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Shigaki T, Hasegawa H, Teramura K, Takeshita N, Ikeda K, Tsukada Y, Nishizawa Y, Sasaki T, Ito M. Development of a laparoscopic sigmoidectomy simulator: Sigmaster. Surg Today 2024; 54:1272-1276. [PMID: 38740574 DOI: 10.1007/s00595-024-02855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/17/2024] [Indexed: 05/16/2024]
Abstract
The sigmoid colon simulator was designed to accurately reproduce the anatomical layer structure and the arrangement of characteristic organs in each layer, and to have conductivity so that energy devices can be used. Dry polyester fibers were used to reproduce the layered structures, which included characteristic blood vessels, nerve sheaths, and intestinal tracts. The adhesive strength of the layers was controlled to allow realistic peeling techniques. The features of the Sigmaster are illustrated through a comparison of simulated sigmoidectomy using Sigmaster and actual surgery. We developed a laparoscopic sigmoidectomy simulator called Sigmaster. Sigmaster is a training device that closely reproduces the membrane structures of the human body and allows surgeons to experience the entire laparoscopic sigmoidectomy process.
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Affiliation(s)
- Takahiro Shigaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Nobuyoshi Takeshita
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
- Surgical Device Innovation Office, NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Japan.
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Kamolvisit S, Limsrivilai J, Mekaroonkamol P, Chantarojanasiri T, Chalermsuksant N, Harinwan K, Rattananukrom C, Wong T, Pittayanon R, Sattayalertyanyong O, Sathirawich P, Kaosombatwattana U, Pulsombat A, Kamalaporn P, Sottisuporn J, Pausawasdi N, Rattanasiri S, Kitiyakara T. Validation and efficacy of the Varix Trainer model as a Training device for esophagogastroduodenoscopy. Endosc Int Open 2024; 12:E1043-E1055. [PMID: 39268154 PMCID: PMC11392590 DOI: 10.1055/a-2374-8476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 07/01/2024] [Indexed: 09/15/2024] Open
Abstract
Background and study aims The Varix Trainer model 1 (VTM1) was created for trainees to safely practice basic endoscope manipulation skills. The VTM1 was tested to see if it could distinguish levels of endoscope manipulation skills (construct validity) and whether training with it could improve these skills faster (content validity). Patients and methods We enrolled 23 novice endoscopists, 18 second-year trainees, and 13 expert endoscopists. They were asked to point with the endoscope tip to 20 numbers in the model as quickly as possible using torque, single-hand small/large wheel manipulation (SHSW), and retroflexion techniques. Their mean times (t20) were compared to determine if the model could distinguish different levels of expertise. Subsequently, 14 novices trained for eight short sessions, and the pre-training and post-training t20 were compared. Nine novice endoscopists received no training and were retested after 4 to 6 weeks (controls). Results Experts had faster t20 than second-year trainees, who were faster than novices, for all three techniques ( P < 0.001). After eight sessions, the mean t20 for novices improved from 112 to 66 seconds for torque, 144 to 72 seconds for SHSW, and 108 to 63 seconds for retroflexion, (all P < 0.001). Their t20 were equivalent to second-year trainees. Improvement in t20 was also seen with the control group, but total reduction was less than for the training group. Conclusions The VTM1 distinguished varying levels of expertise for all techniques, suggesting that it is a valid tool for assessing endoscope manipulation skill. A short curriculum improved novices' manipulation skills faster than traditional practice.
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Affiliation(s)
- Sarunporn Kamolvisit
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Julajak Limsrivilai
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Parit Mekaroonkamol
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tanyaporn Chantarojanasiri
- Division of Gastroenterology, Department of Internal Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Nalerdon Chalermsuksant
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kamin Harinwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Pramongkutklao Hospital and College of Medicine, Royal Thai Army, Bangkok, Thailand
| | - Chitchai Rattananukrom
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand
| | - Thanawin Wong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Rapat Pittayanon
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Onuma Sattayalertyanyong
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phalat Sathirawich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Uayporn Kaosombatwattana
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Akharawit Pulsombat
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patarapong Kamalaporn
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jaksin Sottisuporn
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince Songkla University, Songkla, Thailand
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Taya Kitiyakara
- Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Miutescu B, Dhir V. Training and quality indicators in interventional endoscopic ultrasound. Dig Endosc 2024. [PMID: 39021062 DOI: 10.1111/den.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Abstract
Endoscopic ultrasound (EUS) has transformed the landscape of minimally invasive gastrointestinal procedures, necessitating specialized training for proficiency in interventional EUS (iEUS). This study evaluates the effectiveness of iEUS training, focusing on learning curves, success rates, and the associated risks in various procedures, aiming to recommend practices for standardizing training and ensuring competency. Key metrics such as procedure type, learning curve for proficiency, success rates, and risk of adverse events were analyzed to establish benchmarks for training programs. Proficiency in pancreatic fluid collection drainage was achieved after 20-30 procedures, with a 100% success rate and a complication rate ranging from 1.5 to 80%. Gallbladder drainage required 19 cases to reach an 86% success rate, with adverse events reported in 19% of cases. Choledocoduodenostomy mastery was observed after approximately 100 cases, with postintervention pancreatitis affecting 5.3-6.6% of all cases. Hepaticogastrostomy showed a 93% success rate after 33 cases, with a 24.8% adverse event rate. Hepaticoenterostomy reached 100% success beyond the 40th patient, with a 20% rate of postsurgical strictures. Pancreatic duct drainage achieved 89% technical and 87% clinical success after 27 cases, with 12-15% adverse events. Gastro-enteric anastomosis required 25 cases for proficiency and approximately 40 cases for mastery, with 5.5% immediate and 1% late adverse events. iEUS training outcomes vary significantly across different procedures, highlighting the importance of structured, procedure-specific training programs to achieve proficiency. These findings provide a foundation for developing universal competency benchmarks in iEUS, facilitating consistent and effective training worldwide.
