Effects of a training system that tracks the operator's gaze pattern during endoscopic submucosal dissection on hemostasis.

Background: The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator's viewpoint. Understanding the operator's viewpoint may facilitate the skills.

Aim: To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection (ESD) on hemostasis.

Methods: An eye-tracking system was developed to record the operator's viewpoints during gastric ESD, displaying the viewpoint as a circle. In phase 1, videos of three trainees' viewpoints were recorded. After reviewing these, trainees were recorded again in phase 2. The videos from both phases were retrospectively reviewed, and short clips were created to evaluate the hemostasis skills. Outcome measures included the time to recognize the bleeding point, the time to complete hemostasis, and the number of coagulation attempts.

Results: Eight cases treated with ESD were reviewed, and 10 video clips of hemostasis were created. The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1 (8.3 ± 4.1 seconds vs 23.1 ± 19.2 seconds; P = 0.049). The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different (15.4 ± 6.8 seconds vs 31.9 ± 21.7 seconds; P = 0.056). Significantly fewer coagulation attempts were performed during phase 2 (1.8 ± 0.7 vs 3.2 ± 1.0; P = 0.004).

Conclusion: Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts. Learning from the operator's viewpoint can facilitate acquiring hemostasis skills during ESD.