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VALIDATION OF A NOVEL ENDOSCOPIC ROBOTIC SIMULATOR
Ravi Teja Pasam
*1,2, Trent Walradt
1, Vishal Chandel
1,2, Daniel Szvarca
1, Leander Heisterberg
4,1, Dongsuk Shin
3,1, Pichamol Jirapinyo
1, Christopher C. Thompson
11Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Wentworth-Douglass Hospital, Dover, NH; 3EndoQuest Robotics Inc, Houston, TX; 4ERBE Elektromedizin GmbH, Tübingen, BW, Germany
INTRODUCTIONRobotic endoscopy is an emerging tool that promises improved visualization, control, and ergonomics compared to traditional endoscopy. The skillset required to perform procedures using endoscopic robots differ from traditional endoscopic skills, creating a need for training methods. The aim of this study was to validate a novel endoscopic robotic simulator.
METHODSThis was a prospective study to validate training on a part-task endoscopic robot simulator. Eight endoscopists with no prior ESD or robotic experience were divided equally into the two groups. Group 1 attained proficiency in performing tasks on the simulator and then performed endoscopic submucosal dissection (ESD) of a 2 cm lesion in an ex-vivo bovine colon using an endoscopic robot system (EndoQuest Robotics, Inc, Houston, Tx)
(Figure 1). Group 2 performed ESD without training on the simulator and then perform required simulator tasks afterwards. Both groups were given a 20-minute hands-on session using the robot prior to the ESD. Face validity, validity based on content and validity based on consequences of testing were assessed. Procedure duration, en bloc resection, perforation, muscle injury and National Aeronautics and Space Administration – Task Load Index (NASA-TLX), a validated, quantitative survey of physical and mental workload, were assessed. Fisher test was used for categorical variables. Mann-Whitney U test and t-test were used for continuous variables with non-normal and normal distributions, respectively.
RESULTSAll participants either strongly agreed or agreed that the simulator should be used before performing ex-vivo procedures and clinical cases, and that it has the potential to improve clinical endorobotic performance. A panel of 4 experts assessed the validity based on content. The overall content validity index was 0.88, with a realism sub-score of 0.95, relevance of 0.80, and representativeness of 0.90. The median dissection time was significantly shorter in the simulator-first group (17.29 minutes vs 10.15 minutes, p-value = 0.03). A higher proportion of simulator-first group performed en bloc resection (3/4 vs 1/4) and had lower rates of perforation (0/4 vs 1/4) and muscle injury (2/4 vs 4/4) compared to the ESD-first group. Participants in the simulator-first group reported a significantly higher confidence in their performance of ESD based on NASA-TLX (p-value 0.02) (Table 2).
CONCLUSIONThis novel endoscopic robotic simulator is relevant, realistic, and representative of clinical robotic-assisted endoscopy. There was a statistically significant difference in performance of ESD between the endoscopists with and without simulator training. All endoscopists recommended using the simulator before performing clinical cases. Our results indicate that this simulator is a valuable tool for endoscopists learning robotic endoscopy.
Validity based on consequences of testing
Figure 1A. Endoscopic robot simulator task requiring tracing along the marking with cautery. Figure 1B. Set up for endoscopic submucosal dissection in an ex-vivo bovine colon using an endoscopic robot system. Figure 1C. Screen of the physician console showing final stages of endoscopic submucosal dissection
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