Surgical skills assessment on a vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) simulation box compared to a conventional endoscopic simulation box; the SAVE trial

ObjectiveWith the growing adoption and implementation of vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES), structured hands-on simulation practice is essential for the training of gynecologists and residents. This study compares the performance of validated surgical tasks using a conventional multiport laparoscopy box and a single-port vNOTES box. Additionally, participants' experiences and task load for each training modality were evaluated.Design, setting and participantsThis multi-center, prospective comparative study included three groups: medical students and inexperienced gynecological residents (n = 15), gynecological residents (n = 15), and gynecologists (n = 15). Participants performed four validated laparoscopic skill tests on both the conventional laparoscopy box and the vNOTES box. For each task and box, total task time, number of errors, and total scores were recorded. Questionnaires regarding baseline characteristics, preferred box for hand-eye coordination, depth perception, and instrument handling, as well as task load (NASA Task Load Index scores) for both boxes were evaluated.ResultsA total of 45 participants were included, 35 females (77.8%) and 10 males (22.2%), with a mean age of 34.2 years (SD 11.1). Across all four tasks, the use of the vNOTES box was associated with less favorable scores in terms of task time, error rates, and total scores compared to the conventional laparoscopy box. In addition, the laparoscopy box was favored for depth perception (86.7%), hand-eye coordination (91.1%) and instrument usage (97.8%). The vNOTES box was associated with higher scores across all NASA Task Load Index domains, indicating it was more demanding overall.ConclusionThis study demonstrates that performing standardized surgical tasks using the vNOTES technique is significantly more challenging than with conventional laparoscopy, resulting in higher task load and inferior performance across all experience levels. These findings underline the need for tailored training, as existing laparoscopic skills do not directly translate to vNOTES proficiency. Future research should develop and validate vNOTES simulation exercises.