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Affiliation(s)
- Bogdan Miutescu
- Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
| | - Vinay Dhir
- Institute of Digestive and Liver Care, SL Raheja Hospital, Mumbai, India
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Lugilde-López A, Caeiro-Rodríguez M, Mikic-Fonte FA, Llamas-Nistal M. Systematic review of subjective validation methods for computerized colonoscopy simulators. Health Informatics J 2024; 30:14604582241279692. [PMID: 39251376 DOI: 10.1177/14604582241279692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Introduction: In recent years, different approaches have been used to conduct a subjective assessment of colonoscopy simulators. The purpose of this paper is to review these different approaches, specifically the ones used for computerized simulators, as the first step for the design of a standard validation procedure for this type of simulators. Methods: A systematic review was conducted by searching papers after 2010 in PubMed, Google Scholar, ScienceDirect, and IEEE Xplore databases. Papers were screened and reviewed for procedures regarding the subjective validation of computerized simulators for traditional colonoscopy with an endoscope. Results: An initial search in the databases identified 2094 papers, of which 7 remained after exhaustive review and application of exclusion criteria. All studies used questionnaires for subjective validation, with "face" being the most common validity type tested, while "content" validity and "usability" were less prominent. Conclusions: A classification of subscales for testing face validity was derived from the studies. The Colonoscopy Simulator Realism Questionnaire (CSRQ) was selected as the guide to follow for the development of future questionnaires related to subjective validation. Mislabeling of the validity tested in the studies due to ambiguous interpretations of the validity types was a common occurrence observed in the reviewed studies.
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Affiliation(s)
- Adrián Lugilde-López
- atlanTTic Research Center for Telecommunication Technologies, School of Telecommunication Engineering, University of Vigo, Vigo, Spain
| | - Manuel Caeiro-Rodríguez
- atlanTTic Research Center for Telecommunication Technologies, School of Telecommunication Engineering, University of Vigo, Vigo, Spain
| | - Fernando A Mikic-Fonte
- atlanTTic Research Center for Telecommunication Technologies, School of Telecommunication Engineering, University of Vigo, Vigo, Spain
| | - Martín Llamas-Nistal
- atlanTTic Research Center for Telecommunication Technologies, School of Telecommunication Engineering, University of Vigo, Vigo, Spain
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Díaz-Regañón D, Mendaza-De Cal R, García-Sancho M, Rodríguez-Franco F, Sainz Á, Rodriguez-Quiros J, Rojo C. Canine Upper Digestive Tract 3D Model: Assessing Its Utility for Anatomy and Upper Endoscopy Learning. Animals (Basel) 2024; 14:1070. [PMID: 38612309 PMCID: PMC11010944 DOI: 10.3390/ani14071070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
A teaching strategy using 3D-printed models of the canine upper digestive tract (UDT) for anatomy demonstration and upper endoscopy instruction was evaluated. The canine UDT (esophagus-stomach-duodenum) was scanned and 3D-printed molds were manufactured using silicone casting. First-year students were introduced to these 3D models in practical sessions alongside real specimens. Simultaneously, fifth-year students were trained in endoscope handling and anatomical recognition using 3D specimens. Both groups completed an anonymous survey. Results showed that overall, first-year (n = 93) and fifth-year (n = 45) students agreed or strongly agreed that the 3D-printed model was effective for learning purposes. In summary, first-year students highlighted an improved understanding of size, volume, topography, and easier manipulation of the 3D model compared to fresh specimens. Fifth-year students were more enthusiastic, finding the 3D model valuable for spatial vision and clinical training. While both groups were against completely replacing the natural UDT with the 3D model, first-year students were more hesitant. These findings suggest that the 3D model of the canine UDT is an effective tool for hands-on training in clinical endoscopy and a valuable, albeit complementary, resource for teaching anatomy and topography.
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Affiliation(s)
- David Díaz-Regañón
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; (M.G.-S.); (F.R.-F.); (Á.S.); (J.R.-Q.)
| | - Rosa Mendaza-De Cal
- Departmental Section of Anatomy and Embryology, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain;
| | - Mercedes García-Sancho
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; (M.G.-S.); (F.R.-F.); (Á.S.); (J.R.-Q.)
| | - Fernando Rodríguez-Franco
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; (M.G.-S.); (F.R.-F.); (Á.S.); (J.R.-Q.)
| | - Ángel Sainz
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; (M.G.-S.); (F.R.-F.); (Á.S.); (J.R.-Q.)
| | - Jesus Rodriguez-Quiros
- Department of Animal Medicine and Surgery, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain; (M.G.-S.); (F.R.-F.); (Á.S.); (J.R.-Q.)
| | - Concepción Rojo
- Departmental Section of Anatomy and Embryology, College of Veterinary Medicine, Complutense University of Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain;
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凡 小, 罗 斌, 杨 丽. [Role of Virtual Reality in Gastrointestinal Endoscopy Training and Teaching]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:315-320. [PMID: 38645845 PMCID: PMC11026882 DOI: 10.12182/20240360302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Indexed: 04/23/2024]
Abstract
Gastrointestinal (GI) endoscope is one of the instruments used extensively in the diagnosis and treatment of digestive tract disorders. China is confronted with a great demand for endoscopists working in grassroots healthcare facilities. Furthermore, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS), and endoscopic submucosal dissection (ESD) are becoming the prevailing methods of endoscopic treatment of digestive diseases. Therefore, there is a growing demand for senior endoscopists. Currently, an important focus of GI endoscopy training is the acceleration of standardized training for endoscopists working in grassroots health facilities and advanced training for senior endoscopists. Simulation devices based on virtual reality technology exhibit strengths in objectivity, authenticity, and an immersive experience. These devices show advantages in the training method, the number of participants, and assessment over traditional training programs for GI endoscopy. Their application provides a new approach to the training and teaching of GI endoscopy. Herein, we summarized the explorations and practices of using virtual reality technology in the training and teaching of GI endoscopy, analyzed its application status in China, and discussed its prospects for future application.
