title: 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.
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.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strässe 22, 81675 München, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Gillen
authors.forename: Jörn
authors.initials: J
authors.lastname: Gröne
authors.forename: Fritz
authors.initials: F
authors.lastname: Knödgen
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.forename: Michael
authors.initials: M
authors.lastname: Meyer
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Heinz-Johannes
authors.initials: HJ
authors.lastname: Buhr
authors.forename: Jörg-Peter
authors.initials: JP
authors.lastname: Ritz
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
authors.forename: Kai S
authors.initials: KS
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000193:education*; D002983:Clinical Competence / Q000592:standards; D004502:Education, Medical, Continuing; D016099:Endoscopy, Gastrointestinal / Q000193:education*; D004867:Equipment Design; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D017145:Models, Educational; D057605:Natural Orifice Endoscopic Surgery / Q000193:education*; D011795:Surveys and Questionnaires; D013664:Teaching Materials; D060726:Torso / Q000033:anatomy & histology