Omori Jun, Goto Osamu, Higuchi Kazutoshi, Umeda Takamitsu, Akimoto Naohiko, Suzuki Masahiro, Kirita Kumiko, Koizumi Eriko, Noda Hiroto, Akimoto Teppei, Kaise Mitsuru, Iwakiri Katsuhiko
Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan.
Clin Endosc. 2020 May;53(3):334-338. doi: 10.5946/ce.2019.207. Epub 2020 Apr 24.
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.
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.
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.
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.
背景/目的：三维（3D）柔性内镜检查是一种能提供立体视野的新型成像方式，可促进内镜下手工缝合（EHS），这是一种新型腔内缝合技术。本体外初步研究评估了3D内镜检查在EHS中的实用性。
四名内镜医师（两名有资质，两名无资质）在一个软质树脂垫上进行了六次EHS操作。每次操作包括五针缝合，分别在3D和二维（2D）条件下交替进行。比较了2D和3D条件下的缝合时间（秒/次）、缝合时间的变化以及缝合准确性。
3D条件下的平均缝合时间比2D条件下短（9.8±3.4分钟/次对11.2±5.1分钟/次），并且在3D条件下EHS完成得更快，尤其是无资质的内镜医师。随着3D操作次数的增加，缝合速度加快。3D条件下的错误率（未能抓住针、未能穿针以及穿刺重试）低于2D条件下，而偏差距离没有明显差异。
3D内镜检查可能有助于在短时间内提高EHS的速度和准确性。3D内镜检查期间的立体视野可能有助于高效掌握EHS技能，尤其是对于新手内镜医师。