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Affiliation(s)
- 小丽 凡
- 四川大学华西医院 消化内科,四川大学-牛津大学华西消化道肿瘤联合研究中心 (成都 610041)Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 斌阳 罗
- 四川大学华西医院 消化内科,四川大学-牛津大学华西消化道肿瘤联合研究中心 (成都 610041)Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 丽 杨
- 四川大学华西医院 消化内科,四川大学-牛津大学华西消化道肿瘤联合研究中心 (成都 610041)Department of Gastroenterology and Hepatology, Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu 610041, China
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Kanno T, Arata Y, Greenwald E, Moayyedi P, Suzuki S, Hatayama Y, Saito M, Jin X, Hatta W, Uno K, Asano N, Imatani A, Kagaya Y, Koike T, Masamune A. Interactive training with a novel simulation model for upper gastrointestinal endoscopic hemostasis improves trainee technique and confidence. Endosc Int Open 2024; 12:E245-E252. [PMID: 38420152 PMCID: PMC10901645 DOI: 10.1055/a-2248-5110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
Background and study aims Endoscopic hemostasis is a life-saving procedure for gastrointestinal bleeding; however, training for it is often performed on real patients and during urgent situations that put patients at risk. Reports of simulation-based training models for endoscopic hemostasis are scarce. Herein, we developed a novel simulator called "Medical Rising STAR-Ulcer type" to practice endoscopic hemostasis with hemoclips and coagulation graspers. This study aimed to evaluate the reproducibility of the clinical difficulty of this model and the effectiveness of simulation-based training for clipping hemostasis. Patients and methods This was a prospective educational study. Fifty gastroenterology residents from Japan and Canada were recruited to participate in a simulation-based training program. The primary outcome was the success rate for clipping hemostasis. We measured differences in trainee subjective assessment scores and evaluated the co-occurrence network based on comments after training. Results The hemostasis success rate of the trainees significantly increased after instruction (64% vs. 86%, P < 0.05). The success rate for ulcers in the upper body of the stomach (59%), a high-difficulty site, was significantly lower than that for ulcers in the antrum, even after feedback and instruction. Trainee self-perceived proficiency and confidence significantly improved after simulation-based training ( P < 0.05). Co-occurrence network analysis showed that trainees valued a structured learning approach, acknowledged simulator limitations, and recognized the need for continuous skill refinement. Conclusions Our study demonstrates the potential of our simulation-based training model as a valuable tool for improving technical skills and confidence in trainees learning to perform endoscopic hemostasis.
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Affiliation(s)
- Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
- R & D Division of Career Education for Medical Professionals, Medical Education Center, Jichi Medical University, Shimotsuke, Japan
| | - Yutaro Arata
- Graduate Medical Education Center, Tohoku University Hospital, Sendai, Japan
| | - Eric Greenwald
- Division of Gastroenterology, McMaster University Faculty of Health Sciences, Hamilton, Canada
| | - Paul Moayyedi
- Division of Gastroenterology, McMaster University Faculty of Health Sciences, Hamilton, Canada
| | - Suguo Suzuki
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Hatayama
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yutaka Kagaya
- Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Finocchiaro M, Banfi T, Donaire S, Arezzo A, Guarner-Argente C, Menciassi A, Casals A, Ciuti G, Hernansanz A. A Framework for the Evaluation of Human Machine Interfaces of Robot-Assisted Colonoscopy. IEEE Trans Biomed Eng 2024; 71:410-422. [PMID: 37535479 DOI: 10.1109/tbme.2023.3301741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The Human Machine Interface (HMI) of intraluminal robots has a crucial impact on the clinician's performance. It increases or decreases the difficulty of the tasks, and is connected to the users' physical and mental stress. OBJECTIVE This article presents a framework to compare and evaluate different HMIs for robotic colonoscopy, with the objective of identifying the optimal HMI that minimises the clinician's effort and maximises the clinical outcomes. METHODS The framework comprises a 1) a virtual simulator (clinically validated), 2) wearable sensors measuring the cognitive load, 3) a data collection unit of metrics correlated to the clinical performance, and 4) questionnaires exploring the users' impressions and perceived stress. The framework was tested with 42 clinicians investigating the optimal device for tele-operated control of robotic colonoscopes. Two control devices were selected and compared: a haptic serial-kinematic device and a standard videogame joypad. RESULTS The haptic device was preferred by the endoscopists, but the joypad enabled better clinical performance and reduced cognitive and physical load. CONCLUSION The framework can be used to evaluate different aspects of a HMI, both hardware and software, and determine the optimal HMI that can reduce the burden on clinicians while improving the clinical outcome. SIGNIFICANCE The findings of this study, and of future studies performed with this framework, can inform the design and development of HMIs for intraluminal robots, leading to improved clinical performance, reduced physical and mental stress for clinicians, and ultimately better patient outcomes.
