Potential for remote hands-on training system for colorectal endoscopic submucosal dissection

Hands-on training plays a crucial role in the acquisition of endoscopic skills; however, its transition to an online format has been considered challenging due to the inherently tactile and direct nature of instruction. Since 2020, we have conducted an online colorectal endoscopic submucosal dissection (ESD) training course, holding 9 sessions and training a total of 75 participants. The aim of this study is to evaluate the effectiveness of our remote hands-on training program for colorectal ESD.

Using a wired 50 Mbps connection, we linked a central facility to 3 remote sites across Japan. A 4-screen Picture-in-Picture (PinP) video integrating hand, scope, posture, and endoscopic views was streamed for real-time demonstration. Each participant underwent a structured 70-minute training session consisting of an initial and final time trial using the Scope handling Training (ST) kit, endoscope handling practice, and hands-on ESD training with an artificial model. During the remote hands-on phase, trainees performed procedures while receiving real-time instruction from experts via a Picture-in-Picture video system, which displayed both the endoscopic view and hand movements. There were no detectable delays in audio or video communication, enabling seamless 2-way interaction.

The results of the ST kit time trials conducted before and after the training showed a significant improvement in speed after the training (from 89.3 seconds before training to 49.4 seconds after training). Additionally, a questionnaire survey conducted among participants revealed that 94% expressed a desire to participate in similar remote training sessions in the future.

Colorectal ESD, which involves delicate and highly intricate techniques, is challenging to teach even in face-to-face settings. However, we were able to provide high-quality instruction in this program. This method provides training opportunities for physicians in remote areas, reducing the burden of time, travel, and costs, and has the potential to become a promising educational tool for the future.