Educational and Training Aspects of New Surgical Techniques: Experience with the Endoscopic–laparoscopic Interdisciplinary Training Entity (ELITE) Model in Training for a Natural Orifice Translumenal Endoscopic Surgery (NOTES) Approach To...

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2012 Jan 31

PMID 22286276

Citations 2

Authors

Sonja Gillen

Jorn Grone

Fritz Knodgen

Petra Wolf

Michael Meyer

Helmut Friess

Heinz-Johannes Buhr

Jorg-Peter Ritz

Hubertus Feussner

Kai S Lehmann

Affiliations

Soon will be listed here.

Abstract

Background: Natural orifice translumenal endoscopic surgery (NOTES) is a new surgical concept that requires training before it is introduced into clinical practice. The endoscopic–laparoscopic interdisciplinary training entity (ELITE) is a training model for NOTES interventions. The latest research has concentrated on new materials for organs with realistic optical and haptic characteristics and the possibility of high-frequency dissection. This study aimed to assess both the ELITE model in a surgical training course and the construct validity of a newly developed NOTES appendectomy scenario.

Methods: The 70 attendees of the 2010 Practical Course for Visceral Surgery (Warnemuende, Germany) took part in the study and performed a NOTES appendectomy via a transsigmoidal access. The primary end point was the total time required for the appendectomy, including retrieval of the appendix. Subjective evaluation of the model was performed using a questionnaire. Subgroups were analyzed according to laparoscopic and endoscopic experience.

Results: The participants with endoscopic or laparoscopic experience completed the task significantly faster than the inexperienced participants (p = 0.009 and 0.019, respectively). Endoscopic experience was the strongest influencing factor, whereas laparoscopic experience had limited impact on the participants with previous endoscopic experience. As shown by the findings, 87.3% of the participants stated that the ELITE model was suitable for the NOTES training scenario, and 88.7% found the newly developed model anatomically realistic.

Conclusions: This study was able to establish face and construct validity for the ELITE model with a large group of surgeons. The ELITE model seems to be well suited for the training of NOTES as a new surgical technique in an established gastrointestinal surgery skills course.

Citing Articles

A new experimental model of calculous cholecystitis suitable for the evaluation and training of minimally invasive approaches to cholecystectomy.

Ryska O, Serclova Z, Martinek J, Dolezel R, Kalvach J, Juhas S Surg Endosc. 2016; 31(2):987-994.

PMID: 27495340 DOI: 10.1007/s00464-016-5061-0.

Clinical needs finding: developing the virtual experience-a case study.

Mittal V, Thompson M, Altman S, Taylor P, Summers A, Goodwin K Ann Biomed Eng. 2013; 41(9):1899-912.

PMID: 23483373 PMC: 3759550. DOI: 10.1007/s10439-013-0783-9.

References

Isariyawongse J, McGee M, Rosen M, Cherullo E, Ponsky L . Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol. 2008; 22(5):1087-91. DOI: 10.1089/end.2007.0404. View

Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, von Weyhern C . An innovative, safe and sterile sigmoid access (ISSA) for NOTES. Endoscopy. 2007; 39(5):401-6. DOI: 10.1055/s-2007-966438. View

van Dongen K, Tournoij E, van der Zee D, Schijven M, Broeders I . Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts?. Surg Endosc. 2007; 21(8):1413-7. DOI: 10.1007/s00464-006-9188-2. View

Seymour N . Integrating simulation into a busy residency program. Minim Invasive Ther Allied Technol. 2006; 14(4):280-6. DOI: 10.1080/13645700500272421. View

Vick L, Vick K, Borman K, Salameh J . Face, content, and construct validities of inanimate intestinal anastomoses simulation. J Surg Educ. 2007; 64(6):365-8. DOI: 10.1016/j.jsurg.2007.04.006. View

Bernhardt J, Gerber B, Schober H, Kahler G, Ludwig K . NOTES--case report of a unidirectional flexible appendectomy. Int J Colorectal Dis. 2008; 23(5):547-50. DOI: 10.1007/s00384-007-0427-3. View

Tanoue K, Uemura M, Kenmotsu H, Ieiri S, Konishi K, Ohuchida K . Skills assessment using a virtual reality simulator, LapSim, after training to develop fundamental skills for endoscopic surgery. Minim Invasive Ther Allied Technol. 2010; 19(1):24-9. DOI: 10.3109/13645700903492993. View

Wagh M, Merrifield B, Thompson C . Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc. 2006; 63(3):473-8. DOI: 10.1016/j.gie.2005.06.045. View

Ritz J, Grone J, Hopt U, Saeger H, Siewert J, Vollmar B . ["Practical course for visceral surgery in Warnemünde" 10 years on. Significance and benefits of a surgical training course]. Chirurg. 2009; 80(9):864-71. DOI: 10.1007/s00104-009-1782-0. View

10.

Gallagher A, Smith C, Bowers S, Seymour N, Pearson A, McNatt S . Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures. J Am Coll Surg. 2003; 197(3):479-88. DOI: 10.1016/S1072-7515(03)00535-0. View

11.

Clark J, Sodergren M, Noonan D, Darzi A, Yang G . The natural orifice simulated surgical environment (NOSsE): exploring the challenges of NOTES without the animal model. J Laparoendosc Adv Surg Tech A. 2009; 19(2):211-4. DOI: 10.1089/lap.2008.0357. View

12.

Meining A, Wilhelm D, Burian M, Dundoulakis M, Schneider A, von Delius S . Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study. Endoscopy. 2007; 39(10):860-4. DOI: 10.1055/s-2007-966904. View

13.

Karras D . Statistical methodology: II. Reliability and validity assessment in study design, Part B. Acad Emerg Med. 1997; 4(2):144-7. DOI: 10.1111/j.1553-2712.1997.tb03723.x. View

14.

Schijven M, Jakimowicz J . Face-, expert, and referent validity of the Xitact LS500 laparoscopy simulator. Surg Endosc. 2002; 16(12):1764-70. DOI: 10.1007/s00464-001-9229-9. View

15.

Al-Akash M, Boyle E, TANNER W . Training on N.O.T.E.S.: from history we learn. Surg Oncol. 2008; 18(2):111-9. DOI: 10.1016/j.suronc.2008.11.004. View

16.

Kalloo A, Singh V, Jagannath S, Niiyama H, Hill S, Vaughn C . Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004; 60(1):114-7. DOI: 10.1016/s0016-5107(04)01309-4. View

17.

McDougall E, Corica F, Boker J, Sala L, Stoliar G, Borin J . Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg. 2006; 202(5):779-87. DOI: 10.1016/j.jamcollsurg.2006.01.004. View

18.

Semm K . [Pelvi-trainer, a training device in operative pelviscopy for teaching endoscopic ligation and suture technics]. Geburtshilfe Frauenheilkd. 1986; 46(1):60-2. DOI: 10.1055/s-2008-1036165. View

19.

Seymour N . VR to OR: a review of the evidence that virtual reality simulation improves operating room performance. World J Surg. 2007; 32(2):182-8. DOI: 10.1007/s00268-007-9307-9. View

20.

Dunkin B . Natural orifice transluminal endoscopic surgery: Educational challenge. World J Gastrointest Surg. 2010; 2(6):224-30. PMC: 2999238. DOI: 10.4240/wjgs.v2.i6.224. View