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Robles-Medranda C, Baquerizo-Burgos J, Puga-Tejada M, Del Valle R, Mendez JC, Egas-Izquierdo M, Arevalo-Mora M, Cunto D, Alcívar-Vasquez J, Pitanga-Lukashok H, Tabacelia D. Development of convolutional neural network models that recognize normal anatomic structures during real-time radial-array and linear-array EUS (with videos). Gastrointest Endosc 2024; 99:271-279.e2. [PMID: 37827432 DOI: 10.1016/j.gie.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/05/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND AIMS EUS is a high-skill technique that requires numerous procedures to achieve competence. However, training facilities are limited worldwide. Convolutional neural network (CNN) models have been previously implemented for object detection. We developed 2 EUS-based CNN models for normal anatomic structure recognition during real-time linear- and radial-array EUS evaluations. METHODS The study was performed from February 2020 to June 2022. Consecutive patient videos of linear- and radial-array EUS videos were recorded. Expert endosonographers identified and labeled 20 normal anatomic structures within the videos for training and validation of the CNN models. Initial CNN models (CNNv1) were developed from 45 videos and the improved models (CNNv2) from an additional 102 videos. CNN model performance was compared with that of 2 expert endosonographers. RESULTS CNNv1 used 45,034 linear-array EUS frames and 21,063 radial-array EUS frames. CNNv2 used 148,980 linear-array EUS frames and 128,871 radial-array EUS frames. Linear-array CNNv1 and radial-array CNNv1 achieved a 75.65% and 71.36% mean average precision (mAP) with a total loss of .19 and .18, respectively. Linear-array CNNv2 obtained an 88.7% mAP with a .06 total loss, whereas radial-array CNNv2 achieved an 83.5% mAP with a .07 total loss. CNNv2 accurately detected all studied normal anatomic structures with a >98% observed agreement during clinical validation. CONCLUSIONS The proposed CNN models accurately recognize the normal anatomic structures in prerecorded videos and real-time EUS. Prospective trials are needed to evaluate the impact of these models on the learning curves of EUS trainees.
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Affiliation(s)
- Carlos Robles-Medranda
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Jorge Baquerizo-Burgos
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Miguel Puga-Tejada
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Raquel Del Valle
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Juan C Mendez
- Research and Development Department, mdconsgroup, Guayaquil, Ecuador
| | - Maria Egas-Izquierdo
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Martha Arevalo-Mora
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Domenica Cunto
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Juan Alcívar-Vasquez
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Hannah Pitanga-Lukashok
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador
| | - Daniela Tabacelia
- Gastroenterology and Hepatology, Elias Emergency University Hospital, Bucharest, Romania; Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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10
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Ismail FW, Afzal A, Durrani R, Qureshi R, Awan S, Brown MR. Exploring Endoscopic Competence in Gastroenterology Training: A Simulation-Based Comparative Analysis of GAGES, DOPS, and ACE Assessment Tools. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:75-84. [PMID: 38312535 PMCID: PMC10838491 DOI: 10.2147/amep.s427076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024]
Abstract
Purpose Accurate and convenient evaluation tools are essential to document endoscopic competence in Gastroenterology training programs. The Direct Observation of Procedural Skills (DOPS), Global Assessment of Gastrointestinal Endoscopic Skills (GAGES), and Assessment of Endoscopic Competency (ACE) are widely used validated competency assessment tools for gastrointestinal endoscopy. However, studies comparing these 3 tools are lacking, leading to lack of standardization in this assessment. Through simulation, this study seeks to determine the most reliable, comprehensive, and user-friendly tool for standardizing endoscopy competency assessment. Methods A mixed-methods quantitative-qualitative approach was utilized with sequential deductive design. All nine trainees in a gastroenterology training program were assessed on endoscopic procedural competence using the Simbionix Gi-bronch-mentor high-fidelity simulator, with 2 faculty raters independently completing the 3 assessment forms of DOPS, GAGES, and ACE. Psychometric analysis was used to evaluate the tools' reliability. Additionally, faculty trainers participated in a focused group discussion (FGD) to investigate their experience in using the tools. Results For upper GI endoscopy, Cronbach's alpha values for internal consistency were 0.53, 0.8, and 0.87 for ACE, DOPS, and GAGES, respectively. Inter-rater reliability (IRR) scores were 0.79 (0.43-0.92) for ACE, 0.75 (-0.13-0.82) for DOPS, and 0.59 (-0.90-0.84) for GAGES. For colonoscopy, Cronbach's alpha values for internal consistency were 0.53, 0.82, and 0.85 for ACE, DOPS, and GAGES, respectively. IRR scores were 0.72 (0.39-0.96) for ACE, 0.78 (-0.12-0.86) for DOPS, and 0.53 (-0.91-0.78) for GAGES. The FGD yielded three key themes: the ideal tool should be scientifically sound, comprehensive, and user-friendly. Conclusion The DOPS tool performed favourably in both the qualitative assessment and psychometric evaluation to be considered the most balanced amongst the three assessment tools. We propose that the DOPS tool be used for endoscopic skill assessment in gastroenterology training programs. However, gastroenterology training programs need to match their learning outcomes with the available assessment tools to determine the most appropriate one in their context.
