A task and performance analysis of endoscopic submucosal dissection (ESD) surgery
Background ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endosco...
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| Veröffentlicht in: | Surgical endoscopy 2019-02, Vol.33 (2), p.592-606 |
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| creator | Cetinsaya, Berk Gromski, Mark A. Lee, Sangrock Xia, Zhaohui Demirel, Doga Halic, Tansel Bayrak, Coskun Jackson, Cullen De, Suvranu Hegde, Sudeep Cohen, Jonah Sawhney, Mandeep Stavropoulos, Stavros N. Jones, Daniel B. |
| description | Background
ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.
Methods
We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.
Results
The average time of the marking, injection, and circumferential cutting phases are 203.4 (
σ
: 205.46), 83.5 (
σ
: 49.92), 908.4 s. (
σ
: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (
σ
: 908.43). We also performed correlation analysis (Pearson’s test) among the performance scores of the tasks. There is a moderate positive correlation (
R
= 0.528,
p
= 0.0355) between marking scores and total scores, a strong positive correlation (
R
= 0.7879,
p
= 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (
R
= 0.7095,
p
= 0.0021) between circumferential cutting and submucosal dissection and marking scores.
Conclusions
We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.
Graphical abstract |
| doi_str_mv | 10.1007/s00464-018-6379-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6344246</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2091237635</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-af9c3b1212849335a77560c28abbb51b6df2d58cd7c9282961adc659f8883d623</originalsourceid><addsrcrecordid>eNp1kUtLxDAUhYMoOj5-gBspuNFFNa-myUYYfIMgoq5DmqRa7TRjbivMvzfj-AZXIZwvJ-feg9A2wQcE4_IQMOaC55jIXLBS5WIJjQhnNKeUyGU0worhnJaKr6F1gCeccEWKVbTGMKFSUj5CN-OsN_Ccmc5lUx_rECemsz7dTTuDBrJQZ75zAWyYNjaDoZoMNoBpM9cAeNs3ocv2Tm9P9pMWH3ycbaKV2rTgtz7ODXR_dnp3fJFfXZ9fHo-vcstL3OemVpZVhKYgXDFWmLIsBLZUmqqqClIJV1NXSOtKq6ikShDjrChULaVkTlC2gY4WvtOUyTvruz6aVk9jMzFxpoNp9G-lax71Q3jVgnFOuUgGex8GMbwMHno9acD6tjWdDwNoihWhrBSsSOjuH_QpDDGt6J3ChJDklyiyoGwMANHXX2EI1vPC9KIwnQrT88L0PMTOzym-Xnw2lAC6ACBJXVrw99f_u74BbgKgmw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2090111463</pqid></control><display><type>article</type><title>A task and performance analysis of endoscopic submucosal dissection (ESD) surgery</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Cetinsaya, Berk ; Gromski, Mark A. ; Lee, Sangrock ; Xia, Zhaohui ; Demirel, Doga ; Halic, Tansel ; Bayrak, Coskun ; Jackson, Cullen ; De, Suvranu ; Hegde, Sudeep ; Cohen, Jonah ; Sawhney, Mandeep ; Stavropoulos, Stavros N. ; Jones, Daniel B.</creator><creatorcontrib>Cetinsaya, Berk ; Gromski, Mark A. ; Lee, Sangrock ; Xia, Zhaohui ; Demirel, Doga ; Halic, Tansel ; Bayrak, Coskun ; Jackson, Cullen ; De, Suvranu ; Hegde, Sudeep ; Cohen, Jonah ; Sawhney, Mandeep ; Stavropoulos, Stavros N. ; Jones, Daniel B.</creatorcontrib><description>Background
ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.
Methods
We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.
Results
The average time of the marking, injection, and circumferential cutting phases are 203.4 (
σ
: 205.46), 83.5 (
σ
: 49.92), 908.4 s. (
σ
: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (
σ
: 908.43). We also performed correlation analysis (Pearson’s test) among the performance scores of the tasks. There is a moderate positive correlation (
R
= 0.528,
p
= 0.0355) between marking scores and total scores, a strong positive correlation (
R
= 0.7879,
p
= 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (
R
= 0.7095,
p
= 0.0021) between circumferential cutting and submucosal dissection and marking scores.
Conclusions
We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.
