Clin Endosc.  2023 Sep;56(5):604-612. 10.5946/ce.2022.163.

Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study

• Lee DS
• Lee GH
• Kim SG
• Lee KL
• Kim JW
• Jeong JB
• Jung YJ
• Kang HW

• KMID: 2546139
• DOI: http://doi.org/10.5946/ce.2022.163

Abstract

Background/Aims
We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists.
Methods
An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts.
Results
Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion’s limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures).
Conclusions
We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.

Keyword

Endoscopic submucosal resection; Endoscopy; Hydrogels; Polyvinyl alcohol; Simulation training

Figure

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  Fig. 1. The new endoscopic submucosal dissection (ESD) simulator is composed of three units: the esophagus, gastric wall, and electric units. (A-1) The esophagus unit aids endoscopic insertion. (A-2) The gastric wall unit is connected to an electric surgical unit. (A-3) The gastric wall unit is designed to have three layers of different types of polyvinyl alcohol hydrogel (PVA-H) sheets. (A-4) An electric surgical unit. (B) An existing ESD simulator is composed of three units.

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  Fig. 2. Demonstration of the two endoscopic submucosal dissection (ESD) simulators. (A) The new simulator. (B) The existing simulator. (C) Demonstrations of ESD with the new simulator; a direct view from above the simulator. (C-1) Marking of the target lesion. (C-2) Submucosal injection. (C-3) Circumferential cutting. (C-4) Submucosal dissection. (D-1) ESD with submucosal injection. (D-2) ESD without submucosal injection.

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  Fig. 3. Learning curves for the trainees. (A) Complete resection. (B) Perforation.

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