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Affiliation(s)
| | - Azam Afzal
- Aga Khan University Karachi, Sind, Pakistan
| | | | | | - Safia Awan
- Aga Khan University Karachi, Sind, Pakistan
| | - Michelle R Brown
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Jin Y, Ma M, Yan Y, Guo Y, Feng Y, Chen C, Zhong Y, Huang K, Xia H, Libo Y, Si Y, Zou J. A convenient machine learning model to predict full stomach and evaluate the safety and comfort improvements of preoperative oral carbohydrate in patients undergoing elective painless gastrointestinal endoscopy. Ann Med 2023; 55:2292778. [PMID: 38109932 PMCID: PMC10732178 DOI: 10.1080/07853890.2023.2292778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND AIMS Assessment of the patient's gastric contents is the key to avoiding aspiration incidents, however, there is no effective method to determine whether elective painless gastrointestinal endoscopy (GIE) patients have a full stomach or an empty stomach. And previous studies have shown that preoperative oral carbohydrates (POCs) can improve the discomfort induced by fasting, but there are different perspectives on their safety. This study aimed to develop a convenient, accurate machine learning (ML) model to predict full stomach. And based on the model outcomes, evaluate the safety and comfort improvements of POCs in empty- and full stomach groups. METHODS We enrolled 1386 painless GIE patients between October 2022 and January 2023 in Nanjing First Hospital, and 1090 patients without POCs were used to construct five different ML models to identify full stomach. The metrics of discrimination and calibration validated the robustness of the models. For the best-performance model, we further interpreted it through SHapley Additive exPlanations (SHAP) and constructed a web calculator to facilitate clinical use. We evaluated the safety and comfort improvements of POCs by propensity score matching (PSM) in the two groups, respectively. RESULTS Random Forest (RF) model showed the greatest discrimination with the area under the receiver operating characteristic curve (AUROC) 0.837 [95% confidence interval (CI): 79.1-88.2], F1 71.5%, and best calibration with a Brier score of 15.2%. The web calculator can be visited at https://medication.shinyapps.io/RF_model/. PSM results demonstrated that POCs significantly reduced the full stomach incident in empty stomach group (p < 0.05), but no differences in full stomach group (p > 0.05). Comfort improved in both groups and was more significant in empty stomach group. CONCLUSIONS The developed convenient RF model predicted full stomach with high accuracy and interpretability. POCs were safe and comfortably improved in both groups, with more benefit in empty stomach group. These findings may guide the patients' gastrointestinal preparation.
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Affiliation(s)
- Yuzhan Jin
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Mingtao Ma
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Anesthesiology, Leping People’s Hospital, Jiangxi, China
| | - Yuqing Yan
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yaoyi Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yue Feng
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Yi Zhong
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kaizong Huang
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Huaming Xia
- Nanjing Xiaheng Network System Co., Ltd., Nanjing, China
| | - Yan Libo
- Jiangsu Kaiyuan Pharmaceutical Co., Ltd., Nanjing, China
| | - Yanna Si
- Department of Anesthesiology, Perioperative and Pain Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
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12
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Mascarenhas M, Ribeiro T, Afonso J, Mendes F, Cardoso P, Martins M, Ferreira J, Macedo G. Smart Endoscopy Is Greener Endoscopy: Leveraging Artificial Intelligence and Blockchain Technologies to Drive Sustainability in Digestive Health Care. Diagnostics (Basel) 2023; 13:3625. [PMID: 38132209 PMCID: PMC10743290 DOI: 10.3390/diagnostics13243625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/14/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
The surge in the implementation of artificial intelligence (AI) in recent years has permeated many aspects of our life, and health care is no exception. Whereas this technology can offer clear benefits, some of the problems associated with its use have also been recognised and brought into question, for example, its environmental impact. In a similar fashion, health care also has a significant environmental impact, and it requires a considerable source of greenhouse gases. Whereas efforts are being made to reduce the footprint of AI tools, here, we were specifically interested in how employing AI tools in gastroenterology departments, and in particular in conjunction with capsule endoscopy, can reduce the carbon footprint associated with digestive health care while offering improvements, particularly in terms of diagnostic accuracy. We address the different ways that leveraging AI applications can reduce the carbon footprint associated with all types of capsule endoscopy examinations. Moreover, we contemplate how the incorporation of other technologies, such as blockchain technology, into digestive health care can help ensure the sustainability of this clinical speciality and by extension, health care in general.
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Affiliation(s)
- Miguel Mascarenhas
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Tiago Ribeiro
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - João Afonso
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Francisco Mendes
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Pedro Cardoso
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - Miguel Martins
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
| | - João Ferreira
- Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal;
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
- Precision Medicine Unit, Department of Gastroenterology, Hospital São João, 4200-437 Porto, Portugal; (T.R.); (J.A.); (P.C.); (M.M.)
- WGO Training Center, 4200-437 Porto, Portugal
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13
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Zhao AY, Gimpaya N, Angeli Fujiyoshi MR, Fujiyoshi Y, Khan R, Lisondra J, Walsh CM, Grover SC. How to make cost-effective polyp simulators for high-fidelity simulation-based training in postpolypectomy bleeding management and EMR. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:520-526. [PMID: 38155828 PMCID: PMC10751457 DOI: 10.1016/j.vgie.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Video 1Demonstration of manufacturing instructions and features of the postpolypectomy bleeding and conventional and underwater EMR simulators.
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Affiliation(s)
- Ally Y Zhao
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Yusuke Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rishad Khan
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - James Lisondra
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Catharine M Walsh
- Division of Gastroenterology, Hepatology, and Nutrition and the Research and Learning Institutes, Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Marlicz W, Koulaouzidis A, Charisopoulou D, Jankowski J, Marlicz M, Skonieczna-Zydecka K, Krynicka P, Loniewski I, Samochowiec J, Rydzewska G, Koulaouzidis G. Burnout in healthcare - the Emperor's New Clothes. PRZEGLAD GASTROENTEROLOGICZNY 2023; 18:274-280. [PMID: 37937112 PMCID: PMC10626384 DOI: 10.5114/pg.2023.131595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 05/24/2023] [Indexed: 11/09/2023]
Abstract
Burnout is common among physicians; it severely alters their health and has a negative impact on functioning of healthcare systems. Hypertension, increased cortisol levels, maladaptive behaviors with negative social consequences, and suboptimal quality of care have been associated with healthcare providers' burnout. As the number of patients with cancers, psychiatric and neurodegenerative disorders will rise, we need new solutions to maintain physicians' health and, therefore, quality of care. Coping strategies before the COVID-19 pandemic seem ineffective in scaling all the deficits of the global healthcare systems. Examples of new initiatives include new collaborative projects, such as COH-FIT (The Collaborative Outcomes study on Health and Functioning during Infection Times - https://www.coh-fit.com), which aims to collect global data and understand the impact of the COVID-19 pandemic on physical and mental health in order to identify various coping strategies for patients and healthcare workers during infection times, or MEMO (Minimizing Error, Maximizing Outcome), funded by the Agency of Healthcare Research and Quality (AHRQ). Others: i) Rome Foundation GastroPsych undertake efforts dedicated to the science and practice of psychogastroenterology, a burgeoning field with roots in behavioral intervention, cognitive science and experimental psychology focused on fostering the professional growth and collaboration of those engaged in medical practices, or ii) World Gastroenterology Organisation (WGO), Train The Trainers (TTT) program including a new topic of the impact of burnout on career longevity in order to foster strategies for staying healthy and increasing career satisfaction. There is a need for continuous development of digital technologies (e.g. training simulators, telemedicine, robots and artificial intelligence). Their implementation into medical practice is inevitable. Now more than ever, there is a need for a new spirit in healthcare. Together with others in the field, we believe this article is a desperate call for maximizing the use of novel technologies supported by collaborative interactions among healthcare providers and medical professionals of diverse medical fields.
