NOViSE: a virtual natural orifice transluminal endoscopic surgery simulator.
OBJECTIVE
Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique in minimally invasive surgery whereby a flexible endoscope is inserted via a natural orifice to gain access to the abdominal cavity, leaving no external scars. This innovative use of flexible endoscopy creates many new challenges and is associated with a steep learning curve for clinicians.


METHODS
We developed NOViSE-the first force-feedback-enabled virtual reality simulator for NOTES training supporting a flexible endoscope. The haptic device is custom-built, and the behaviour of the virtual flexible endoscope is based on an established theoretical framework-the Cosserat theory of elastic rods.


RESULTS
We present the application of NOViSE to the simulation of a hybrid trans-gastric cholecystectomy procedure. Preliminary results of face, content and construct validation have previously shown that NOViSE delivers the required level of realism for training of endoscopic manipulation skills specific to NOTES.


CONCLUSIONS
VR simulation of NOTES procedures can contribute to surgical training and improve the educational experience without putting patients at risk, raising ethical issues or requiring expensive animal or cadaver facilities. In the context of an experimental technique, NOViSE could potentially facilitate NOTES development and contribute to its wider use by keeping practitioners up to date with this novel surgical technique. NOViSE is a first prototype, and the initial results indicate that it provides promising foundations for further development.
Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
Przemyslaw
P
Korzeniowski
Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
Alastair
A
Barrow
Department of Surgery and Cancer, Imperial College London, London, UK.
Mikael H
MH
Sodergren
Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK.
Niels
N
Hald
Centre for Engagement and Simulation Science, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH, London, UK. f.bello@imperial.ac.uk.
Fernando
F
Bello
D002763:Cholecystectomy / Q000379:methods*; D003198:Computer Simulation; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*
Cosserat rod; Flexible endoscope; NOTES; Natural orifice surgery; Virtual reality simulator