Zhaohui Xia, PhD1, Sudeep Hegde, PhD2, Nicholas Milef1, Suvranu De, PhD1, Daniel Jones, MD3, Mandeep Sawhney, MD3, Cullen Jackson, PhD3. 1Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY, 2Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, 3Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
INTRODUCTION: Endoscopic Submucosal Dissection (ESD) is a minimally-invasive technique that allows complete en-bloc resection and lower recurrence rates at long-term follow-ups compared to endoscopic submucosal resection (EMR). In ESD procedures, a fluid is injected underneath the lesion, and then the submucosal layer is dissected by a specialized knife below the lesion. However, performing ESD is technically demanding, and there is lack of sufficient number of expert instructors for ESD training in Western countries. One approach to reducing this gap is to design and develop an ESD surgical simulator as part of a training curriculum.
OBJECTIVES: The aim of the study is to design and develop a virtual endoluminal surgical simulator (VESS) with visual and haptic feedback along with assessment metrics based on a cognitive task analysis (CTA) approach, which can be used to train endoscopists in ESD and assess the trainees’ performance.
METHODS AND PROCEDURES: To develop a virtual ESD simulator that will allow trainees to hone their ability to recognize and anticipate critical obstacles during the performance of ESD procedures, and enhance their decision-making skills, the results of a CTA are being integrated into the development of the simulator as learning objectives and associated metrics.
RESULTS: From the CTA, we derived several key learning objectives that center on the cognitive skills required for ESD. Some of these include: (1) recognizing polyp boundaries to ensure accurate marking for complete en-bloc resection; (2) deciding on appropriate approach for initial incision (e.g., circumferential, pockets); (3) choosing appropriate coag and cutting current settings according to field dynamics; (4) adapting approach to account for tissue retraction and maximize field visualization; (5) maintaining the orientation of lesion boundaries and tissue layers during cutting to minimize tissue damage and perforations; (6) recognizing vessel type and choosing electrocautery settings accordingly to minimize bleeding in the field.
CONCLUSIONS: This study presents a novel CTA-based approach to developing a virtual ESD simulator that involves high-fidelity anatomical organ modeling, physics-based tool-tissue interactions, and performance metrics based on a cognitive task analysis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95581
Program Number: P376
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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