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Assistant skill in gastric endoscopic submucosal dissection using a clutch cutter

World Journal of Gastrointestinal Surgery 2021年第2期13卷 116-126页

作者： Mitsuru Esaki Toshiki Horii Ryoji Ichijima Masafumi Wada Seiichiro Sakisaka Shuichi Abe Naru Tomoeda Yusuke Kitagawa Kei Nishioka Yosuke Minoda Shinichi Tsuruta Sho Suzuki Hirotada Akiho Eikichi Ihara Yoshihiro Ogawa Takuji Gotoda Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan Division of Gastroenterology and Hepatology Department of MedicineNihon University School of MedicineTokyo 101-8309Japan Department of Gastroenterology Kitakyushu Municipal Medical CenterKitakyushu 802-0077FukuokaJapan Department of Internal Medicine Saiseikai Fukuoka General HospitalFukuoka 810-0001Japan Department of Gastroenterology Hara-Sanshin HospitalFukuoka 812-0033Japan Department of Gastroenterology Clinical Research InstituteNational Hospital Organization Kyushu Medical CenterFukuoka 810-0065Japan Department of Anatomic Pathology Kyushu UniversityFukuoka 812-8582Japan Department of Gastroenterology and Metabolism Graduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan

BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract *** assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and grasp the target tissue appropriately;therefore,the assistant’s skill may affect the technical outcomes of *** To determine how assistant skill level affected the technical outcomes of gastric ESD-C using an ex vivo porcine training *** In this pilot study,mock lesions of 15-30 mm in diameter were created in the middle or lower third of the porcine stomach.A total of 32 ESD-C procedures were performed by 16 *** trainee operator performed two ESD-C procedures;one ESD-C was assisted by an expert(ESD-C-E),and the other was assisted by a non-expert(ESD-C-NE).The total procedure time of the ESD was set as the primary outcome,and en bloc resection rate,complete procedure rate,perforation rate,and each procedure time/speed for mucosal incision or submucosal dissection were set as the secondary *** addition,we investigated factors associated with the difficulty of ESD including incompletion of ESD procedure,a long procedure time(≥20 min)or intraoperative *** The median total procedure time of the ESD-C-E was significantly shorter than that of the ESD-C-NE(12.9 min vs 21.9 min,P=0.001).The en bloc resection rate was 100%in both *** resection rates of the ESD-C-E and ESD-C-NE groups were 100%and 93.8%,*** intraoperative perforation was observed in both *** the multivariate analysis,assistant skill was significantly associated with the difficulty of ESD,with the highest odds ratio of *** Assistance by an expert is an important factor when trainees perform ESD-C procedures.

关键词： Endoscopic submucosal dissection porcine training model Clutch cutter Assistant Skill level

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