Okusa K contributed methodology, software, and resources to the manuscript; Suzuki S supervised; Tonishi T, Ishibashi F and Suzuki S conducted the research; Okusa K, Mochida K, and Suzuki S wrote, reviewed, and edited the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
Supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research, No. 23K11902.
Institutional review board statement: This study was approved by the Medical Ethics Committee of International University of Health and Welfare, approval No. 23-Ic-008.
Informed consent statement: Written informed consent was not obtained from all participants; instead, the study plan was publicized by posting the study protocol on the hospital’s website, and patients who did not wish to participate in the study were excluded using the opt-out approach.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fumiaki Ishibashi, MD, PhD, Associate Professor, Department of Gastroenterology and Hepatology, International University of Health and Welfare Ichikawa Hospital, 6-1-14, Konodai, Ichikawa-shi, Chiba 272-0827, Japan. f.jazzmaster@gmail.com
Received: December 17, 2024
Revised: February 16, 2025
Accepted: February 27, 2025
Published online: March 16, 2025
Processing time: 87 Days and 6.4 Hours
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.

Keywords: Eye tracking; Hemostasis; Endoscopic submucosal dissection; Gastric cancer; Training

Core Tip: The early acquisition of endoscopic hemostasis skills may be hindered by the lack of tools for assessing the operator’s viewpoint. We validated the effects of a training system that allowed an understanding of the operator’s gaze pattern during gastric endoscopic submucosal dissection on hemostasis. The time required to recognize the bleeding point was shorter after gaze pattern education using the training system. The number of coagulation attempts was fewer after the education. Learning from the operator’s viewpoint can facilitate acquiring the skills required to achieve hemostasis during endoscopic submucosal dissection.