A randomized controlled trial evaluating endoscopic and laparoscopic training in skills transfer for novices...

Area of Science:

• Minimally Invasive Surgery
• Surgical Education
• Medical Simulation

Background:

• Natural orifice translumenal endoscopic surgery (NOTES) requires specialized training for safe clinical application.
• Evaluating different simulator curricula is crucial for optimizing surgical education in NOTES.

Purpose of the Study:

• To compare the effectiveness of laparoscopic versus endoscopic simulator training on novice performance in a simulated NOTES task.
• To assess the impact of simulator-based training on the procedural steps and overall time for a NOTES simulation.

Main Methods:

• 30 medical undergraduates were randomized into three groups: no training, endoscopy simulator training, or laparoscopy simulator training.
• All participants performed a standardized 7-step simulated NOTES task on the ELITE model.
• Performance was evaluated by measuring time for individual steps, total procedure time, and error count.

Main Results:

• The endoscopy training group was significantly faster than the control group in key procedural steps, including peritoneal cavity access and appendix base diathermy.
• Endoscopy-trained participants completed the entire simulated NOTES procedure substantially faster than the laparoscopy-trained group (median 863 vs. 2074 seconds).
• Laparoscopic training showed some benefit for operative maneuvers but was less effective than endoscopic training for the overall NOTES task.

Conclusions:

• Endoscopic simulator training is highly beneficial for improving performance in simulated NOTES procedures involving navigation and resection.
• While laparoscopic training offers some advantages for specific operative maneuvers, it is less effective than endoscopic training for overall NOTES task proficiency.
• This study underscores the necessity of tailored endoscopic training curricula for developing competency in NOTES surgery.