Development of a novel endoscopic suturing simulator: validation and impact on clinical learning curve (with video)

Background and Aims Endoscopic suturing is a complex skill with broad applications. This study aims to develop and validate a novel endoscopic suturing simulator and scoring system for the pursestring suture pattern. Methods This was a prospective study of an endoscopic suturing simulator, which consists of a circular opening representing a dilated gastrojejunal anastomosis of Roux-en-Y gastric bypass with 12 small target holes around its circumference. Pursestring suturing is performed in a counterclockwise fashion. Time allotted is 5 minutes. Each successful bite is awarded 10 points. Participants were divided into the novice, intermediate and experienced groups. Validity evidence based on content, validity evidence based on other variables and validity evidence based on consequences of testing were assessed. Results 17 subjects (3 novice, 7 intermediate and 7 experienced) participated in the study. Validity evidence based on content: The content validity index for realism, relevance and representativeness was 0.89, 1.00 and 1.00, respectively. Validity evidence based on other variables: The novice, intermediate and experienced groups scored 30.0±8.2, 57.1±28.1 and 131.2±51.7, respectively (p=0.001). Validity evidence based on consequences of testing: The simulator group required 5±5 transoral outlet reduction cases before being able to independently complete an entire pursestring, while the non-simulator group required 38±11 clinical cases (p<0.0001). Conclusion This novel endoscopic suturing simulator appears realistic, relevant and representative of the clinical suturing experience. Additionally, it appears effective at objectively assessing suturing skills and shortening the clinical learning curve.