Development of a colonic endoscopic submucosal dissection training model that simulates respiratory movements

Endoscopic submucosal dissection (ESD) is an established endoscopic treatment for esophageal and stomach tumors, as well as colorectal tumors. The cure rate, operation time, and complication rate for colonic ESD have improved with standardization of the procedure.¹ However, colonic ESD is technically difficult due to factors such as the thinness of the intestinal wall, maneuverability of the endoscope, physiological bending, peristalsis, respiratory movements, and heartbeat.^{2, 3} Various training models have previously been reported to overcome these difficulties, such as a colonic ESD training model using an animal model⁴ and a model that simulates heartbeat using a motor device⁵; however, there are no reports of ESD training models that simulate respiratory movements. In this report, we introduce the first such ESD training model (Video S1). We use an accordion hose, battery-powered toy train, smartphone holder, turntable (20 cm diameter), plastic plate, a three-plate bolt assembly, two springs, two paper cups, an A4-size binder, and versatile training tissue (VTT; Kotobuki Medical, Saitama, Japan). VTT is a simulated mucosal model consisting of a food-quality konjac, which is readily obtainable and poses few hygiene issues. Moving the toy train fixed with a smartphone holder on the turntable automatically rotates the turntable (Fig. 1a). When the turntable and plastic plate are connected with the bolt plate, the plastic plate moves linearly back and forth (Fig. 1b). This model makes a reciprocating linear movement ~10 times per min. Placing the VTT on this plastic plate results in a movement on the monitor that is very similar to the respiratory movements experienced during colonoscopy (Fig. 2). This model enables training on handling respiratory movements, which pose a difficulty in colonic ESD. Two experts and four trainees at our hospital who trained with this model rated this model highly, suggesting that it could be useful as a colonic ESD training model.

Authors declare no conflict of interest for this article.