Optimizing surgical approach for natural orifice translumenal endoscopic procedures

Area of Science:

• Minimally Invasive Surgery
• Surgical Simulation
• Endoscopic Techniques

Background:

• Natural orifice translumenal endoscopic surgery (NOTES) often necessitates endoscopic retroflexion.
• This study evaluates the effect of retroflexion on task performance within NOTES procedures.

Purpose of the Study:

• To assess the impact of endoscopic retroflexion on surgical task performance in a simulated NOTES environment.
• To compare performance between forward-view and retroflexed-view conditions.

Main Methods:

• A bench-top simulation was employed using a single-channel endoscope.
• Surgeons manipulated the endoscope to touch four designated dots sequentially.
• Tasks were performed and timed under both forward-view and retroflexed-view conditions.

Main Results:

• Task completion time was significantly longer in the retroflexed-view condition compared to the forward-view condition (P = .005).
• Experienced surgeons outperformed novices, completing tasks faster (P = .043).
• Novices experienced greater difficulty with image malalignment, while experienced surgeons were less affected by the inverted image.

Conclusions:

• Strategic selection of surgical approaches is crucial to mitigate image malalignment for safe NOTES execution.
• Novice surgeons require comprehensive training to address vision-motion difficulties inherent in NOTES before safe and effective practice can be achieved.