通过分析电外科设备，为动物训练模型中的内镜黏膜下剥离术的效率和精度建立新型定量评估指标。
Novel quantitative assessment indicators for efficiency and precision of endoscopic submucosal dissection in animal training models by analyzing an electrical surgical unit.
机构信息
Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan.
出版信息
Dig Endosc. 2024 Jan;36(1):19-27. doi: 10.1111/den.14632. Epub 2023 Aug 3.
OBJECTIVES
Although endoscopic submucosal dissection (ESD) training is important, quantitative assessments have not been established. This study aimed to explore a novel quantitative assessment system by analyzing an electrical surgical unit (ESU).
METHODS
This was an ex vivo study. Step one: to identify the novel efficiency indicators, 20 endoscopists performed one ESD each, and we analyzed correlations between their resection speed and electrical status. Step two: to identify the novel precision indicators, three experts and three novices performed one ESD each, and we compared the stability of the electrical status. Step three: three novices in step two performed 19 additional ESDs, and we analyzed the learning curve using novel indicators.
RESULTS
Step one: the percentage of total activation time (AT) of ESU in the procedure time (β coefficient, 0.80; P < 0.01) and AT required for submucosal dissection (β coefficient, -0.57; P < 0.01) were significantly correlated with the resection speed. Step two: coefficient of variation of the AT per one pulse (0.16 [range, 0.13-0.17] vs. 0.26 [range, 0.20-0.41], P = 0.049) and coefficient of variation of the peak electric power per pulse during mucosal incision (0.14 [range, 0.080-0.15] vs. 0.25 [range, 0.24-0.28], P = 0.049) were significantly lower in the experts than in the novices. Regarding the learning curve, the percentage of total AT of ESU in the procedure time and AT required for submucosal dissection had a trend of improvement.
CONCLUSION
Novel indicators identified by analyzing ESU enable quantitative assessment for endoscopist's skill.
目的
尽管内镜黏膜下剥离术（ESD）培训很重要，但尚未建立定量评估方法。本研究旨在通过分析电外科设备（ESU）来探索一种新的定量评估系统。
方法
这是一项离体研究。第一步：为了确定新的效率指标，20 名内镜医生每人进行一次 ESD，我们分析了他们的切除速度与电外科设备的电切状态之间的相关性。第二步：为了确定新的精度指标，三位专家和三位新手每人进行一次 ESD，我们比较了电切状态的稳定性。第三步：在第二步中，三位新手进行了 19 次额外的 ESD，我们使用新指标分析了学习曲线。
结果
第一步：电外科设备总激活时间（AT）占手术时间的百分比（β系数，0.80；P<0.01）和黏膜下剥离所需的 AT（β系数，-0.57；P<0.01）与切除速度显著相关。第二步：每个电切脉冲的 AT 变异系数（0.16 [范围，0.13-0.17] 与 0.26 [范围，0.20-0.41]，P=0.049）和每个电切脉冲的峰值电功率变异系数（0.14 [范围，0.080-0.15] 与 0.25 [范围，0.24-0.28]，P=0.049）在专家中显著低于新手。关于学习曲线，电外科设备总 AT 占手术时间的百分比和黏膜下剥离所需的 AT 呈改善趋势。
结论
通过分析电外科设备确定的新指标可以对内镜医生的技能进行定量评估。
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