Endoscopic Simulator Research Articles

Development and Validation of a Simulation Model for Ureteral Stent Placement

Importance Currently, there are no validated training models for cystoscopy with ureteral stent placement. Objectives The objectives of this study were to develop and validate a novel endoscopic simulation model for training in ureteral stent placement. Study Design A low-cost, low-fidelity training model was developed to simulate ureteral stent placement. Recruited participants were divided into 3 groups: novices (postgraduate year 3/4 gynecology residents), advanced learners (urogynecology and reconstructive pelvic surgery fellows), and experts (urology residents, urogynecology faculty, and urology faculty). Construct validity was measured using de-identified video-recorded performances on the model, which were evaluated by 2 expert reviewers using validated scales (Global Operative Assessment of Laparoscopic Skills [GOALS], Global Rating Scale [GRS]) and procedure-specific metrics. Results The model was created using a hollow Styrofoam sphere, plastic tubing from a retropubic sling, and a silicone pacifier. Thirty-six surgeons were assessed performing the procedure using the model with cystoscopic equipment. The experts (n = 12) performed significantly better than the advanced learners (n = 17) and novices (n = 7) in total scores (max 75, median [IQR]: 75 [75–75], 61 [56.5–68.5], 45 [43–46], respectively; P < 0.001) and within each individual scale domain. Increasing experience with ureteral stent placement had a significant correlation (P < 0.001) with better performance on the model. A minimum total passing score of 63 was established. On post simulation assessment, most participants “agreed” or “strongly agreed” that the model closely approximates the feel of ureteral stent placement. Conclusion This ureteral stenting simulation model is easy to construct, affordable, and reproducible. The model is valid and reliable for practicing the procedure in preparation for live surgery.

S874 Simulations Today, Gastroenterologists Tomorrow: A Study Assessing Use of Endoscopy Simulators to Increase Interest and Understanding of Gastroenterology Among Medical Trainees

S874 Simulations Today, Gastroenterologists Tomorrow: A Study Assessing Use of Endoscopy Simulators to Increase Interest and Understanding of Gastroenterology Among Medical Trainees

Preliminary validation of the virtual bariatric endoscopic simulator

Background and AimsObesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field. MethodsWe designed the Virtual Bariatric Endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. It features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of the procedural details. Furthermore, it incorporates performance metrics utilizing a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks. ResultsTwelve participants, comprising five experts and seven novices, participated in the study. They were asked to complete a post-questionnaire featuring seven items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points. ConclusionThe ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator is to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.

Current status of resident simulation training curricula: pearls and pitfalls.

Residency programs are required to incorporate simulation into their training program. Ideally, simulation provides a safe environment for a trainee to be exposed to both common and challenging clinical scenarios. The purpose of this review is to detail the current state of the most commonly used laparoscopic, endoscopic, and robotic surgery simulation programs in general surgery residency education, including resources required for successful implementation and benchmarks for evaluation. Members of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Resident and Fellow Task Force (RAFT) Committee performed a literature review using PubMed and training websites. Information regarding the components of the most commonly used laparoscopic, endoscopic, and/or robotic simulation curriculum, including both formal and informal benchmarks for evaluating training competence, were collected. Laparoscopic simulation revolves around the Fundamentals of Laparoscopic Surgery (FLS). Proficiency-based as well as virtual simulation have been utilized for FLS training curricula. Challenges include less direct translation to the technical complexities that can arise in laparoscopic surgery. Endoscopic simulation focuses on the Fundamentals of Endoscopic Surgery. There are virtual reality simulation platforms that can be used for skills assessment and training. Challenges include simulator types and access, as well as structured mentoring and feedback. Robotic simulation training curricula have not been standardized. Simulation includes one primary technology, which can be prohibitive based on cost and requirements for onboarding. While surgical simulation seems to be a fundamental and integrated part of surgical training, it requires a significant number of resources, which can be daunting for residency training programs. Regardless of the barriers outlined, the need for surgical simulation in laparoscopy, endoscopy, and robotics at surgical education training programs is clear.

Validation of the ViGaTu Immersive Virtual Reality Endoscopy Training System for Physicians and Nurses.

