Learning colorectal endoscopic submucosal dissection: a prospective learning curve study using a novel ex vivo...

Area of Science:

• Gastroenterology
• Surgical Simulation
• Medical Education

Background:

• Endoscopic submucosal dissection (ESD) is a minimally invasive technique for large superficial colorectal tumors.
• The learning curve and effectiveness of ex vivo simulators for colonic ESD training are not well-established.

Purpose of the Study:

• To determine the learning curve for colonic endoscopic submucosal dissection (ESD) using an ex vivo simulator.

Main Methods:

• A prospective study involved three endoscopists performing 30 colonic ESD resections each on standardized lesions in ex vivo porcine colons.
• Key metrics recorded included procedure time, en bloc resection status, and perforation rates.

Main Results:

• A total of 90 lesions were resected, with a mean procedure time of 49.6 minutes.
• The aggregate perforation rate was 14.4%, and non-en bloc resection rate was 5.6%.
• A significant improvement in a composite quality score was observed after the 9th procedure, indicating the learning curve's traversal.

Conclusions:

• Significant improvements in colonic ESD performance were achieved after 9 procedures in the ex vivo simulator.
• At least 9 ex vivo procedures are recommended before progressing to live animal or proctored training for colonic ESD.