Graphical abstract</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-018-6379-6</identifier><identifier>PMID: 30128824</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>2018 SAGES Oral ; Abdominal Surgery ; Business metrics ; Clinical Competence ; Colorectal cancer ; Dissection ; Endoscopic Mucosal Resection - education ; Endoscopic Mucosal Resection - instrumentation ; Endoscopic Mucosal Resection - methods ; Endoscopy ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Medicine ; Medicine & Public Health ; Proctology ; Simulation Training ; Software Design ; Surgery ; Task analysis ; Task Performance and Analysis</subject><ispartof>Surgical endoscopy, 2019-02, Vol.33 (2), p.592-606</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2018</rights><rights>Surgical Endoscopy is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-af9c3b1212849335a77560c28abbb51b6df2d58cd7c9282961adc659f8883d623</citedby><cites>FETCH-LOGICAL-c470t-af9c3b1212849335a77560c28abbb51b6df2d58cd7c9282961adc659f8883d623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-018-6379-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-018-6379-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30128824$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cetinsaya, Berk</creatorcontrib><creatorcontrib>Gromski, Mark A.</creatorcontrib><creatorcontrib>Lee, Sangrock</creatorcontrib><creatorcontrib>Xia, Zhaohui</creatorcontrib><creatorcontrib>Demirel, Doga</creatorcontrib><creatorcontrib>Halic, Tansel</creatorcontrib><creatorcontrib>Bayrak, Coskun</creatorcontrib><creatorcontrib>Jackson, Cullen</creatorcontrib><creatorcontrib>De, Suvranu</creatorcontrib><creatorcontrib>Hegde, Sudeep</creatorcontrib><creatorcontrib>Cohen, Jonah</creatorcontrib><creatorcontrib>Sawhney, Mandeep</creatorcontrib><creatorcontrib>Stavropoulos, Stavros N.</creatorcontrib><creatorcontrib>Jones, Daniel B.</creatorcontrib><title>A task and performance analysis of endoscopic submucosal dissection (ESD) surgery</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.
Methods
We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.
Results
The average time of the marking, injection, and circumferential cutting phases are 203.4 (
σ
: 205.46), 83.5 (
σ
: 49.92), 908.4 s. (
σ
: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (
σ
: 908.43). We also performed correlation analysis (Pearson’s test) among the performance scores of the tasks. There is a moderate positive correlation (
R
= 0.528,
p
= 0.0355) between marking scores and total scores, a strong positive correlation (
R
= 0.7879,
p
= 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (
R
= 0.7095,
p
= 0.0021) between circumferential cutting and submucosal dissection and marking scores.
Conclusions
We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.
Graphical abstract</description><subject>2018 SAGES Oral</subject><subject>Abdominal Surgery</subject><subject>Business metrics</subject><subject>Clinical Competence</subject><subject>Colorectal cancer</subject><subject>Dissection</subject><subject>Endoscopic Mucosal Resection - education</subject><subject>Endoscopic Mucosal Resection - instrumentation</subject><subject>Endoscopic Mucosal Resection - methods</subject><subject>Endoscopy</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Simulation Training</subject><subject>Software Design</subject><subject>Surgery</subject><subject>Task analysis</subject><subject>Task Performance and Analysis</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kUtLxDAUhYMoOj5-gBspuNFFNa-myUYYfIMgoq5DmqRa7TRjbivMvzfj-AZXIZwvJ-feg9A2wQcE4_IQMOaC55jIXLBS5WIJjQhnNKeUyGU0worhnJaKr6F1gCeccEWKVbTGMKFSUj5CN-OsN_Ccmc5lUx_rECemsz7dTTuDBrJQZ75zAWyYNjaDoZoMNoBpM9cAeNs3ocv2Tm9P9pMWH3ycbaKV2rTgtz7ODXR_dnp3fJFfXZ9fHo-vcstL3OemVpZVhKYgXDFWmLIsBLZUmqqqClIJV1NXSOtKq6ikShDjrChULaVkTlC2gY4WvtOUyTvruz6aVk9jMzFxpoNp9G-lax71Q3jVgnFOuUgGex8GMbwMHno9acD6tjWdDwNoihWhrBSsSOjuH_QpDDGt6J3ChJDklyiyoGwMANHXX2EI1vPC9KIwnQrT88L0PMTOzym-Xnw2lAC6ACBJXVrw99f_u74BbgKgmw</recordid><startdate>20190201</startdate><enddate>20190201</enddate><creator>Cetinsaya, Berk</creator><creator>Gromski, Mark A.</creator><creator>Lee, Sangrock</creator><creator>Xia, Zhaohui</creator><creator>Demirel, Doga</creator><creator>Halic, Tansel</creator><creator>Bayrak, Coskun</creator><creator>Jackson, Cullen</creator><creator>De, Suvranu</creator><creator>Hegde, Sudeep</creator><creator>Cohen, Jonah</creator><creator>Sawhney, Mandeep</creator><creator>Stavropoulos, Stavros N.