Department of Computer Science, University of Arkansas at Little Rock, Little Rock, AR, United States.
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Surg Endosc. 2019 Feb;33(2):592-606. doi: 10.1007/s00464-018-6379-6. Epub 2018 Aug 20.
ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.
We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.
The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson's test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores.
We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.
ESD 是一种用于整块切除胃肠道病变的内镜技术。ESD 在日本和亚洲被广泛应用，但在欧洲和美国并不流行。该手术技术难度较大，与内镜黏膜切除术相比，不良事件（出血、穿孔）发生率更高。缺乏足够的培训平台和既定的培训课程限制了它在美国的广泛接受。因此，我们旨在开发一种虚拟内镜腔内手术模拟器（VESS），用于客观的 ESD 培训和评估。在这项工作中，我们对 ESD 手术进行了任务和性能分析。
我们对结直肠 ESD 任务进行了详细的分析，并确定了用于识别病变、标记、注射、环形切割、解剖、术中并发症管理和术后检查的关键 ESD 步骤。我们构建了一个层次任务树，详细阐述了这些步骤中的任务顺序。此外，我们还开发了定量 ESD 绩效指标。我们测量了由四位不同的内镜外科医生进行的 16 例 ESD 手术的任务时间和得分。
标记、注射和环形切割阶段的平均时间分别为 203.4（σ：205.46）、83.5（σ：49.92）和 908.4s（σ：584.53）。黏膜下层的切割过程占据了整个 ESD 手术时间的大部分，平均为 1394.7s（σ：908.43）。我们还对任务绩效得分进行了相关性分析（Pearson 检验）。标记得分与总分之间存在中度正相关（R=0.528，p=0.0355），环形切割与黏膜下解剖和总分之间存在强正相关（R=0.7879，p=0.0003）。同样，我们注意到环形切割与黏膜下解剖和标记得分之间存在强正相关（R=0.7095，p=0.0021）。
我们详细阐述了 ESD 任务，并开发了用于分析实际手术性能的定量绩效指标。这些 ESD 指标将用于我们的 VESS 模拟器的未来验证研究。
