A task and performance analysis of endoscopic submucosal dissection (ESD) surgery.

Area of Science:

• Gastroenterology
• Surgical Simulation
• Medical Education

Background:

• Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique for gastrointestinal lesion resection, widely adopted in Asia but less so in Europe and the US.
• Technical challenges and higher adverse event rates (bleeding, perforation) compared to endoscopic mucosal resection (EMR) have limited ESD adoption in Western countries.
• Inadequate training platforms and curricula hinder the widespread acceptance and proficiency of ESD in the US.

Purpose of the Study:

• To develop a Virtual Endoluminal Surgery Simulator (VESS) for objective training and assessment of ESD procedures.
• To perform a detailed task and performance analysis of colorectal ESD surgeries to inform simulator development.

Main Methods:

• A comprehensive task analysis of colorectal ESD was conducted, identifying critical steps from lesion identification to post-procedure examination.
• A hierarchical task tree was constructed to outline the sequence of ESD tasks.
• Quantitative performance metrics were developed and applied to analyze task times and scores from 16 ESD surgeries performed by four surgeons.

Main Results:

• The average times for marking, injection, and circumferential cutting phases were recorded (e.g., circumferential cutting: 908.4 s).
• Submucosal layer cutting represented the longest procedural phase, averaging 1394.7 s.
• Significant positive correlations were found between marking, circumferential cutting, submucosal dissection scores, and total performance scores (e.g., R=0.7879 for cutting/dissection and total scores).

Conclusions:

• Elaborated ESD tasks and developed quantitative performance metrics for analyzing surgical performance.
• These metrics are crucial for the future validation of the VESS simulator.
• The developed metrics and task analysis provide a foundation for objective ESD training and assessment.