Skip to main content
SpringerLink
Log in

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 appendectomy

  • Endoluminal Surgery
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Al-Akash M, Boyle E, Tanner WA (2009) Training on NOTES: from history we learn. Surg Oncol 18:111–119

    Article  PubMed  CAS  Google Scholar 

  2. Vick LR, Vick KD, Borman KR, Salameh JR (2007) Face, content, and construct validities of inanimate intestinal anastomoses simulation. J Surg Educ 64:365–368

    Article  PubMed  Google Scholar 

  3. McDougall EM, Corica FA, Boker JR, Sala LG, Stoliar G, Borin JF, Chu FT, Clayman RV (2006) Construct validity testing of a laparoscopic surgical simulator. J Am Coll Surg 202:779–787

    Article  PubMed  Google Scholar 

  4. Schijven M, Jakimowicz J (2002) Face, expert, and referent validity of the Xitact LS500 laparoscopy simulator. Surg Endosc 16:1764–1770

    Article  PubMed  CAS  Google Scholar 

  5. Karras DJ (1997) Statistical methodology: II. Reliability and validity assessment in study design. Part B. Acad Emerg Med 4:144–147

    Article  CAS  Google Scholar 

  6. Gillen S, Wilhelm D, Meining A, Fiolka A, Doundoulakis E, Schneider A, von Delius S, Friess H, Feussner H (2009) The “ELITE” model: construct validation of a new training system for natural orifice transluminal endoscopic surgery (NOTES). Endoscopy 41:395–399

    Article  PubMed  CAS  Google Scholar 

  7. Ritz JP, Grone J, Hopt U, Saeger HD, Siewert JR, Vollmar B, Lauscher JC, Lehmann KS, Buhr HJ (2009) Practical course for visceral surgery in Warnemunde 10 years on: significance and benefits of a surgical training course. Chirurg 80:864–871

    Article  PubMed  Google Scholar 

  8. Wilhelm D, Meining A, von Delius S, Fiolka A, Can S, Hann von Weyhern C, Schneider A, Feussner H (2007) An innovative, safe, and sterile sigmoid access (ISSA) for NOTES. Endoscopy 39:401–406

    Article  PubMed  CAS  Google Scholar 

  9. Dunkin BJ (2010) Natural orifice transluminal endoscopic surgery: educational challenge. World J Gastrointest Surg 2:224–230

    Article  PubMed  Google Scholar 

  10. Meining A, Wilhelm D, Burian M, Dundoulakis M, Schneider A, von Delius S, Feussner H (2007) Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study. Endoscopy 39:860–864

    Article  PubMed  CAS  Google Scholar 

  11. Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61:601–606

    Article  PubMed  Google Scholar 

  12. Bernhardt J, Gerber B, Schober HC, Kahler G, Ludwig K (2008) NOTES–case report of a unidirectional flexible appendectomy. Int J Colorectal Dis 23:547–550

    Article  PubMed  Google Scholar 

  13. Isariyawongse JP, McGee MF, Rosen MJ, Cherullo EE, Ponsky LE (2008) Pure natural orifice transluminal endoscopic surgery (NOTES) nephrectomy using standard laparoscopic instruments in the porcine model. J Endourol 22:1087–1091

    Article  PubMed  Google Scholar 

  14. Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61:449–453

    Article  PubMed  Google Scholar 

  15. Merrifield BF, Wagh MS, Thompson CC (2006) Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc 63:693–697

    Article  PubMed  Google Scholar 

  16. Wagh MS, Merrifield BF, Thompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63:473–478

    Article  PubMed  Google Scholar 

  17. Kavic MS, Mirza B, Horne W, Moskowitz JB (2008) NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program. JSLS 12:37–45

    PubMed  Google Scholar 

  18. 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 

  19. Meining A, Kahler G, von Delius S, Buess G, Schneider A, Hochberger J, Wilhelm D, Kubler H, Kranzfelder M, Bajbouj M, Fuchs KH, Gillen S, Feussner H (2009) Natural orifices transluminal endoscopic surgery (NOTES) in Germany: summary of the working group reports of the D-NOTES meeting 2009. Z Gastroenterol 47:1160–1167