Endoscopy simulators are primarily designed to provide training in interventions performed during procedures. Peri-interventional tasks such as checking patient data, filling out forms for team time-out, patient monitoring, and performing sedation are often not covered. This study assesses the face, content, and construct validity of the ViGaTu (Virtual Gastro Tutor) immersive virtual reality (VR) simulator in teaching these skills. 71 nurses and physicians were invited to take part in VR training. The participants experienced an immersive VR simulation of an endoscopy procedure, including setting up the endoscopic devices, checking sign-in and team time-out forms, placing monitoring devices, and performing sedation. The actions performed by the participants and their timing were continuously recorded. Face and content validity, as well as the System Usability Scale (SUS), were then assessed. 43 physicians and 28 nurses from 43 centers took a mean of 27.8 min (standard deviation ± 14.42 min) to complete the simulation. Seventy-five percent of the items for assessing face validity were rated as realistic, and 60% of items assessing content validity and usefulness of the simulation for different learning goals were rated as useful by the participants (four out of five on a Likert scale). The SUS score was 70, demonstrating a high degree of usability. With regard to construct validity, experienced endoscopy staff were significantly faster in setting up the endoscope tower and instruments than beginners. This multicenter study presents a new type of interdisciplinary endoscopy training system featuring peri-interventional tasks and sedation in an immersive VR environment.

A structured curriculum for the acquisition of basic surgical endoscopic skills for surgical residents and quantification of skills improvement

IntroductionNew strategies and methods are needed to ensure that new generations can train and acquire surgical skills in a safe environment. Materials and methodsFrom January 2020 to October 2020, we performed a single centre, prospective observational cohort study. 19 participants (15 students, 4 residents) enrolled and 16 participants (13 students, 3 residents) successfully completed the curriculum. We performed a quantitative data analysis to evaluate its effectiveness in gaining and improving basic surgical endoscopic skills. ResultsThe time for single knot tying pre-, mid-, and post-training was reduced significantly, the average time (sec) decreased by 79.5 % (p < 0.001), the total linear distance (cm) by 74.5 % (p < 0.001) and the total angular distance (rad) by 71.7 % (p < 0.001). The average acceleration (mm/s2) increased by 20 % (p = 0.041). Additionally, the average speed increased by 23.5 % (p < 0.001), while motion smoothness (m/s3) increased by 20.4 % (p = 0.02). ConclusionThe obtained performance scores showed a significant increase in participants improving their basic surgical performance skills on the endoscopic simulator. This curriculum can be easily implemented in any surgical specialty as part of the residency training curriculum before first exposure in the operation room. All 16 participants recommended the implementation of such simulator training in their surgical training curriculum.

Virtual reality tools for training in gastrointestinal endoscopy: A systematic review

BACKGROUND Virtual reality (VR) has emerged as an innovative technology in endoscopy training, providing a simulated environment that closely resembles real-life scenarios and offering trainees a valuable platform to acquire and enhance their endoscopic skills. This systematic review will critically evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. AIM To evaluate the effectiveness and feasibility of VR-based training compared to traditional methods. By examining the current state of the field, this review seeks to identify gaps, challenges, and opportunities for further research and implementation of VR in endoscopic training. METHODS The study is a systematic review, following the guidelines for reporting systematic reviews set out by the PRISMA statement. A comprehensive search command was designed and implemented and run in September 2023 to identify relevant studies available, from electronic databases such as PubMed, Scopus, Cochrane, and Google Scholar. The results were systematically reviewed. RESULTS Sixteen articles were included in the final analysis. The total number of participants was 523. Five studies focused on both upper endoscopy and colonoscopy training, two on upper endoscopy training only, eight on colonoscopy training only, and one on sigmoidoscopy training only. Gastrointestinal Mentor virtual endoscopy simulator was commonly used. Fifteen reported positive results, indicating that VR-based training was feasible and acceptable for endoscopy learners. VR technology helped the trainees enhance their skills in manipulating the endoscope, reducing the procedure time or increasing the technical accuracy, in VR scenarios and real patients. Some studies show that the patient discomfort level decreased significantly. However, some studies show there were no significant differences in patient discomfort and pain scores between VR group and other groups. CONCLUSION VR training is effective for endoscopy training. There are several well-designed randomized controlled trials with large sample sizes, proving the potential of this innovative tool. Thus, VR should be more widely adopted in endoscopy training. Furthermore, combining VR training with conventional methods could be a promising approach that should be implemented in training.

