title: A randomized controlled trial evaluating endoscopic and laparoscopic training in skills transfer for novices performing a simulated NOTES task.
abstract: BACKGROUND
  The NOSCAR white paper lists training as an important step to the safe clinical application of natural orifice translumenal endoscopic surgery (NOTES). The aim of this randomized controlled trial was to evaluate whether training novices in either a laparoscopic or endoscopic simulator curriculum would affect performance in a NOTES simulator task.
  
  
  METHODS
  A total of 30 third-year medical undergraduates were recruited. They were randomized to 3 groups: no training (control; n = 10), endoscopy training on a validated colonoscopy simulator protocol (n = 10), and training on a validated laparoscopy simulator curriculum (n = 10). All participants subsequently completed a simulated NOTES task, consisting of 7 steps, on the ELITE (endoscopic-laparoscopic interdisciplinary training entity) model. Performance was assessed as time taken to complete individual steps, overall task time, and number of errors.
  
  
  RESULTS
  The endoscopy group was significantly faster than the control group at accessing the peritoneal cavity through the gastric incision (median 27 vs 78 s; P = .015), applying diathermy to the base of the appendix (median 103.5 vs 173 s; P = .014), and navigating to the gallbladder (median 76 vs 169.5 s; P = .049). Endoscopy participants completed the full NOTES procedure in a shorter time than the laparoscopy group (median 863 vs 2074 s; P < .001).
  
  
  CONCLUSIONS
  This study highlights the importance of endoscopic training for a simulated NOTES task that involves both navigation and resection with operative maneuvers. Although laparoscopic training confers some benefit for operative steps such as applying diathermy to the gallbladder fossa, this was not as beneficial as training in endoscopy.
authors.affiliation: 1Imperial College, London, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Nehme
authors.forename: Mikael Hans
authors.initials: MH
authors.lastname: Sodergren
authors.forename: Colin
authors.initials: C
authors.lastname: Sugden
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Sonja
authors.initials: S
authors.lastname: Gillen
authors.forename: Huburtus
authors.initials: H
authors.lastname: Feussner
authors.forename: Guang-Zhong
authors.initials: GZ
authors.lastname: Yang
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003113:Colonoscopy; D003198:Computer Simulation; D004502:Education, Medical, Continuing; D006804:Ergonomics; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000193:education* / Q000592:standards; D013647:Task Performance and Analysis; D055815:Young Adult
keywords: NOTES; ergonomics and/or human factors study; flexible endoscopy; simulation