title: Needs analysis for developing a virtual-reality NOTES simulator.
abstract: INTRODUCTION AND STUDY AIM: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical technique that requires a cautious adoption approach to ensure patient safety. High-fidelity virtual-reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing the virtual transluminal endoscopic surgery trainer (VTEST) for this purpose. The objective of this study is to conduct a structured needs analysis to identify the design parameters for such a virtual-reality-based simulator for NOTES.
  
  
  METHODS
  A 30-point questionnaire was distributed at the 2011 National Orifice Surgery Consortium for Assessment and Research meeting to obtain responses from experts. Ordinal logistic regression and the Wilcoxon rank-sum test were used for analysis.
  
  
  RESULTS
  A total of 22 NOTES experts participated in the study. Cholecystectomy (CE, 68 %) followed by appendectomy (AE, 63 %) (CE vs AE, p = 0.0521) was selected as the first choice for simulation. Flexible (FL, 47 %) and hybrid (HY, 47 %) approaches were equally favorable compared with rigid (RI, 6 %) with p < 0.001 for both FL versus RI and HY versus RI. The transvaginal approach was preferred 3 to 1 to the transgastric. Most participants preferred two-channel (2C) scopes (65 %) compared with single (1C) or three (3C) or more channels with p < 0.001 for both 2C versus 1C and 2C versus 3C. The importance of force feedback and the utility of a virtual NOTES simulator in training and testing new tools for NOTES were rated very high by the participants.
  
  
  CONCLUSIONS
  Our study reinforces the importance of developing a virtual NOTES simulator and clearly presents expert preferences. The results of this analysis will direct our initial development of the VTEST platform.
authors.affiliation: Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY 12180, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Sankaranarayanan
authors.forename: Kai
authors.initials: K
authors.lastname: Matthes
authors.forename: Arun
authors.initials: A
authors.lastname: Nemani
authors.forename: Woojin
authors.initials: W
authors.lastname: Ahn
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.forename: Steven
authors.initials: S
authors.lastname: Schwaitzberg
authors.forename: Suvranu
authors.initials: S
authors.lastname: De
mesh_terms: D000826:Animal Testing Alternatives; D000818:Animals; D001062:Appendectomy / Q000379:methods; D002102:Cadaver; D002763:Cholecystectomy / Q000379:methods; D003198:Computer Simulation; D003258:Consumer Behavior / Q000706:statistics & numerical data; D004285:Dogs; D019723:Endoscopes; D004867:Equipment Design; D056228:Feedback, Sensory; D006301:Health Services Needs and Demand; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D008953:Models, Anatomic; D057605:Natural Orifice Endoscopic Surgery / Q000193:education*; D012756:Sheep; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation; D013552:Swine; D014110:Touch; D014584:User-Computer Interface