Training in Endoscopic Endonasal Neurosurgical Procedures: A Systematic Review of Available Models

Abstract Background Proficiency in endoscopic endonasal neurosurgery (EEN) requires a unique skill set and is associated with a steep learning curve. Endoscopic simulation models present an opportunity for trainees to enhance their surgical skills and anatomical knowledge in a risk-free environment. To date, four main categories of training modalities have been recorded: cadaveric, synthetic, animal, and virtual reality (VR) models. Objective To analyze the features, advantages, and disadvantages of each EEN training model, describe the stages of simulation training, and propose future directions and an algorithm for EEN training. Methods A comprehensive search was performed including studies published before August 2023. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed in the search and selection of studies included. Terms for searching title and abstract were (“simulation”) AND (“endoscopic endonasal”) AND (“neurosurgery”). Articles were screened for duplicates. Results We identified 176 references, and 43 studies met the inclusion criteria. Twelve articles described cadaveric models, with 7 of them studying internal carotid artery injury management and 3 of them cerebrospinal leak management; 14 articles illustrated synthetic models, 1 article described animal models, and 16 articles outlined VR simulations. Conclusion Cadaveric models provide realistic hands-on surgical training with acceptable cost and remain the gold standard method for training. Synthetic models are most effective for preoperative surgical planning and animal models are best suited for testing of hemostatic techniques. VR simulations may become the primary training tool for novices to acquire basic anatomical knowledge as their role in advanced surgical planning is evolving.

A115 EVALUATING THE CONTENT AND FACE VALIDITY OF LOW-COST GEL POLYPS FOR POLYPECTOMY SKILLS TRAINING IN NOVICE ENDOSCOPISTS

Abstract Background Polypectomy is an essential endoscopic skill involving the removal of potentially premalignant lesions during colonoscopy. The ad hoc nature of polyp encounters is a significant barrier to polypectomy training, as this limits the ability to deliberately practice the skill. Effective and accessible polypectomy simulators may improve global implementation of polypectomy curricula. Aims To determine the face and content validity of a novel low-cost gel polyp simulator for use in endoscopic training programs. Methods A novel gel polyp simulator with multiple polyp morphologies based on the Paris classification was developed and used with a commercially available colonic phantom (Koken Lower GI Endoscopy Simulator Type II LM-107, Koken CO.LTD, Japan) in an endoscopy simulation-based training course (July, 2023). Feedback based on previous prototypes of the simulator were implemented into the simulator utilized in the present study. Novice (ampersand:003C25 procedures) and expert (ampersand:003E1000 procedures) endoscopists performed simulated procedures with the gel polyps. Using a five-point Likert scale (“strongly agree” to “strongly disagree”), a post-training survey based on previously published surveys used to determine the face and content validity of low-cost physical colonic simulators was administered. A section for additional comments was placed at the end of the survey. Results The face and content validity survey was completed by 3 experts and 21 novices. The median score for all face validity questions was 5 (IQR 5-5) from experts and 5 (IQR 5-5) from novices. The median score for all content validity questions was 5 (IQR 5-4) from experts and 5 (IQR 5-5) from novices. In the additional comments section of the survey, one expert commented that future iterations of the gel polyps should be made thicker so that trainees could practice using endoscopic clips. The gel polyp simulator cost $0.61 CAD/polyp including the cost of materials and 3D printed molds. Conclusions The gel polyp simulator appears to be a feasible modality for polypectomy training that is reproducible using accessible and low cost materials. Face and Content Validity Survey (questions and median survey score) Funding Agencies None

Comparative study to determine the proper sequence of simulation training, pelvic trainer versus virtual reality simulator: a pilot study