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Affiliation(s)
- Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Anastasios Koulaouzidis
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
- Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Dafni Charisopoulou
- Amalia Children’s Hospital, Radboud University Medical Centre, Nijmegen, Netherlands
- Academic Centre for Congenital Heart Disease, Netherlands
| | - Janusz Jankowski
- Institute for Clinical Trials, University College London, London, UK
| | - Maria Marlicz
- Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland
| | | | - Patrycja Krynicka
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Igor Loniewski
- Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - George Koulaouzidis
- Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland
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15
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Ahmed IA, Senan EM, Shatnawi HSA. Hybrid Models for Endoscopy Image Analysis for Early Detection of Gastrointestinal Diseases Based on Fused Features. Diagnostics (Basel) 2023; 13:diagnostics13101758. [PMID: 37238241 DOI: 10.3390/diagnostics13101758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
The gastrointestinal system contains the upper and lower gastrointestinal tracts. The main tasks of the gastrointestinal system are to break down food and convert it into essential elements that the body can benefit from and expel waste in the form of feces. If any organ is affected, it does not work well, which affects the body. Many gastrointestinal diseases, such as infections, ulcers, and benign and malignant tumors, threaten human life. Endoscopy techniques are the gold standard for detecting infected parts within the organs of the gastrointestinal tract. Endoscopy techniques produce videos that are converted into thousands of frames that show the disease's characteristics in only some frames. Therefore, this represents a challenge for doctors because it is a tedious task that requires time, effort, and experience. Computer-assisted automated diagnostic techniques help achieve effective diagnosis to help doctors identify the disease and give the patient the appropriate treatment. In this study, many efficient methodologies for analyzing endoscopy images for diagnosing gastrointestinal diseases were developed for the Kvasir dataset. The Kvasir dataset was classified by three pre-trained models: GoogLeNet, MobileNet, and DenseNet121. The images were optimized, and the gradient vector flow (GVF) algorithm was applied to segment the regions of interest (ROIs), isolating them from healthy regions and saving the endoscopy images as Kvasir-ROI. The Kvasir-ROI dataset was classified by the three pre-trained GoogLeNet, MobileNet, and DenseNet121 models. Hybrid methodologies (CNN-FFNN and CNN-XGBoost) were developed based on the GVF algorithm and achieved promising results for diagnosing disease based on endoscopy images of gastroenterology. The last methodology is based on fused CNN models and their classification by FFNN and XGBoost networks. The hybrid methodology based on the fused CNN features, called GoogLeNet-MobileNet-DenseNet121-XGBoost, achieved an AUC of 97.54%, accuracy of 97.25%, sensitivity of 96.86%, precision of 97.25%, and specificity of 99.48%.
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Affiliation(s)
| | - Ebrahim Mohammed Senan
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Alrazi University, Sana'a, Yemen
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16
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Kim Y, Lee JH, Lee GH, Kim GH, Huh G, Hong SW, Jung HY. Simulator-based training method in gastrointestinal endoscopy training and currently available simulators. Clin Endosc 2023; 56:1-13. [PMID: 36604834 PMCID: PMC9902695 DOI: 10.5946/ce.2022.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/19/2022] [Indexed: 01/07/2023] Open
Abstract
The apprenticeship-based training method (ABTM) is highly effective for gastrointestinal (GI) endoscopic training. However, the conventional ABTM has significant issues. Although many supplementary training methods (TMs) have been developed and utilized, they cannot entirely replace the ABTM, which remains the major TM strategy. Currently, new TM construction is crucial and necessary due to financial constraints, difficulty of obtaining sufficient training time due to patient safety-related regulations, and catastrophic damage caused by disasters such as the coronavirus disease 2019 pandemic. The simulator-based TM (SBTM) is widely accepted as an alternative to the ABTM, owing to the SBTM's advantages. Since the 1960s, many GI endoscopy training simulators have been developed and numerous studies have been published on their effectiveness. While previous studies have focused on the simulator's validity, this review focused on the accessibility of simulators that were introduced by the end of 2021. Although the current SBTM is effective in GI endoscopic education, extensive improvements are needed to replace the ABTM. Incorporating simulator-incorporated TMs into an improved ABTM is an attempt to overcome the incompleteness of the current SBTM. Until a new simulator is developed to replace the ABTM, it is desirable to operate a simulator-integrated and well-coordinated TM that is suitable for each country and institution.
