title: Simulated transanal NOTES sigmoidectomy training improves the responsiveness of surgical endoscopists.
abstract: BACKGROUND
  There is no evidence demonstrating the feasibility of colorectal natural orifice transluminal endoscopic surgery (NOTES) resection with currently available endoscopic instrumentation.
  
  
  OBJECTIVE
  This study aimed to evaluate the responsiveness of surgical endoscopists to simulated transanal NOTES sigmoidectomy training.
  
  
  METHODS
  Participants were trained in simulated NOTES sigmoidectomy by using disposable abdominal trays with tattooed sigmoid cancer in a hybrid simulator.
  
  
  METHODS
  Endoscopy simulation laboratory in a university hospital.
  
  
  METHODS
  NOTES sigmoidectomy included 8 steps performed transanally with 2 colonoscopes, endoscopic scissors, and clip applier: (1) colonoscopic viscerotomy with a balloon; (2) retroperitoneal dissection; (3) left ureter identification, inferior mesenteric vessels division; (4) colonoscopy; (5) splenic flexure mobilization; (6) left side of the colon/rectal mobilization; (7) transanal specimen transection; (8) extracorporeal colorectal anastomosis.
  
  
  METHODS
  Responsiveness was defined as a change in performance over time and assessed comparing baseline testing with unmentored final testing. Content-valid measures included the length of the specimen, the distance of the anastomosis from the anal verge, and the proximal and distal resection margins and operating time (minutes).
  
  
  RESULTS
  Four participants performed 21 resections. Tumor distance from the anal verge was 29.2 cm (range 26-2.5 cm). Operating time overall (127.5 vs 74 minutes, P = .068), viscerotomy (17.5 vs 9 minutes, P = .197), colonoscopy (4.5 vs 3.5 minutes, P = .655), flexure mobilization (19.5 vs 10 minutes, P = .144), colon mobilization (20 vs 14.5 minutes, P = .461), specimen extraction (9.5 vs 8.5 minutes, P = .465), and anastomosis (14 vs 11 minutes, P = .715) times improved.
  
  
  CONCLUSIONS
  Ceiling effects because of fixed anatomy.
  
  
  CONCLUSIONS
  Simulated NOTES sigmoidectomy training affected responsiveness of surgical endoscopists with a 42% reduction in operating time.
authors: Division of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors: Jonathan M
authors: JM
authors: Buscaglia
authors: Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.
authors: Joshua
authors: J
authors: Karas
authors: Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.
authors: Nicholas
authors: N
authors: Palladino
authors: Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.
authors: Jordan
authors: J
authors: Fakhoury
authors: Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.
authors: Paula I
authors: PI
authors: Denoya
authors: Division of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors: Satish
authors: S
authors: Nagula
authors: Division of Gastroenterology, State University of New York, Stony Brook, New York, USA.
authors: Juan Carlos
authors: JC
authors: Bucobo
authors: Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.
authors: Muath
authors: M
authors: Bishawi
authors: Division of Colorectal Surgery, State University of New York, Stony Brook, New York, USA.
authors: Roberto
authors: R
authors: Bergamaschi
mesh_terms: D000328:Adult; D001003:Anal Canal; D000714:Anastomosis, Surgical / Q000193:education / Q000295:instrumentation / Q000379:methods; D002983:Clinical Competence; D003082:Colectomy / Q000193:education* / Q000295:instrumentation / Q000379:methods; D012809:Colon, Sigmoid / Q000601:surgery*; D003113:Colonoscopy / Q000193:education* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D008953:Models, Anatomic; D017145:Models, Educational; D057605:Natural Orifice Endoscopic Surgery / Q000193:education* / Q000295:instrumentation / Q000379:methods; D061646:Operative Time; D011446:Prospective Studies; D014481:United States