BackgroundIncreased surgical efficacy has led to a remarkable increase in the usage of minimally invasive surgical procedures since their inception. The use of simulation in surgical teaching has grown significantly during the past 10 years. Several laparoscopic simulators have been built. Virtual reality (VR) simulators and box trainers (BTs), often known as pelvic trainers, are the two primary training modalities used in hospitals and clinical training institutes for the development and acquisition of laparoscopic skills. Our study aimed to evaluate the proper sequence of pelvic trainers and VR simulator training to improve laparoscopic gynecological skills.MethodologyWe carried out this pilot study at the Virtual Endoscopic Simulation and Skills Acquisition Laboratory at the Obstetrics and Gynecology Department in the Kasr Al Ainy Hospital, Faculty of Medicine, Cairo University, Egypt, from February to August 2022. All residents with minimal or without laparoscopic experience (twenty residents) were divided into two groups and classified as (group A versus group B). Group A’s training began with a pelvic trainer, which was tested using a checklist. Later, the group trained on a virtual reality simulator, which tested them using an electronic autoassessment. After training on a virtual reality simulator and passing an electronic autoassessment test, group B moved on to pelvic trainers and had a checklist-based assessment.ResultsWe compared pelvic trainer tasks between the training groups, and detected no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.646, 0.341, 0.179, and 0.939 respectively); when we compared VR simulator tasks between the training groups, there were no significant differences in camera navigation, cutting pattern, peg transfer, or running stitches (P values 0.79, 0.3, 0.33, and 0.06, respectively).ConclusionThere was no difference in training, between residents who started on a pelvic trainer or the VR simulator; therefore, both could be used in laparoscopic training with no preferred order.Trial registrationThe trial was registered at clinicaltrials.gov with the name “Pelvic trainer vs VRS” and the identifier “NCT05255614.” The registration date was January 19, 2022, and the trial was prospectively registered. URL: https://register.clinicaltrials.gov/prs/app/action/ViewOrUnrelease?uid=U0004GED&ts=22&sid=S000BR5D&cx=t6mc14

Does Virtual Video Endoscopy simulation training aid postgraduate endoscopy trainee learning of pathology in the era of COVID-19?- A single centre experience in a Dublin Teaching Hospital

COVID-19 has had a significant impact on post-graduate gastrointestinal endoscopy education in Ireland. The signature pedagogy of endoscopy education is the hands-on apprenticeship model however this was impeded during the restrictions imposed by the pandemic. To progress endoscopy learning at a time when exposure was reduced, we, as consultant trainers, focused on teaching pathology recognition, a known deficit in the current endoscopy curriculum. A series of five virtual endoscopy simulation sessions consisting of endoscopic videos and pictures demonstrating upper gastrointestinal pathology were taught to six endoscopy trainee specialist registrars in a single Dublin teaching hospital. Pathology quizzes were administered to trainees pre and post undertaking the sessions to measure learning. Semi-structured interviews were used to assess the utility of the sessions and a qualitative analysis of responses was undertaken. Amongst the six trainees, virtual video endoscopy simulation training led to a statistically significant increase in endoscopy trainees’ pathology recognition scores in the post-intervention quiz. All trainees found the virtual video simulation sessions to be useful and relevant to their stage of training, with demonstration of active learning after the teaching sessions. However, the personal and professional effect of the pandemic on trainees was profound, with senior trainees being disproportionally affected. Trainees also identified that the current apprenticeship model for endoscopy learning is no longer fit for purpose. Given the effect of the pandemic on trainee learning it is important that we take a systematic approach to analyse teaching tools that were used during the pandemic to ensure that they are helping trainees reach their learning goals.

Training in Pediatric Gastrointestinal Endoscopy during Surgery Residency: Can Training Programs Currently Educate Proficient Pediatric Endoscopists? A Nationwide Assessment

