Preliminary validation of the virtual bariatric endoscopic simulator

Obesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field.

We designed the virtual bariatric endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. The ViBE simulator features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of procedural details. Furthermore, the simulator incorporates performance metrics using a reverse scoring system to evaluate users' proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks.

Twelve participants, comprising 5 experts and 7 novices, were asked to complete a post-training questionnaire featuring 7 items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points.

The ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator was to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.