Virtual Translumenal Endoscopic Surgical Trainer (VTEST(tm)): An Evaluation Study

Jinling Wang, PhD1, Woojin Ahn, PhD2, Denis Dorozhkin, PhD2, Daniel B Jones, MD, MS, FACS3, Suvranu De, ScD2, Caroline G.L. Cao, PhD1. 1Wright State University, 2Rensselaer Polytechnic Institute, 3Beth Israel Deaconess Medical Center, Harvard Medical School

INTRODUCTION: Natural Orifice Translumenal Endoscopic Surgery (NOTES), as a new procedure, needs effective training methods. A virtual translumenal endoscopic surgical trainer (VTEST™) is being developed for the training of the hybrid rigid transvaginal NOTES cholecystectomy procedure. It is the first virtual NOTES simulator. After modifications based on the feedback collected at the 2013 and 2014 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR®) Summit, the new and improved simulator was evaluated at the 2015 NOSCAR summit.

METHODS AND PROCEDURES: Ten participants were recruited at the 2015 NOSCAR® Summit. There were 9 males and 1 female with an average age of 42.7 (SD=6.1). Three of them had performed NOTES. The participants were asked to complete a questionnaire about their surgical experience. After being shown a demo video of the simulator and a hybrid transvaginal NOTES cholecystectomy procedure, the participants were asked to perform the task on the simulator and then fill out a questionnaire to provide their feedback.

RESULTS: There were 18 subjective preference questions. Subjects rated their preference using a 5-point Likert scale (ranging from 1: not realistic/not useful/not trustworthy/disagree; to 5: realistic/useful/trustworthy/agree). Participants gave a median score of ≥3 for 13 questions, including those related to the realism of anatomy/Calot’s triangle/simulator interface/rigid endoscope navigation/gall bladder removal task, usefulness in learning hand-eye coordination/ambidexterity skills/fundamental NOTES technical skills, trustworthy in quantifying accurate measures of performance/providing different hand-eye coordination, realism of the simulator as a trainer, and usefulness of the simulator for training before operating room experience and certification. A median score of <3 was noted for only 5 questions which were related to the realism of the instrument handling and the blunt dissection task/overall realism/quality of force feedback/and usefulness of force feedback. These results were consistent with the responses to the open-ended questions.

CONCLUSION: Expert feedback results show that the simulator is deemed to be useful and trustworthy, but further improvement is needed especially for the quality of force feedback in the simulator. 

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