[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-459160-105":59,"doc-detail-459160-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","high-fidelity-endoscopic-submucosal-dissection-simulator-reproducing-full-procedure-training-bleeding-and-perforation","High-fidelity endoscopic submucosal dissection simulator - reproducing full-procedure training, bleeding, and perforation","","The simulator for endoscopic submucosal dissection (ESD) is designed to reproduce full-procedure training with realistic complications, addressing limitations of existing dry models that cannot mimic bleeding, perforation, or air-responsive luminal deformation. A multilayer resectable lesion sheet recreates GI layers and submucosal lifting tactile resistance, while embedded simulated arteries enable controlled bleeding and deep incision exposes a perforation-like fat layer. Deformable airtight stomach and colon lumens support scope handling, and expert validation (N=5) shows low variability and improved training expectations.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/high-fidelity-endoscopic-submucosal-dissection-simulator-reproducing-full-procedure-training-bleeding-and-perforation/459160/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/high-fidelity-endoscopic-submucosal-dissection-simulator-reproducing-full-procedure-training-bleeding-and-perforation/459160.png","ImageObject",300,407,{"name":92,"@type":93},"MrHarris58","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What makes this ESD simulator different from existing dry simulators?","Question",{"text":112,"@type":113},"It reproduces the full ESD sequence, including controlled bleeding and perforation, and supports air-responsive luminal deformation, which prior dry simulators cannot replicate.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the simulator generate bleeding and simulate perforation?",{"text":117,"@type":113},"Simulated arteries are embedded in the submucosa to trigger controlled bleeding, and accidental deep incision exposes a yellow fat-like layer to effectively simulate perforation.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the key findings from the expert validation?",{"text":121,"@type":113},"In expert evaluations (N=5), the median total procedure time was 25:42 with low variability, hemostasis time clustered around the median, and VAS expectations increased after the trial.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},459160,1790755301,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":39,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article published online: 2026-01-08  \nHigh-fidelity endoscopic submucosal dissection simulator reproducing full-procedure training, bleeding, and perforation  \n▶Fig. 1 Structure of the multilayer resectable lesion sheet and associated complication reproduction. An overview of the endoscopic submucosal dissection (ESD) sheet that mimics mucosa, submucosa, muscularis propria, and an omentum-like adipose layer. The submucosa incorporates an absorbent polymer and fibres to reproduce submucosal lifting and tactile resistance during dissection. Artificial submucosal arteries permit controlled bleeding, and exposure of a yellow fat-like layer indicates perforation. Representative endoscopic views illustrate incision, submucosal dissection, bleeding, hemostasis, and perforation appearance.  \n▶Fig.3 Upper-gastrointestinal and colon lumen models. The silicone-based, airtight lumens deform with insufflation and suction enabling realistic scope handling. The luminal pattern permits the adjustment of the lesion placement to reflect different anatomic configurations. The airtight design also enables observation under water and gel-immersion endoscopy. Representative images show deformation with air-volume control and lesion positioning in stomach and colon configurations.  \nEndoscopic submucosal dissection (ESD) requires advanced technical skills, including the ability to maintain stable visuali-  \nsation and dissect within the submucosal layer while controlling bleeding and perforation [1] . Training is largely on-the-  \n▶Fig.2 An automatic bleeding trigger mechanism. Demonstration of automated trigger for the reproducible onset of bleeding, used in standardised hemostasis practice.  \njob, increasing safety and standardisation concerns [2] . Existing dry simulators allow basic incision and dissection practice but cannot reproduce critical complications or air-responsive luminal deformation [3,4] . To bridge these gaps, we developed a dry simulator capable of reproducing the full ESD sequence, including bleeding and perforation, within deformable stomach and colon lumens. The simulator features a multilayered resectable lesion sheet mounted within a flexible lumen. The resin-based sheet reproduced the gastrointestinal tract layers including mucosa, submucosa, and muscularis propria. Sodium polyacrylate and polyethylene terephthalate fibres replicated submucosal lifting and tactile resistance. Simulated arteries were embedded in the submucosa to allow controlled bleeding [5], while accidental deep incision exposed a yellow fat-like layer, effectively simulating perforation ( ▶ Fig. 1 ,▶ Fig.2) . The silicone-based airtight lumen, which deforms in response to air volume control, enabled realistic scope handling. The cardia and anal sphincter were modelled with thermoplastic elastomers to provide stable yet soft gripping, closely resembling real-patient procedures ( ▶ Fig.3) .  \nValidation was performed on gastric antral lesions by five board-certified  \nKanno Takeshi et al. High-fidelity endoscopic submucosal… Endoscopy 2026; 58: E23–E25 | © 2026. The Author(s) . E23  \n▶Fig.4 Expert validation of the novel ESD simulator. The pilot evaluation was conducted using the upper GI model. The resectable lesion sheet was affixed to the greater curvature of the gastric antrum, which is a common site for ESD practice. a Total procedure time (N=5) . Boxplot with individual data points. Cross marks (×) indicate each expert ’s score. The median total time was 25:42 (IQR 22: 22–29: 46; 1542 [1342]–[1786] sec), showing low variability (CV=0.19). b Hemostasis time (N =5). Boxplot with individual data points. Cross marks (×) indicate each expert ’s score. The median hemostasis time was 2: 40 (IQR 2:04–3: 52; 160 [124]–[232] sec) . c Expectations of simulator-based training using this model. VAS scores improved after the procedure (median 76, IQR 74–78at baseline; median 99, IQR 95–100 post-procedure) . d Free-text analysis by the co-occurrence network. The no","cbCaihR8uMP2HDuK","https://ap.wps.com/l/cbCaihR8uMP2HDuK","pdf",1148671,"English","# Background and need for advanced ESD simulation\n# Simulator design and components\n# Validation study and expert evaluation\n# Training outcomes and usability analysis","[{\"question\":\"What makes this ESD simulator different from existing dry simulators?\",\"answer\":\"It reproduces the full ESD sequence, including controlled bleeding and perforation, and supports air-responsive luminal deformation, which prior dry simulators cannot replicate.\"},{\"question\":\"How does the simulator generate bleeding and simulate perforation?\",\"answer\":\"Simulated arteries are embedded in the submucosa to trigger controlled bleeding, and accidental deep incision exposes a yellow fat-like layer to effectively simulate perforation.\"},{\"question\":\"What were the key findings from the expert validation?\",\"answer\":\"In expert evaluations (N=5), the median total procedure time was 25:42 with low variability, hemostasis time clustered around the median, and VAS expectations increased after the trial.\"}]","High-fidelity endoscopic submucosal dissection simulator - reproducing full-procedure training, bleeding, and perforation | PDF"]