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Natural orifice translumenal endoscopic surgery (NOTES): emerging trends and specifications for a virtual simulator

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Abstract

Introduction and study aim

A virtual translumenal endoscopic surgical trainer (VTEST™) is being developed to accelerate the development of natural orifice translumenal endoscopic surgery (NOTES) procedures and devices in a safe and risk-free environment. For a rapidly developing field such as NOTES, a needs analysis must be conducted regularly to discover emerging research trends and areas of potential high impact for a virtual simulator. This paper presents a survey-based study which follows a similar study conducted by this group in 2011 (Sankaranarayanan et al. in Surg Endosc 27:1607–1616, 2013).

Methods

A 32-point questionnaire was distributed at the 2012 Natural Orifice Surgery Consortium for Assessment and Research annual meeting. These data were 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.

Results

Twenty-eight NOTES experts participated in the 2012 study. Cholecystectomy (CE) procedure remained the most commonly performed NOTES technique, with 18 positive responses (64 %). In contrast to 2011, the popularity of the NOTES appendectomy (AE) was significantly lower, with only 2 (7 %) instances (CE vs. AE, p < 0.001), while the number of peroral endoscopic myotomy (POEM, PE) cases had increased significantly, with 11 (39 %) positive responses, respectively (PE vs. AE, p = 0.013). Strong preference toward hybrid rather than pure NOTES techniques (82 vs. 11 %, p < 0.001) was also expressed. Other responses were similar to those in the 2011 study, with the VTEST™ utility in developing and testing new techniques and instruments ranked particularly high.

Conclusion

Based on the results of this study, a decision was made to focus exclusively on the transvaginal hybrid NOTES cholecystectomy procedure, including both rigid and flexible scope techniques. The importance of developing a virtual NOTES simulator was reaffirmed, with POEM identified as a promising candidate for future simulator development.

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References

  1. Sankaranarayanan G, Matthes K, Nemani A, Ahn W, Kato M, Jones DB, Schwaitzberg S, De S (2013) Needs analysis for developing a virtual-reality NOTES simulator. Surg Endosc 27:1607–1616. doi:10.1007/s00464-012-2637-1

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moris DN, Bramis KJ, Mantonakis EI, Papalampros EL, Petrou AS, Papalampros AE (2012) Surgery via natural orifices in human beings: yesterday, today, tomorrow. Am J Surg 204:93–102

    Article  PubMed  Google Scholar 

  3. Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117

    Article  PubMed  Google Scholar 

  4. Huang C (2011) Natural orifice transluminal endoscopic surgery: new minimally invasive surgery come of age. World J Gastroenterol 17:4382

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rattner D, Kalloo A (2006) ASGE/SAGES working group on natural orifice translumenal endoscopic surgery. October 2005. Surg Endosc 20:329–333

    Article  PubMed  CAS  Google Scholar 

  6. Rattner DW, NOTES SAJC (2008) NOTES: where have we been and where are we going? Surg Endosc 22:1143–1145

    Article  PubMed  Google Scholar 

  7. Hochberger J, Matthes K, Maiss J, Koebnick C, Hahn EG, Cohen J (2005) Training with the compactEASIE biologic endoscopy simulator significantly improves hemostatic technical skill of gastroenterology fellows: a randomized controlled comparison with clinical endoscopy training alone. Gastrointest Endosc 61:204–215

    Article  PubMed  Google Scholar 

  8. Fiolka A, Gillen S, Meining A, Feussner H (2010) ELITE—the ex vivo training unit for NOTES: development and validation. Minim Invasive Ther Allied Technol 19:281–286. doi:10.3109/13645706.2010.510673

    Article  PubMed  Google Scholar 

  9. Seymour NE, Gallagher AG, Roman SA, O’TMBrien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance. Ann Surg 236:458–464

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wilson MS, Middlebrook A, Sutton C, Stone R, McCloy RF (1997) MIST VR: a virtual reality trainer for laparoscopic surgery assesses performance. Ann R Coll Surg Engl 79:403–404

    PubMed  CAS  PubMed Central  Google Scholar 

  11. Triantafyllou K, Lazaridis LD, Dimitriadis GD (2014) Virtual reality simulators for gastrointestinal endoscopy training. World J Gastrointest Endosc 6:6–12. doi:10.4253/wjge.v6.i1.6

