Clin Endosc.  2020 May;53(3):334-338. 10.5946/ce.2019.207.

Three-Dimensional Flexible Endoscopy Can Facilitate Efficient and Reliable Endoscopic Hand Suturing: An ex-vivo Study

• Omori J
• Goto O
• Higuchi K
• Umeda T
• Akimoto N
• Suzuki M
• Kirita K
• Koizumi E
• Noda H
• Akimoto T
• Kaise M
• Iwakiri K

• KMID: 2502768
• DOI: http://doi.org/10.5946/ce.2019.207

Abstract

Background/Aims
Three-dimensional (3D) flexible endoscopy, a new imaging modality that provides a stereoscopic view, can facilitate endoscopic hand suturing (EHS), a novel intraluminal suturing technique. This ex-vivo pilot study evaluated the usefulness of 3D endoscopy in EHS.
Methods
Four endoscopists (two certified, two non-certified) performed EHS in six sessions on a soft resin pad. Each session involved five stitches, under alternating 3D and two-dimensional (2D) conditions. Suturing time (sec/session), changes in suturing time, and accuracy of suturing were compared between 2D and 3D conditions.
Results
The mean suturing time was shorter in 3D than in 2D (9.8±3.4 min/session vs. 11.2±5.1 min/session) conditions and EHS was completed faster in 3D conditions, particularly by non-certified endoscopists. The suturing speed increased as the 3D sessions progressed. Error rates (failure to grasp the needle, failure to thread the needle, and puncture retrial) in the 3D condition were lower than those in the 2D condition, whereas there was no apparent difference in deviation distance.
Conclusions
3D endoscopy may contribute to increasing the speed and accuracy of EHS in a short time period. Stereoscopic viewing during 3D endoscopy may help in efficient skill acquisition for EHS, particularly among novice endoscopists.

Keyword

Endoscopic suturing; Learning curve; Three-dimensional endoscopy

Figure

• 

  Fig. 1. Ex-vivo settings of endoscopic hand suturing. (A) Locations of the markings on the urethane pad. Five markings at 5-mm intervals are linearly placed in both the right and left rows. (B) The pad after suturing. The suture needle is inserted from the marking point on the right row and pulled out from the marking point on the left row; this suturing is repeated five times per session.

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  Fig. 2. Suturing time during endoscopic hand suturing (EHS). (A) Comparison of suturing time (min/session) between two-dimensional (2D) and three-dimensional (3D) endoscopy showing a shorter time in 3D. (B) Comparison of suturing time for each endoscopist. (C) Among non-certified participants, EHS is completed faster in 3D than in 2D. Bar: 95% confidence interval.

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  Fig. 3. Changes in suturing time. (A) Under two-dimensional (2D) conditions, the suturing time per session tends to decrease as the study proceeded. (B) The time also decreases in the three-dimensional (3D) condition, although the magnitude of change is less than that seen under 2D conditions. (C) Comparison of suturing times in the former and latter halves of the suture sessions showing a reduced time in the 3D condition. Bar: 95% confidence interval.

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