Background: Technological advances in pediatric gastrointestinal (GI) endoscopy require highly specialized physicians. Therefore, proper training is fundamental. The aim of this study was to assess the level of competence of pediatric surgery residents to determine areas that should be addressed to design better training programs focused on pediatric GI endoscopy. Methods: An observational study was performed on all Italian pediatric surgery trainees that concluded the training program by the end of 2021, who were asked to answer a questionnaire about the quality of the GI endoscopy education received during their 5 years of residency. Results: 12 out 14 (86%) pediatric surgery trainees answered the questionnaire. A total of 50% (6/12) of the trainees declared they were interested in pediatric GI endoscopy, and 42% (5/12) said that they would be interested in dedicating themselves to this discipline in the future. Only 33% (4/12) of them were in a center equipped with endoscopy simulators. Among them, 17% (2/12) never took part in GI endoscopic procedures while working in centers in which GI endoscopy is performed exclusively by pediatric gastroenterologists, 25% (3/12) had never performed GI endoscopic procedures as a first operator and 17% (2/12) not even as assistant. Overall, 50% (6/12) were not satisfied with the level of education received and only 17% (2/12) declared that they felt confident enough to perform routine endoscopies alone. Conclusions: Our study highlights great inhomogeneity between different schools and some important failings. Better programs should be designed to educate proficient pediatric GI endoscopists.

Just five more minutes, mom: why video games could make you a better endoscopist.

Gaming is a growing industry, having met an exponential growth amid the pandemic context. Video games improve the allocation and speed of attention and provide better spatial orientation in visual processing. These same qualities are sought after in GI endoscopists. This study aimed to investigate whether individuals with a gaming history have superior fine motor and visual skills on a virtual reality (VR) endoscopy simulator and if gaming consoles could be added as a proficiency tool in acquiring endoscopic skills. Firstly, subjects' baseline psychomotor skills and hand-eye coordination were tested using a VR simulator. Secondly, subjects were assigned to either group C and asked to refrain from any gaming for 14days, or group T, who were asked to play on a console for 14days. All subjects were then retested. 81 students were included in the study. Baseline VR simulator testing showed better scores in those with a higher number of previous gaming hours (0h-1598, 0 to 30h-1970, 30 to 50h-2150, 50 to 100h-2395, > 100h-2519; p < 0.05), with males outperforming females (p < 0.01). After spending an average of 19h gaming, all parameters showed noteworthy improvement for those in group T (p < 0.01). No improvement was seen in group C. Subjects who engage in console gaming have superior psychomotor skills and perform better on VR simulators. Approximately 20h of console gaming can improve one's simulator skills. With consoles being accessible, entertaining, and cheap, they could be used as an additional training platform for GI endoscopy residents.

Simulated Reality: How Endoscopic Simulators Improve GI Fellow Procedural Training?

Simulated Reality: How Endoscopic Simulators Improve GI Fellow Procedural Training?

WEO Newsletter.

WEO Newsletter.

Review] The Use of Simulation in Endoscopic Retrograde Cholangiopancreatography training: A Literature Review

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopy procedure that has become the gold standard minimally invasive method of diagnosing and treating a vast variety of hepatopancreatobiliary diseases. It is associated with a significantly higher rate and wider range of adverse events compared with standard Upper GI endoscopy, with fewer of these procedures being performed in most centres and with procedure specific equipment and skills that most novice endoscopists will not be familiar with. These issues make training in ERCP challenging. AIMS: This literature review aims to look at the existing information available in the literature on the use of endoscopy simulators in ERCP training to see whether simulation training has a role in ERCP training, the main benefits and drawbacks of endoscopic simulation training, and how simulation training can be integrated into the learning process for achieving competence in ERCP. METHOD: Study searches were conducted in the MEDLINE, EMBASE, CENTRAL/Cochrane Library databases, Web of Science, Google Scholar, LILACS and FINDit. Studies assessing simulation training against traditional training or against other methods of simulation were identified for inclusion in this literature review. Results: Eight studies met the criteria for inclusion in this literature review with five of these being randomised control trials, where the primary outcome was biliary cannulation rates in simulation training against a control group. CONCLUSION: Simulation training has the potential to make trainees more knowledgeable about the basics of ERCP and help develop the technical skills required to perform ERCP competently, as shown by all four RCTs demonstrating that trainees in the simulation group had a statistically higher rate of achieving biliary cannulation against control groups. Endoscopic simulation training should be embedded in ERCP training programmes to act as an important part of the initial development of skills in a safe environment, where trainees can achieve a satisfactory level of proficiency before performing procedures on patients to limit the risk of adverse events and complications. Further trials are required to assess EMS and ECS against traditional methods of learning.

Face validity of a virtual reality simulation platform to improve competency in endoscopy: a prospective observational cohort study.

Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1–5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence ( P = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3–5), P < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5–5], P = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1–3], P < 0.001, P = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.

