Cadaver-based therapeutic endoscopic training for peroral endoscopic myotomy: a realistic model for skill acquisition.

The rarity of achalasia has led to limited opportunities for practical training in educational environments. Cadaver surgical training was developed to enhance surgical skills by providing physicians with experience comparable to that of on-the-job training using structures identical to living organs, thereby proving highly beneficial. Recently, cadavers have been preserved using the Thiel method, which maintains both mobility and organizational flexibility.　However, there are few reports on therapeutic endoscopy, including peroral endoscopic myotomy, in the context of cadaver surgical training. We investigated the feasibility of using cadaver surgical training for therapeutic endoscopy training, termed Cadaver-based Therapeutic Endoscopy Training, for peroral endoscopic myotomy. This study was conducted in 2024 at the Cadaver Surgical Center of Nagasaki University using four cadavers preserved using the Thiel method. We performed peroral endoscopic myotomies on three cadavers and evaluated the observability of the esophageal mucosa, penetration of the local injection fluid, feasibility of creating a submucosal tunnel, visibility of indocyanine green injection, and inner circular muscle incision. The layered structure of the digestive tract was well preserved in the Thiel-fixed cadavers, and peroral endoscopic myotomy was performed without major issues. Cadaver-based Therapeutic Endoscopy Training may serve as a realistic training model and may be beneficial for peroral endoscopic myotomy training.