Feasibility of a plug-and-play virtual endoscopy simulator

Aims The implementation of high-quality training in endoscopy remains challenging as various simulators exist with varying usage across institutions and countries with an unknown impact on training. In this study, we evaluated a novel virtual endoscopy simulator for the first time. The 3D-printed simulator with an endoscope handle can be connected to a computer and used immediately without the need for dedicated endoscopy equipment (“plug-and-play”). The aim of this study was to evaluate the simulator’s feasibility and the adoption of simulators in current practice.

Methods We invited delegates at two conferences (Visceral Medicine 2024 by DGVS in Leipzig/Germany and EndoClub North 2024 in Hamburg/Germany) to evaluate the Endonix simulator. A total of 310 sufficient data sets (146 DGVS, 164 EndoClub) were analyzed from 332 participants. Each participant was offered the opportunity to perform two different training modules (line markings in a virtual environment and ESD markings in a virtual colon) with the same settings. Prior to and following simulator usage, every participant completed an anonymous survey comprising questions on endoscopy experience, evaluation of the simulator, and validated scores such as the System Usability Scale (SUS) and the NASA Task Load Index (NASA TLX). For comparison between groups, the Mann-Whitney U test was employed, given that the data did not follow a normal distribution.

Results In total, 303 and 292 participants completed the line and ESD modules, respectively. Beginners had a median age of 31 years (IQR 8), while non-beginners were 40 years old (IQR 17.5). A mere of 16.1% of participants had access to a simulator at their respective institution, while 21.0% of participants reported that their institution has a structured curriculum for endoscopy training. A majority of participants (79.4%) expressed support for the incorporation of simulators in general into endoscopy training. Moreover, 58.8% of respondents indicated a preference for mandatory simulator training before starting endscopy in patients. Comparing beginners to non-beginners in endoscopy, we revealed a consensus regarding the integration of the Endonix simulator in clinical practice. The majority of participants indicated that the tested simulator was more beneficial for beginners than for experienced endoscopists. Additionally, a greater proportion of beginners expressed support for the implementation of the tested simulator at their respective institutions. The SUS yielded a median of 75 out of 100 points (corresponding to good usability) with no discernible difference between beginners and non-beginners. The NASA TLX, corresponding to level of exhaustion, exhibited a higher median score in beginners than non-beginners (270, IQR 150 vs. 224, IQR 135, p=0.004).

Conclusions This first study evaluating the Endonix, found it to be a feasible virtual simulator with good usability resulting in a majority favouring its implementation in endoscopy training.

Publication History

Article published online:
27 March 2025