    Article  PubMed  CAS  Google Scholar 

  20. Semm K (1986) Pelvi-trainer, a training device in operative pelviscopy for teaching endoscopic ligation and suture technics. Geburtshilfe Frauenheilkd 46:60–62

    Article  PubMed  CAS  Google Scholar 

  21. Gallagher AG, Smith CD, Bowers SP, Seymour NE, Pearson A, McNatt S, Hananel D, Satava RM (2003) Psychomotor skills assessment in practicing surgeons experienced in performing advanced laparoscopic procedures. J Am Coll Surg 197:479–488

    Article  PubMed  Google Scholar 

  22. Tanoue K, Uemura M, Kenmotsu H, Ieiri S, Konishi K, Ohuchida K, Onimaru M, Nagao Y, Kumashiro R, Tomikawa M, Hashizume M (2010) Skills assessment using a virtual reality simulator, LapSim, after training to develop fundamental skills for endoscopic surgery. Minim Invasive Ther Allied Technol 19:24–29

    Article  PubMed  Google Scholar 

  23. van Dongen KW, Tournoij E, van der Zee DC, Schijven MP, Broeders IA (2007) Construct validity of the LapSim: can the LapSim virtual reality simulator distinguish between novices and experts? Surg Endosc 21:1413–1417

    Article  PubMed  Google Scholar 

  24. Lehmann KS, Ritz JP, Maass H, Cakmak HK, Kuehnapfel UG, Germer CT, Bretthauer G, Buhr HJ (2005) A prospective randomized study to test the transfer of basic psychomotor skills from virtual reality to physical reality in a comparable training setting. Ann Surg 241:442–449

    Article  PubMed  Google Scholar 

  25. Seymour NE (2005) Integrating simulation into a busy residency program. Minim Invasive Ther Allied Technol 14:280–286

    Article  PubMed  Google Scholar 

  26. Seymour NE (2008) VR to OR: a review of the evidence that virtual reality simulation improves operating room performance. World J Surg 32:182–188

    Article  PubMed  Google Scholar 

  27. Satava RM (2001) Surgical education and surgical simulation. World J Surg 25:1484–1489

    Article  PubMed  CAS  Google Scholar 

  28. 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 

  29. Clark J, Sodergren M, Noonan D, Darzi A, Yang GZ (2009) The natural orifice simulated surgical environment (NOSsE): exploring the challenges of NOTES without the animal model. J Laparoendosc Adv Surg Tech A 19:211–214

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Marcus Sommer and team from SOMSO for providing the manikin and for the further development of the model. This study was supported Bundesministerium für Wirtschaft und Technologie and AiF.

Disclosure

Sonja Gillen, Jörn Gröne, Fritz Knödgen, Petra Wolf, Michael Meyer, Helmut Friess, Heinz-Johannes Buhr, Jörg-Peter Ritz, Hubertus Feussner, and Kai S. Lehmann have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strässe 22, 81675, München, Germany

    Sonja Gillen, Helmut Friess & Hubertus Feussner

  2. Research Group MITI, Minimally Invasive Therapy and Intervention, Munich, Germany

    Sonja Gillen, Fritz Knödgen & Hubertus Feussner

  3. Department of Surgery, Charité–Campus Benjamin Franklin, Berlin, Germany

    Jörn Gröne, Heinz-Johannes Buhr, Jörg-Peter Ritz & Kai S. Lehmann

  4. Institute of Medical Statistics and Epidemiology, Technische Universität München, Ismaninger Strässe 22, 81675, München, Germany

    Petra Wolf

  5. Research Institute of Leather and Plastic Sheeting, FILK, Freiberg, Germany

    Michael Meyer

Authors
  1. Sonja Gillen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jörn Gröne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fritz Knödgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petra Wolf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Helmut Friess
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Heinz-Johannes Buhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jörg-Peter Ritz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Hubertus Feussner
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kai S. Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hubertus Feussner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gillen, S., Gröne, J., Knödgen, F. et al. 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 appendectomy. Surg Endosc 26, 2376–2382 (2012). https://doi.org/10.1007/s00464-012-2165-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2165-z

Keywords

Search

Navigation