Endoscopic hand-suturing training model

Endoscopic hand-suturing (EHS) is a novel suturing method that allows optimal and secure intraluminal suturing [1] [2]. On the other hand, the procedure is reported to be complicated, difficult, and time-consuming [3] [4]. At present, there is no appropriate training model for it and no established method for learning it.

We have developed a training sheet we called SuTURE (Suture Trainer Using Re-usable Elastomer; Kotobuki Medical Inc., Saitama, Japan) for EHS by applying the G-Master, which was initially developed as a training model for gastric endoscopic submucosal dissection (ESD) ([Fig. 1]). SuTURE has a two-layer structure of elastomer, a polymer material that exhibits rubber-like elasticity, and has a virtual mucosal defect with a major diameter of 40 mm on the upper sheet and a gusset at the edge to reproduce the sensation of applying a needle similar to that of a real case ([Fig. 2]).

Fig. 1 Suture Trainer Using Re-usable Elastomer (SuTURE) & G-Master (training model for endoscopic submucosal dissection (ESD))

Fig. 2 Two-layer sheet with gussets for 40-mm virtual post-ESD ulcer.

It is also strong enough to practice suture closure without tearing when pulled with a thread. The difficulty of the EHS operation depends on the angle at which the lesion is confronted. The G-Master is an ESD training model characterized by the ability to freely set the angle at which the scope faces the lesion. EHS training was performed by fixing the scope and SuTURE in various positions, such as perpendicular, anterior wall side, and superior wall side ([Fig. 3], [Video 1]).

Fig. 3 You can train with various body parts that can be set with G-Master.

Features of Suture Trainer Using Re-usable Elastomer (SuTURE) and actual training.Video 1

This virtual lesion does not use biological material and does not require a dedicated room or endoscope. It is easy to prepare and can be disposed of as regular trash after training.

At present, there is no EHS specialized training model, but EHS requires technical mastery. This training model could contribute to EHS proficiency.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgement

First of all, I would like to thank the editors and readers who read my paper. In developing this training model and writing the paper, Dr. Ohata and Dr. Minato provided guidance and advice. We would also like to express our sincere gratitude to Kotobuki medical inc. for developing such an amazing product. I would also like to express my gratitude to Dr. Araki, Dr. Koda, and the endoscopy staff at Omuta City Hospital. Finally, I would like to express my gratitude to Dr. Kawaguchi, Department of Gastroenterology, Kurume University, and Dr. Torimura, Director of Omuta City Hospital.

• References

• 1 Akimoto T, Goto O, Sasaki M. et al. Endoscopic hand suturing for mucosal defect closure after gastric endoscopic submucosal dissection may reduce the risk of postoperative bleeding in patients receiving antithrombotic therapy. Dig Endosc 2022; 34: 123-132
• 2 Goto O, Oyama T, Ono H. et al. Endoscopic hand-suturing is feasible, safe, and may reduce bleeding risk after gastric endoscopic submucosal dissection: a multicenter pilot study (with video). Gastrointest Endosc 2020; 91: 1195-1202
• 3 Goto O, Sasaki M, Akimoto T. et al. Endoscopic hand-suturing for defect closure after gastric endoscopic submucosal dissection: a pilot study in animals and in humans. Endoscopy 2017; 49: 792-797
• 4 Abe S, Saito Y, Tanaka Y. et al. A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study. Endoscopy 2020; 52: 780-785

Publication History

Article published online:
03 April 2024