Transgastric or Trans-Sigmoidal? The Impact of the Choice of Access on Task Performance in Target Natural Orifice Translumenal Endoscopic Surgery Procedures

Abstract Introduction: The effect of the choice of access upon endoscope control during a navigational task is explored within a simulator model. Materials and Methods: The study was conducted within the endoscopic–laparoscopic interdisciplinary training entity (ELITE) model (Minimally Invasive Therapy and Intervention Research Group [MITI], Technische Universitat, Germany)—a validated natural orifice translumenal endoscopic surgery (NOTES) simulator. Seventeen subjects, 15 with no endoscopic experience, navigated the endoscope from predefined trans-sigmoidal and transgastric access points to the appendix and the gallbladder. A previously defined and validated quantitative analysis of endoscope control, in addition to time taken to complete the task, was used to evaluate overall performance. The quantitative analysis extrapolated the movements of the subject's wrist in control of the endoscope and rated the movements using a scoring system of 0–3 based upon the smoothness of the movements recorded. Result...