Dae Jin Jung; Gwang Ha Kim

doi:10.5946/ce.2024.272

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Letter to the Editor Comments on ‘Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea’: Dae Jin Jung, Gwang Ha Kim^,; DOI: https://doi.org/10.5946/ce.2024.272
Published online: January 10, 2025

Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Correspondence: Gwang Ha Kim Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea E-mail: doc0224@pusan.ac.kr

• Received: October 9, 2024 • Revised: October 22, 2024 • Accepted: October 23, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the article "Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea" on page 790.

This letter to the editor is in response to the article entitled “Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea”.¹ We commend the authors for their innovative approach in developing a colonic stent simulator that addresses the need for effective training models in gastrointestinal endoscopy. This article represents a significant advancement in the field of medical simulation, and we share our thoughts and provide constructive feedback on the findings of this study and potential future applications.

The use of three-dimensional printing technology to create a realistic colonic stent simulator is a noteworthy accomplishment. As described by Gu et al.,¹ the simulator incorporated interchangeable stenotic modules, enabling comprehensive training of various colonic stent insertion techniques. This modular design is particularly valuable for simulating diverse clinical scenarios encountered in practice, ranging from rectal to ascending colonic stenosis. The inclusion of realistic anatomical features such as tumor contours and blood vessel structures, coupled with real-time visualization during stenting, enhances the fidelity of the simulation and offers trainees a unique learning experience.

One of the key strengths of this study is its emphasis on practicality and reusability. The decision of the authors to use materials that allowed repeated deployment and retraction of self-expandable metallic stents (SEMS) is commendable. This feature reduces the costs associated with training and provides trainees with multiple opportunities to refine their skills in stent insertion and troubleshooting common complications. The reusability of SEMS without compromising the quality of training is a major step in the field of endoscopic education.

However, we highlight a few areas in which further research and refinement can enhance the utility of the simulator. First, although interchangeable modules allow practice at different anatomical locations, it would be beneficial to explore the incorporation of dynamic elements within the simulator. For instance, integrating peristaltic movements or variable luminal pressures can replicate more challenging conditions and better simulate real-life scenarios. Such advancements can help trainees gain proficiency in handling adverse situations such as stent migration or perforation, which are often influenced by factors other than static anatomical structures. Second, the authors mentioned that the use of silicone for certain segments of the colon resulted in higher surface tension, leading to increased resistance during colonoscopy insertion. Although the authors mitigated this issue using lubricants, alternative materials that more closely resemble the mucosal properties of human tissue should be investigated. Materials with lower friction coefficients can enhance the simulation experience by providing more realistic feedback to the endoscopist, thereby preparing them for clinical practice. Moreover, although the transparent center of the stenotic modules facilitates visualization during stent insertion, this feature may not fully replicate the complexity of stent deployment under fluoroscopic guidance. Therefore, future iterations of the simulator should incorporate optical sensors or imaging technologies that mimic fluoroscopy, thereby providing a more comprehensive training environment for complex stenting procedures. Such enhancements would allow training in both basic and advanced endoscopic skills within the same platform.

The approach of the authors to training evaluation, which included feedback from both novice and experienced endoscopists, is another noteworthy aspect of this study. The results suggest that the simulator is effective in replicating the texture and shape of the human colon. In addition, the positive reception from trainees and professionals alike is a testament to the potential of the simulator as a teaching tool. However, a more formalized assessment of skill acquisition, such as pre- and post-training evaluations or objective, structured clinical examinations, can provide quantifiable data on the impact of the simulator on learner outcomes.²

The colonic stent simulator developed by Gu et al.¹ is a promising tool for enhancing the education and training of endoscopists. Its design and functionality address several limitations associated with traditional training methods and provide a practical and cost-effective solution for improving proficiency in colonic stenting procedures. We encourage the authors of the present study to continue refining the simulator and explore novel avenues for incorporating additional features that can further enhance its realism and educational value. We believe that this work will pave the way for future innovations in medical simulations and contribute significantly to the field of gastrointestinal endoscopy.

Conflicts of Interest

Gwang Ha Kim is currently serving as a deputy editor for Clinical Endoscopy; however, he was not involved in the peer reviewer selection, evaluation, or decision process for this article. Dae Jin Jung has no potential conflicts of interest.

Funding

This work was supported by clinical research grant from Pusan National University Hospital in 2024.

Author Contributions

Conceptualization: GHK; Data curation: DJJ; Writing–original draft: SH; Writing–review & editing: all authors.

REFERENCES

1. Gu H, Lee S, Kim S, et al. Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea. Clin Endosc 2024;57:000–000.Article
2. Kim Y, Lee JH, Lee GH, et al. Simulator-based training method in gastrointestinal endoscopy training and currently available simulators. Clin Endosc 2023;56:1–13.Article PubMed PMC PDF

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Comments on ‘Development of colonic stent simulator using three-dimensional printing technique: a simulator development study in Korea’

DOI: https://doi.org/10.5946/ce.2024.272

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