Who should do NOTES? Initial endoscopic performance of laparoscopic surgeons compared to gastroenterologists and untrained individuals.
BACKGROUND
Natural orifice transluminal endoscopic surgery (NOTES) is a multidisciplinary surgical technique. If conventional endoscopic instrumentation can be easily mastered, surgeons with laparoscopic experience could head NOTES interventions.


METHODS
Thirty individuals were tested for endoscopic dexterity. Group 1 included seven gastroenterologists, group 2 included 12 laparoscopically experienced surgeons lacking endoscopic experience, and group 3 included 11 interns who had no hands-on endoscopic or surgical experience. Each individual repeated an easy (T1), medium (T2), and difficult (T3) task ten times with endoscopic equipment on a NOTES skills-box.


RESULTS
Group 3 had significantly poorer performances for all three tasks compared to the other groups. No significant differences were seen between groups 1 and 2 for T1 and T2. The initial T3 performance of group 1 was better than that of group 2, but their performance after repetition was not statistically different. Groups 2 and 3 improved significantly with repetition, and group 2 eventually performed as well as group 1.


CONCLUSIONS
The data indicate that laparoscopic surgeons quickly learned to handle the endoscopic equipment. This suggests that a lack of endoscopic experience does not handicap laparoscopic surgeons when performing endoscopic tasks. Based on their knowledge of anatomy and the complication management acquired during surgical education, surgeons are well equipped to take the lead in interdisciplinary NOTES collaborations.
Wagner
Oliver J
OJ
Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland. oliver.wagner@bluewin.ch
Hagen
Monika
M
Morel
Philippe
P
Inan
Ihsan
I
Candinas
Daniel
D
Vorburger
Stephan A
SA
D000328:Adult; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D005762:Gastroenterology / Q000706:statistics & numerical data*; D013502:General Surgery / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D011597:Psychomotor Performance