    Article  PubMed  PubMed Central  Google Scholar 

  12. Auyang ED, Santos BF, Enter DH, Hungness ES, Soper NJ (2011) Natural orifice translumenal endoscopic surgery (NOTES): a technical review. Surg Endosc 25:3135–3148

    Article  PubMed  Google Scholar 

  13. Chukwumah C, Zorron R, Marks JM, Ponsky JL (2010) Current status of natural orifice translumenal endoscopic surgery (NOTES). Curr Probl Surg 47:630–668

    Article  PubMed  Google Scholar 

  14. Coomber RS, Sodergren MH, Clark J, Teare J, Yang G-Z, Darzi A (2012) Natural orifice translumenal endoscopic surgery applications in clinical practice. World J Gastrointest Endosc 4:65–74

    Article  PubMed  PubMed Central  Google Scholar 

  15. Dallemagne B, Marescaux J (2010) NOTES: past, present and future. Asian J Endosc Surg 3:115–121

    Article  Google Scholar 

  16. Dehn T, Austin RCT (2009) Natural orifice translumenal endoscopic surgery (NOTES)—scar free or scary? Ann R Coll Surg Engl 91:192–194

    Article  PubMed  Google Scholar 

  17. Nemani A, Sankaranarayanan G, Olasky J, Roberts K, Panait L, Schwaitzberg S, Jones D, De S (2014) A comparison of NOTES transvaginal and laparoscopic cholecystectomy procedures based upon task analysis. Surg Endosc 28:2443–2451

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ahn W, Dargar S, Halic T, Lee J, Li B, Pan J, Sankaranarayanan G, Roberts K, De S (2014) Development of a virtual reality simulator for natural orifice translumenal endoscopic surgery (NOTES) cholecystectomy procedure. Stud Health Technol Inform 196:1–5

    PubMed  Google Scholar 

  19. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271

    Article  PubMed  CAS  Google Scholar 

  20. Von Renteln D, Inoe H, Minami H, Werner Y, Pace A, Kersten J, Much C, Schachschal G, Mann O, Keller J, Fuchs K, Rosch T (2012) Peroral endoscopic myotomy for the treatment of achalasia: a prospective single center study. Am J Gastroenterol 107:411–417

    Article  Google Scholar 

  21. Minami H, Isomoto H, Yamaguchi N, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Inoue H, Nakao K (2014) Peroral endoscopic myotomy for esophageal achalasia: clinical impact of 28 cases. Dig Endosc 26:43–51

    Article  PubMed  Google Scholar 

  22. Eleftheriadis N, Inoue H, Ikeda H, Onimaru M, Yoshida A, Hosoya T, Maselli R, Kudo SE (2012) Training in peroral endoscopic myotomy (POEM) for esophageal achalasia. Ther Clin Risk Manag 8:329–342

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This work was supported by NIBIB/NIH Grant #R01EB009362.

Disclosures

Dr. Kai Matthes: Endosim, LLC (ownership), Ovesco Endoscopy USA Inc. (consultation, equipment support), Olympus America Inc. (equipment support); Dr. Daniel B. Jones: Allurion Technologies, Intuitive Surgical Inc.; Dr. Steven D. Schwaitzberg: Serves as a consultant for Covidien, Olypus, Surgiquest, Human Extensions, Cambridge Endo, and Acuity Bio; Drs. Denis Dorozhkin, Ganesh Sankaranarayanan, and Suvranu De have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA

    Steven D. Schwaitzberg

  2. Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY, 12180, USA

    Denis Dorozhkin, Ganesh Sankaranarayanan & Suvranu De

  3. Department of Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, 110 8th Street, Troy, NY, 12180, USA

    Ganesh Sankaranarayanan & Suvranu De

  4. Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Kai Matthes

  5. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Daniel B. Jones

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  1. Steven D. Schwaitzberg
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  2. Denis Dorozhkin
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  3. Ganesh Sankaranarayanan
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Correspondence to Suvranu De.

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Schwaitzberg, S.D., Dorozhkin, D., Sankaranarayanan, G. et al. Natural orifice translumenal endoscopic surgery (NOTES): emerging trends and specifications for a virtual simulator. Surg Endosc 30, 190–198 (2016). https://doi.org/10.1007/s00464-015-4182-1

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