title: [Endoscopic inanimate biological simulators for training in endoscopic mucosal dissection].
abstract: BACKGROUND
  Simulators have been used as a training method; they allow training, skill development, standardization of techniques and the performance of a greater number of risk-free procedures. Endoscopic submucosal dissection (ESD) is the standard treatment for early gastric cancer since it allows en bloc resection of larger lesions however requires longer procedure time and has more complications than endoscopic mucosal resection.
  
  
  OBJECTIVE
  To evaluate the use of biological inanimate simulators in endoscopic training for the development of skills required for ESD.
  
  
  METHODS
  Experimental design using a biological inanimate simulator to evaluate the development of endoscopic skills. Five trained endoscopists with knowledge of the ESD technique, but without previous experience were selected. Technical success, complication rate and procedure time were evaluated. Each participant performed a self-evaluation.
  
  
  RESULTS
  18 lesions of 10-20 mm in diameter were dissected, with a mean area of 2.64 ± 2 cm2 and a mean procedure time of 21.08 ± 14.01 minutes (5.48 - 48.61). Self-evaluation and instructor's evaluation showed a strong positive correlation. There was no correlation between lesion size and procedure time. There was one perforation (5.8%), which was successfully managed with one endoclip. Complications such as bleeding could not be assed.
  
  
  CONCLUSIONS
  The use of inanimate biological simulators allows training in complex endoscopic procedures such as ESD with a wide safety margin. Lesion size did not correlate with procedure time. It is necessary to increase the number of procedures to improve the learning curve. This simulator does not allow evaluation of complications other than perforations.
authors.affiliation: Departamento de Endoscopia, Instituto Nacional de Cancerología, México, D.F. México. drapaolafigueroa@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Figueroa-Barojas
authors.forename: S
authors.initials: S
authors.lastname: Sobrino-Cossío
authors.forename: A
authors.initials: A
authors.lastname: Hernández-Guerrero
authors.forename: M E
authors.initials: ME
authors.lastname: Ramírez-Solís
authors.forename: J O
authors.initials: JO
authors.lastname: Alonso-Lárraga
authors.forename: V
authors.initials: V
authors.lastname: Rodríguez-Brambila
authors.forename: J
authors.initials: J
authors.lastname: Álvaro-Villegas
mesh_terms: D000818:Animals; D004210:Dissection; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy / Q000193:education*; D023421:Models, Animal; D013552:Swine