# Feasibility, usability, and validity assessment of a novel plug-and-play virtual endoscopy simulator

## TL;DR

A new virtual endoscopy simulator was tested for its usefulness in training endoscopists at different skill levels.

## Contribution

This is the first validation of a plug-and-play virtual endoscopy simulator for endoscopy training.

## Key findings

- The simulator showed good face validity and usability with a score of 75 out of 100 on the System Usability Scale.
- Experienced endoscopists performed better than novices, indicating favorable construct validity.
- Most participants supported integrating the simulator into endoscopy training, especially for beginners.

## Abstract

A virtual endoscopy simulator with a 3D-printed endoscope handle (“Endonix®”) that can be used without dedicated equipment (“plug and play”) to train endoscope handling has yet not been tested. We prospectively evaluated the simulator’s validity, feasibility, and usability in novices, beginners, and experienced endoscopists.

Delegates at two congresses (DGVS and ENDOCLUBNORD, both 2024 in Germany) were invited. 310 complete datasets (146 DGVS, 164 ENDOCLUBNORD) were analyzed. Each participant performed two different simulation modules and completed a survey comprising questions on endoscopy experience, simulator evaluation, as well as the System Usability Scale (SUS) and the National Aeronautics and Space Administration Task Load Index (NASA-TLX).

The simulator demonstrated good face validity, but only merely sufficient content validity as 67.8% of all participants favored its implementation into endoscopy training. Construct validity was also favorable as experienced endoscopists completed both modules faster than novices or beginners (P < 0.001). In line, criterion validity was given as performance correlated with self-assessed experience. The SUS yielded 75 out of 100 points (corresponding to good usability) with no discernible difference between novices, beginners, and experienced endoscopists. The NASA-TLX, ranging from 0 to 600 points, reflecting level of exhaustion, exhibited a higher score in novices and beginners than experienced endoscopists (285 vs. 210 vs. 225 points, respectively, P < 0.001). Only 16.1% of participants had access to a simulator at their respective institutions, while 79.4% wished for the incorporation of simulators into endoscopy training.

The first validation of a novel virtual simulator demonstrated its feasibility and usability, with mostly sufficient validity. Many participants favored its implementation in endoscopy training, particularly for novice and beginner endoscopists, who were identified as the most suitable target learners.

Created in BioRender. Hamesch, K. (2025) https://BioRender.com/q0x2gxz

Created in BioRender. Hamesch, K. (2025) https://BioRender.com/q0x2gxz

The online version contains supplementary material available at 10.1007/s00464-025-12396-8.