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

This 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.