Needs analysis for developing a virtual-reality NOTES simulator

Ganesh Sankaranarayanan, Kai Matthes, Arun Nemani, Woojin Ahn, Masayuki Kato, Daniel B. Jones, Steven Schwaitzberg, Suvranu De

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)1607-1616
Number of pages10
JournalSurgical endoscopy
Issue number5
StatePublished - May 2013
Externally publishedYes


  • Natural orifice surgery
  • Simulator
  • Transgastric
  • Transvaginal
  • Virtual reality

ASJC Scopus subject areas

  • Surgery


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