</creator><creator>Jones, Daniel B.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190201</creationdate><title>A task and performance analysis of endoscopic submucosal dissection (ESD) surgery</title><author>Cetinsaya, Berk ; Gromski, Mark A. ; Lee, Sangrock ; Xia, Zhaohui ; Demirel, Doga ; Halic, Tansel ; Bayrak, Coskun ; Jackson, Cullen ; De, Suvranu ; Hegde, Sudeep ; Cohen, Jonah ; Sawhney, Mandeep ; Stavropoulos, Stavros N. ; Jones, Daniel B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-af9c3b1212849335a77560c28abbb51b6df2d58cd7c9282961adc659f8883d623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>2018 SAGES Oral</topic><topic>Abdominal Surgery</topic><topic>Business metrics</topic><topic>Clinical Competence</topic><topic>Colorectal cancer</topic><topic>Dissection</topic><topic>Endoscopic Mucosal Resection - education</topic><topic>Endoscopic Mucosal Resection - instrumentation</topic><topic>Endoscopic Mucosal Resection - methods</topic><topic>Endoscopy</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Simulation Training</topic><topic>Software Design</topic><topic>Surgery</topic><topic>Task analysis</topic><topic>Task Performance and Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cetinsaya, Berk</creatorcontrib><creatorcontrib>Gromski, Mark A.</creatorcontrib><creatorcontrib>Lee, Sangrock</creatorcontrib><creatorcontrib>Xia, Zhaohui</creatorcontrib><creatorcontrib>Demirel, Doga</creatorcontrib><creatorcontrib>Halic, Tansel</creatorcontrib><creatorcontrib>Bayrak, Coskun</creatorcontrib><creatorcontrib>Jackson, Cullen</creatorcontrib><creatorcontrib>De, Suvranu</creatorcontrib><creatorcontrib>Hegde, Sudeep</creatorcontrib><creatorcontrib>Cohen, Jonah</creatorcontrib><creatorcontrib>Sawhney, Mandeep</creatorcontrib><creatorcontrib>Stavropoulos, Stavros N.</creatorcontrib><creatorcontrib>Jones, Daniel B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cetinsaya, Berk</au><au>Gromski, Mark A.</au><au>Lee, Sangrock</au><au>Xia, Zhaohui</au><au>Demirel, Doga</au><au>Halic, Tansel</au><au>Bayrak, Coskun</au><au>Jackson, Cullen</au><au>De, Suvranu</au><au>Hegde, Sudeep</au><au>Cohen, Jonah</au><au>Sawhney, Mandeep</au><au>Stavropoulos, Stavros N.</au><au>Jones, Daniel B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A task and performance analysis of endoscopic submucosal dissection (ESD) surgery</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2019-02-01</date><risdate>2019</risdate><volume>33</volume><issue>2</issue><spage>592</spage><epage>606</epage><pages>592-606</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries.
Methods
We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons.
Results
The average time of the marking, injection, and circumferential cutting phases are 203.4 (
σ
: 205.46), 83.5 (
σ
: 49.92), 908.4 s. (
σ
: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (
σ
: 908.43). We also performed correlation analysis (Pearson’s test) among the performance scores of the tasks. There is a moderate positive correlation (
R
= 0.528,
p
= 0.0355) between marking scores and total scores, a strong positive correlation (
R
= 0.7879,
p
= 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (
R
= 0.7095,
p
= 0.0021) between circumferential cutting and submucosal dissection and marking scores.
Conclusions
We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator.
Graphical abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>30128824</pmid><doi>10.1007/s00464-018-6379-6</doi><tpages>15</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Surgical endoscopy, 2019-02, Vol.33 (2), p.592-606 |
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| source | MEDLINE; SpringerNature Journals |
| subjects | 2018 SAGES Oral Abdominal Surgery Business metrics Clinical Competence Colorectal cancer Dissection Endoscopic Mucosal Resection - education Endoscopic Mucosal Resection - instrumentation Endoscopic Mucosal Resection - methods Endoscopy Gastroenterology Gynecology Hepatology Humans Medicine Medicine & Public Health Proctology Simulation Training Software Design Surgery Task analysis Task Performance and Analysis |
| title | A task and performance analysis of endoscopic submucosal dissection (ESD) surgery |
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