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Affiliation(s)
- Yuri Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence: Gin Hyug Lee Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea E-mail:
| | - Ga Hee Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Gunn Huh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Reperfused human cadaver as a new simulation model for colonoscopy: a pilot study. Surg Endosc 2022; 37:3224-3232. [PMID: 36443563 PMCID: PMC9707156 DOI: 10.1007/s00464-022-09763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The reperfused human cadaver is a validated simulator for surgery. We aimed to use it as a colonoscopy simulator. METHODS Novices, intermediates and skilled participants in gastrointestinal endoscopy were included. They performed one colonoscopy on a reperfused human cadaver and reaching rates, time, and length needed to reach anatomical landmarks were reported for construct validity analysis. We also assessed our model realism (SRS survey), educational content (CVS survey) and task load (NASA-TLX index). Score items were collected and defined as "favorable" when items were rated ≥ 5/7 with an inter-quartile range (IQR) overlapping four, and "very favorable" when rated ≥ 5/7 with an IQR excluding four (neutral). Primary endpoints were the rectosigmoid junction (RSJ) reaching rate and the descending colon (DC) reaching time. Secondary objectives were SRS, CVS and NASA-TLX questionnaire results. RESULTS A total of 11 skilled participants, 5 intermediates and 8 novices were included. Skilled participants reached RSJ more often than novice and intermediary groups, respectively, 100%, 80% and 75% without differing significantly. They reached DC more frequently (100% for skilled, 80% for intermediates and 50% for novices, p = 0.018). The median time to reach RSJ (59, 272 and 686 s for skilled, intermediates and novices group, respectively) and DC (90, 534 and 1360 s for skilled, intermediates and novices) was significantly shorter for skilled participants (both p < .01). Nineteen out of the 22 items composing the realism survey obtained "very favorable" and "favorable" scores. Educational content was designated as "very favorable". Mental, physical, and technical demands were gradually higher the lower the initial level of experience. CONCLUSIONS Reperfused human cadaver model has the potential to be valid simulation tool for diagnostic colonoscopy training.
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Matsumoto K, Ueyama H, Yao T, Iwano T, Yamamoto M, Utsunomiya H, Uchida R, Abe D, Oki S, Suzuki N, Ikeda A, Yatagai N, Akazawa Y, Takeda T, Ueda K, Asaoka D, Hojo M, Nagahara A. Endoscopic Features of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage. Diagnostics (Basel) 2022; 12:2666. [PMID: 36359508 PMCID: PMC9689643 DOI: 10.3390/diagnostics12112666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 08/30/2023] Open
Abstract
The endoscopic features of gastric epithelial neoplasms of fundic gland mucosa lineage (GEN-FGML) have not been well investigated. We aimed to clarify the endoscopic features of GEN-FGML and differences between gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosa type (GA-FGM). A total of 62 GEN-FGML lesions, including 52 GA-FG and 10 GA-FGM, were retrospectively analyzed using endoscopic and clinicopathological findings to provide information of diagnostic value using white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (M-NBI). GA-FG frequently presented with a whitish, submucosal tumor (SMT) shape with dilated vessels with branching architecture and background mucosa without atrophic change in WLI, an indistinct demarcation line (DL), dilatation of the crypt opening and intervening part (IP), and microvessels without distinct irregularity in M-NBI. GA-FGM frequently presented as a reddish, elevated lesion in WLI, with a distinct DL, dilatation of the IP, and an irregular microvascular pattern in M-NBI. As for an M-NBI diagnosis, five GA-FGM lesions met the diagnostic criteria for cancer, whereas none of the GA-FG lesions met the same criteria. We highlight the endoscopic features of GEN-FGML, and the differentiation between GA-FG and GA-FGM might be possible by combination of lesion color and morphology in WLI and M-NBI diagnoses.
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Affiliation(s)
- Kohei Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Tomoyo Iwano
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Momoko Yamamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Hisanori Utsunomiya
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Ryota Uchida
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Shotaro Oki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Nobuyuki Suzuki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Atsushi Ikeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Noboru Yatagai
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
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Xu C, Zhu Y, Wu L, Yu H, Liu J, Zhou F, Xiong Q, Wang S, Cui S, Huang X, Yin A, Xu T, Lei S, Xia Z. Evaluating the effect of an artificial intelligence system on the anesthesia quality control during gastrointestinal endoscopy with sedation: a randomized controlled trial. BMC Anesthesiol 2022; 22:313. [PMID: 36207701 PMCID: PMC9540709 DOI: 10.1186/s12871-022-01796-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022] Open
Abstract
Background Sedative gastrointestinal endoscopy is extensively used worldwide. An appropriate degree of sedation leads to more acceptability and satisfaction. Artificial intelligence has rapidly developed in the field of digestive endoscopy in recent years and we have constructed a mature computer-aided diagnosis (CAD) system. This system can identify the remaining parts to be examined in real-time endoscopic procedures, which may help anesthetists use anesthetics properly to keep patients in an appropriate degree of sedation. Aims This study aimed to evaluate the effects of the CAD system on anesthesia quality control during gastrointestinal endoscopy. Methods We recruited 154 consecutive patients at Renmin Hospital of Wuhan University, including 76 patients in the CAD group and 78 in the control group. Anesthetists in the CAD group were able to see the CAD system’s indications, while anesthetists in the control group could not. The primary outcomes included emergence time (from examination completion to spontaneous eye opening when doctors called the patients’ names), recovery time (from examination completion to achievement of the primary recovery endpoints) and patient satisfaction scores. The secondary outcomes included anesthesia induction time (from sedative administration to successful sedation), procedure time (from scope insertion to scope withdrawal), total dose of propofol, vital signs, etc. This trial was registered in the Primary Registries of the WHO Registry Network, with registration number ChiCTR2100042621. Results Emergence time in the CAD group was significantly shorter than that in the control group (p < 0.01). The recovery time was also significantly shorter in the CAD group (p < 0.01). Patients in the CAD group were significantly more satisfied with their sedation than those in control group (p < 0.01). Vital signs were stable during the examinations in both groups. Propofol doses during the examinations were comparable between the two groups. Conclusion This CAD system possesses great potential for anesthesia quality control. It can improve patient satisfaction during endoscopic examinations with sedation. Trial registration ChiCTR2100042621. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01796-1.
