Needs analysis for developing a VR simulator for NOTES

Arun Nemani1, Woojin Ahn, PhD1, Denis Dorozhkin, PhD1, Steven Schwaitzberg, MD2, Daniel Jones, MD3, Suvranu De, ScD1. 1Rensselaer Polytechnic Institute, 2University at Buffalo School of Medicine and Biomedical Sciences, Harvard Medical School, 3Beth Israel Deaconess Medical Center, Harvard Medical School

INTRODUCTION: A virtual translumenal endoscopic surgical trainer (VTESTTM) is being developed to provide a safe and risk-free platform that enables developing and training new procedures and designing and testing new instruments for natural orifice translumenal endoscopic surgery (NOTES). As new NOTES procedures are being developed in diverse surgical fields, emerging trends and needs must be continually investigated to ensure clinical relevance of the virtual reality simulator. This paper reports a questionnaire survey that follows previously conducted similar studies in 2011 (Sankaranarayanan et al. in Surg Endosc 27:1607-1616, 2013) and 2012 (Schwaitzberg et al. in Surg Endosc online 2015)

METHODS: A 32-point questionnaire was distributed at the 2015 annual Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) meeting.  The obtained responses from experts were analyzed using one and two sample t-test for comparison of two proportions.

RESULTS: Thirteen NOTES experts participated in the 2015 study. In similar to 2012, cholecystectomy (CE) has remained the most commonly performed NOTES procedure, with eight (62%) responses (2012 vs 2015, p=0.85), followed by peroral endoscopic myotomy (POEM)  with five (38%) responses (2012 vs 2015, p-value= 0.95). Interestingly, in contrast to 2011 and 2012, POEM is reported as the single best indication for NOTES to eventually become standard of care with five (38%) instances while only one (7%) participant indicated cholecystectomy (POEM vs CE, p-value=0.08). The trends remains consistent since POEM was identified as a promising candidate for future simulator development in the 2012 study (2012 vs 2015, p-value=0.85). The popularity of the NOTES appendectomy remained relatively lower (15%) compared to cholecystectmy (p-value=0.03) and POEM (p-value = 0.25). Other NOTES procedures preformed recently include tubal ligation, colectomy, transgastic peritoneoscopy, pancreatic necrosectomy, fundoplication, specimen extraction, pancreatic pseudocyst, gastrostomy, and GIST removal. The importance of virtual reality NOTES simulators for training and developing in new procedures has been scored highly with a mean score of 4.04, 4.15 and 4.07 for the five-point Likert scale questions in 2011, 2012, and 2015, respectively.  The participants rated the importance of VR-NOTES simulator for POEM training with a mean score of 3.83.

CONCLUSION: The results indicate that POEM should be the next virtual NOTES simulator to be developed.  These preliminary survey data will be subsequently augmented by an identical online survey, targeted at the members of the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons, and analyzed to obtain more statistically meaningful results.

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