Background: NOTES adds a novel paradigm to surgical techniques. In the NOTES paradigm, it may require long periods of training to overcome difficulties in interpreting unstable images and controlling flexible instruments in order to master basic surgical skills. This study takes an initial step into understanding the learning process of NOTES. Bimanual coordination learning curves were contrasted between three different surgical paradigms. We hypothesized that the use of an open or laparoscopic paradigm will have a better performance and a shorter learning process (reaching a learning plateau earlier) than an endoscopic paradigm.
Methods: Our model required 7 subjects to perform identical bimanual coordination tasks with 3 different tools (a dual channel endoscope with graspers, a laparoscopic Maryland grasper and straight artery forceps for open surgery). The task required subjects to press a trigger to start, grab a rubber ring from a cone with right instrument, pass it to left instrument, place it with left instrument on a different cone, press trigger again, grab the same ring with left grasper, pass it to right grasper, place it on a cone, and press the trigger to establish performance time. Performance was measured by movement speed and accuracy. The learning curves of 4 novices for 30 tasks with each device were compared to the performance of 2 experienced participants and 1 endoscopy and laparoscopy expert. The first 6 trials of the expert were averaged and created a baseline for reference.
Results: Overall performance speed was significantly faster using open or laparoscopic tools than endoscopy for all groups (seconds: open 13+/-1; lap 28+/-3; endo 202+/-82; P
Session: Podium Presentation
Program Number: S128
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