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Affiliation(s)
- Cheng Xu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China
| | - Yijie Zhu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianlian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fang Zhou
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China
| | - Qiutang Xiong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shanshan Wang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China
| | - Shanshan Cui
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China
| | - Xu Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Anning Yin
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tingting Xu
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China
| | - Shaoqing Lei
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China.
| | - Zhongyuan Xia
- Department of Anesthesiology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, 430060, Wuhan, Hubei Province, China.
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Maulahela H, Annisa NG, Konstantin T, Syam AF, Soetikno R. Simulation-based mastery learning in gastrointestinal endoscopy training. World J Gastrointest Endosc 2022; 14:512-523. [PMID: 36186944 PMCID: PMC9516469 DOI: 10.4253/wjge.v14.i9.512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/03/2022] [Accepted: 08/16/2022] [Indexed: 02/05/2023] Open
Abstract
Simulation-based mastery learning (SBML) is an emerging form of competency-based training that has been proposed as the next standard method for procedural task training, including that in gastrointestinal endoscopy. Current basic gastrointestinal endoscopy training relies on the number of procedures performed, and it has been criticized for its lack of objective standards that result in variable skills among trainees and its association with patient safety risk. Thus, incorporating simulators into a competency-based curriculum seems ideal for gastrointestinal endoscopy training. The curriculum for SBML in gastrointestinal endoscopy is currently being developed and has promising potential to translate into the clinical performance. Unlike the present apprenticeship model of “see one, do one, teach one,” SBML integrates a competency-based curriculum with specific learning objectives alongside simulation-based training. This allows trainees to practice essential skills repeatedly, receive feedback from experts, and gradually develop their abilities to achieve mastery. Moreover, trainees and trainers need to understand the learning targets of the program so that trainees can focus their learning on the necessary skills and trainers can provide structured feedback based on the expected outcomes. In addition to learning targets, an assessment plan is essential to provide trainees with future directions for their improvement and ensure patient safety by issuing a passing standard. Finally, the SBML program should be planned and managed by a specific team and conducted within a developed and tested curriculum. This review discusses the current state of gastrointestinal endoscopy training and the role of SBML in that field.
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Affiliation(s)
- Hasan Maulahela
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General Central National Hospital, Jakarta 10430, Indonesia
| | | | | | - Ari Fahrial Syam
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General Central National Hospital, Jakarta 10430, Indonesia
| | - Roy Soetikno
- Department of Internal Medicine, Gastroenterology Division, Faculty of Medicine University of Indonesia-Cipto Mangunkusumo General Central National Hospital, Jakarta 10430, Indonesia
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Bhat Balekuduru A, Sahu MK. A Simulation Study to Investigate the Usefulness of a Novel Stricture Tool for Training Wire Guided Balloon Dilation. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1751109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Background and Aims The training in esophageal stricture dilation is difficult to obtain and have few simulation models. The aim of the study was to evaluate a novel stricture simulation for training a wire-guided, controlled radial expansile (CRE) balloon dilation.
Methods The study was a pretest–posttest design without a control group involving a novel simulation device for esophageal stricture. The training session involved 12 final year gastroenterology fellows from five different centers. The trainees received 2 hours of education sessions featuring didactic content, a live demonstration of step-by-step demonstration of wire-guided CRE balloon dilation and a study material on the procedure. The simulation device used was a single-use hose pipe along with a red color nonhardening modeling clay with a 5.0-to-8.0-mm hole in the center.
Results All the trainees and instructor uniformly rated the model as excellent or good with simulation device being mild stiffer in haptics than of the real tissue. The mean (%) pretest scores of 39 (21.6%) improved significantly to 160 (88.8%) in mean (%) posttest questionnaire (p < 0.05). There was a significant improvement in the questionnaire of the dilation procedure after the simulation training episode.
Conclusion The novel stricture simulation model had good performance evaluation and can be used to train CRE balloon dilation procedure.
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Affiliation(s)
- Avinash Bhat Balekuduru
- Department of Gastroenterology, Mathikere Sampangi Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Manoj K. Sahu
- Department of Gastroenterology, Sum Hospitals, Bhubaneshwar, Orissa, India
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Kim DY, Tan X, Li D, Yilmaz M, Miernik A, Qiu T. A Hybrid Surgical Simulator for Interactive Endoscopic Training. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:971-974. [PMID: 36086164 DOI: 10.1109/embc48229.2022.9871697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Endoscopy serves as an indispensable minimally-invasive surgical procedure. Due to the limited view and non-intuitive operation of the instrument, the mastery of endoscopic manipulation requires deep medical knowledge as well as complex perception and motor skills of the surgeon. Intensive surgical training is required, and simulation-based training is of more and more importance over traditional animal- or cadaver-based approaches. Here, we developed a hybrid surgical simulator that consists of a realistic physical organ model and an artificial intelligence (AI)-driven cyber model. We built a physical model of the full urinary tract with soft materials and detailed blood vessel structures. Endourological procedures were performed to localize and treat renal calculi by a flexible endoscope. An AI algorithm detects the lesions automatically with high accuracy and provides quantitative feedback about an operator's endoscopic skills. The hybrid simulator system shows great potential as an interactive and personalized learning environment for endoscopic skills. Clinical Relevance- This work establishes a preliminary approach for realistic endoscopic training. The developed hybrid surgical simulator - with high-fidelity physical organ models and quantitative feedback - can deliver effective hands-on learning to surgeons to improve their endoscopic skills.
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A Flavor of the Future of GI Endoscopy-New Solutions Shape the Field of Modern Gastrointestinal Care. Cancers (Basel) 2021; 13:cancers13123007. [PMID: 34208440 PMCID: PMC8235533 DOI: 10.3390/cancers13123007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/08/2021] [Indexed: 12/02/2022] Open
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