Evidence-Based Cognitive Endoscopy Simulators: Do They Exist? A Systematic Search and Evaluation of Existing Platforms.

BackgroundThe development of guidelines by gastroenterology societies increasingly stresses evidence-based endoscopic practice.AimsWe performed a systematic assessment to determine whether endoscopic video teaching platforms incorporate evidence-based educational strategies and methods in order to disseminate guideline-based endoscopic management strategies.MethodsPlatforms with a video component were systematically identified using the Google search engine, Apple and Android application stores, and searching four major gastroenterology society websites and three known platforms, to identify all relevant platforms. Two video samples from each teaching platform were reviewed independently by two authors and assessed for use of a priori defined principles of evidence-based medicine, as determined by consensus agreement and for the use of simulation.ResultsFourteen platforms were included in the final analysis, and two videos from each were analyzed. One of the 14 platforms used simulation and incorporated evidence-based medicine principles consistently. Nine of the 14 platforms were not transparent in regard to citation. None of the platforms consistently cited the certainty of evidence or explained how evidence was selected.ConclusionsEducation of guideline-based endoscopic management strategies using principles of evidence-based medicine is under-utilized in endoscopic videos. In addition, the use of cognitive simulation is absent in this arena. There is a paucity of evidence-based cognitive endoscopy simulators designed for fellows that incorporate systematic evaluation, and efforts should be made to create this platform.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10620-022-07558-w.

Portable Endoscopic Simulator for Urologic Training: A Face/Content and Construct Validity Study.

Mastering a surgical skill requires experience and repetition, yet opportunities for surgical trainees to gain real experience are variable and limited by case load. Surgical simulators have emerged in an attempt to overcome these limitations. However, the few currently available skills simulators for flexible endoscopy are costly, have limited accessibility and versatility, lack portability, and require dedicated time for practice. The use of a portable skills simulator to teach flexible endoscopy may provide a feasible alternative. This study introduces a novel, low-cost, portable, endoscopic simulation system for training basic endoscopic skills. Using custom software, the simulator presents a virtual environment featuring 3D models of anatomy, endoscopes, and endoscopic tools. The virtual endoscope and its tools are directly controlled in the simulation by motion input from a custom-manufactured portable endoscopic controller that communicates data via a Bluetooth interface. This two-part study presents proof of concept and initial pilot data examining the face/content validity and preliminary construct validity of the portable endoscopic simulator. In part 1, experts (n = 2) and novices (n = 6) provided ratings of fidelity and utility as a training tool. In part 2, experts (n = 4) and novices (n = 4) completed 10 simulated sequential basic endoscopic tasks, and time to completion was assessed. Findings indicate that the simulator has good utility as a training tool, but some features require modification to be more realistic. Furthermore, both novices and experts improved on the task with repeated measurements (p < 0.001), but there were no significant differences between experts and novices in time to completion. Although more robust validation is required, this simulator appears promising as a feasible and cost-effective tool for providing simulation training on basic endoscopic skills.

Simulation training in endoscopic skull base surgery: A scoping review.

ObjectiveProficiency in endoscopic endonasal skull base surgery requires both substantial baseline training and progressive lifelong learning. Endoscopic simulation models continue to evolve in an effort to optimize trainee education and preoperative preparation and improve surgical outcomes. The current scoping review systematically reviews all available literature and synthesizes the current paradigms of simulation models for endoscopic skull base surgery training and skill enhancement.MethodsIn accordance with Preferred Reporting Items for Systemic Review and Meta‐Analyses guidelines, we systematically searched PubMed, Embase, CINAHL, and Cochrane databases. Studies were categorized according to the type of simulation models investigated.ResultsWe identified 238 unique references, with 55 studies ultimately meeting inclusion criteria. Of these, 19 studies described cadaveric dissection models, 17 discussed three‐dimensional (3D) printed models, 14 examined virtual surgical planning and augmented reality‐based models, and five 5 articles described task trainers.ConclusionsThere are a wide variety of simulation models for endoscopic skull base surgery, including high‐fidelity cadaveric, virtual reality, and 3D‐printed models. These models are an asset for trainee development and preoperative surgical preparation.