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Who Should Do Notes: Initial Endoscopic Performance and Early Learning Curve of Laparoscopic Surgeons in Comparison to Endoscopists and Untrained Individuals
Oliver J. Wagner*1, Monika E. Hagen2, Francois Pugin2, Philippe Morel2, Daniel Candinas1
1Department of Visceral and Transplantation Surgery, University Bern, Bern, Switzerland; 2Digestive Surgery, University Hospital Geneva, Geneva, Switzerland
Background: A concern in the field of NOTES is the question if surgeons with their lack of endoscopic experience or endoscopists without intrabdominal routine should perform that type of new treatment. Still, due to well trained manual dexterity, spatial orientation and hand-eye alignment, laparoscopically experienced surgeons - even without endoscopic experience - should master very quickly the handling of endoscopic equipment. Initial performance should be superior when compared to individuals without surgical training and learning curve rapid. Endoscopically inexperienced laparoscopic surgeons may even quickly reach the endoscopic dexterity of endoscopists.
Methods and Design: 25 individuals were tested for endoscopic dexterity. Group1 included 5 endoscopists. Group 2 included 10 laparoscopic surgeons without endoscopic experience. Group 3 contained 10 medical students without endoscopic and surgical experience. Each individual performed 10 times an easy, a medium and a difficult task with endoscopic equipment on a NOTES skills-box. Time and errors were meassured, an overall score allocated and evaluated statistically.
Results: Group 3 performed all 3 of their allocated tasks significantly worse when compared to group 1 and 2 (p<0,05). No differences were detected between the performances of group 1 and 2 for the easy and the medium task (p>0,05). Group 1 performed the difficult tasks significantly better than group 2 (p<0,05). Group 2 demonstrated a very rapid learning curve between the first and tenth performance with a significantly better result for the tenth time of performance when compared to the first (p<0,05).
Conclusion: The data support the conclusion that endoscopically inexperienced laparoscopic surgeons learn very quickly the handling of endoscopic equipment. Their initial performance is superior when compared to individuals without any surgical training. Furthermore, intitial performance is similar when compared to trained endoscopists for easy and tasks of moderate difficulty. However, endoscopists are still superior in handling endoscopic material for complex tasks when compared to endoscopically untrained surgeons. The data therefore suggest that laparoscopic surgeons are not severely disadvantaged by their lack of endoscopic experience and - due to their surgical experience - should perform NOTES.
