Despite advances in minimally invasive surgery, pain after appendectomy remains common. The transversus abdominis plane (TAP) block has been proposed as an alternative to port site local anesthetic. We aimed to synthesize randomized controlled trials (RCTs) comparing the efficacy and safety of 1) TAP block versus port site local anesthetic, and 2) ultrasound to laparoscope-guided TAP blocks following adult minimally invasive appendectomy. Relevant databases were searched for RCTs until December 2024. Two authors independently identified trials, extracted data, assessed risk of bias (ROB 2), and evaluated evidence certainty (GRADE). Four RCTs (233 patients) were included comparing TAP block to port site anesthetic in laparoscopic appendectomy. No studies examined robotic surgery, and none compared ultrasound to laparoscope-guided technique. TAP block led to decreased total opioid consumption (mean difference: − 4.50 mg morphine equivalents, 95

Guidelines recommend routine colonoscopy 1 year after curative colorectal cancer resection, despite limited evidence supporting its diagnostic yield. This study evaluated the real-world outcomes of 1-year surveillance colonoscopy following colorectal cancer resection. This is a retrospective observational study using pathology, clinic, and endoscopy data patients who underwent segmental oncologic resection for primary colon or rectal. Adenocarcinoma between January 2007 and June 2020 in Winnipeg, Manitoba. Patients were excluded if they had a total proctocolectomy, if no follow-up colonoscopy data were available, or if the date of the first surveillance scope was < 6 months or > 24 months from surgery. Colonoscopy findings were categorized as adenocarcinoma, advanced adenoma, simple adenoma or normal. A total of 454 patients met the inclusion criteria. The 1-year surveillance colonoscopy detected 2 (0.44

BACKGROUND:Repeat preoperative endoscopy is a common practice in colorectal cancer care; however, it is often viewed as inefficient, potentially avoidable, and incurring costs or delays. While provider and system perspectives have been examined, this study aimed to explore patients' experiences and perspectives regarding repeat preoperative colonoscopy to understand its perceived value within the cancer care pathway. METHODS:We conducted a qualitative study using semi-structured telephone interviews at a tertiary academic center. Twenty adult patients treated for colorectal cancer (2019-2025) who underwent repeat preoperative endoscopy were recruited to explore their perspectives. Transcripts were analyzed using inductive thematic analysis rooted in grounded theory. RESULTS:Despite the procedural burden, 80% of participants reported a positive overall experience, and 75% perceived a clear benefit from the repeat procedure. Three major themes emerged: (1) Trust and Verification, where patients valued relationship-building with the surgeon and the reassuring "second look" for surgical accuracy and planning; (2) Part of the Patient Journey, where the procedure was accepted and normalized as a manageable step despite the burden of bowel preparation; and (3) Communication and Coordination, where participants highlighted gaps in care plan comprehension and logistical navigation. CONCLUSIONS:Patients largely accepted repeat preoperative endoscopy as a justified and reassuring component of their care, fostering trust in the surgical plan, rather than perceiving it as a redundant or burdensome delay in their treatment. This counter-narrative to traditional provider-focused metrics suggests that while system efficiency remains important, repeat endoscopy provides a unique opportunity for enhancing the patient-provider therapeutic alliance.

Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor (VEGF) and inhibits angiogenesis in solid organ tumors. Its use in conjunction with fluorouracil-based chemotherapy for the management of metastatic colorectal cancer (CRC) has proven effective. There is a known, rare chance of gastrointestinal perforation associated with its use. We present a case of a man in his 70s on bevacizumab for metastatic rectal cancer, who presented to the hospital with small bowel evisceration through perforation at his colostomy site, ostensibly caused by a chronic parastomal hernia and bevacizumab chemotherapy. He required emergent surgery. After undergoing resection of an ischemic segment of small bowel, the perforated segment of his colon, and primary repair of his parastomal hernia, and fashioning of a new end colostomy, he recovered well and left the hospital two weeks later. After discharge from the hospital, he was able to continue with palliative chemotherapy.

Background: Workplace injuries are increasingly recognized as a substantial detriment to surgeon longevity and productivity. Limited data exist on pain and injury prevalence among rectal surgeons. In this epidemiologic study, we aimed to estimate the prevalence of physical discomfort among rectal surgeons in Canada and identify potential causative factors.Methods: We distributed a web-based survey to rectal surgeons in Canada between January and October 2022. We included colorectal surgeons, surgical oncologists, and colorectal surgery fellows associated with Canadian university hospitals.Results: Of the 72 surgeons we contacted, 48 participated (67%). More than 98% reported experiencing physical discomfort or pain during rectal surgery, with more than half experiencing these symptoms weekly. Neck, shoulders, and back were common pain or discomfort locations, whether surgeons were performing open surgery or using a minimally invasive platform. Laparoscopic equipment, headlight, and pelvic retractor use were the most common causes. Many surgeons (54%) sought professional treatment and employed risk-reducing strategies such as intraoperative stretching (48%) or after-work strength training exercises (52%). Satisfaction with pain levels during surgery was uncommon (40%). Multivariable analysis showed advancing age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.02-1.23) and larger percentage of minimally invasive surgeries (OR 2.61, 95% CI 1.28-5.33) as significant predictors of increased discomfort. After-work exercise participation was protective in both open (OR 0.14, 95% CI 0.02-0.95) and minimally invasive surgeries (OR 0.60, 95% CI 0.37-0.98).Conclusion: Rectal surgeons in Canada commonly experience pain and injury during surgery, underscoring the need for improved safety measures to preserve their physical health and career longevity. Contexte: Les blessures subies en milieu de travail sont de plus en plus reconnues comme un important frein & agrave; la long & eacute;vit & eacute; professionnelle et & agrave; la productivit & eacute; des chirurgiennes et chirurgiens. On dispose de peu de donn & eacute;es sur la pr & eacute;valence de la douleur et des blessures subies dans le contexte de la chirurgie rectale. Dans la pr & eacute;sente & eacute;tude & eacute;pid & eacute;miologique, nous avons voulu mesurer la pr & eacute;valence des douleurs physiques chez les chirurgiennes et chirurgiens qui pratiquent des interventions rectales au Canada, et d & eacute;gager les possibles facteurs en cause.M & eacute;thodes: Nous avons distribu & eacute; un questionnaire en ligne aux m & eacute;decins canadiens concern & eacute;s entre janvier et octobre 2022. Nous avons inclus les sp & eacute;cialistes de la chirurgie colorectale, les chirurgiens-oncologues et les stagiaires en chirurgie colorectale affili & eacute;s & agrave; des h & ocirc;pitaux universitaires canadiens.R & eacute;sultats: Parmi les 72 chirurgiennes et chirurgiens que nous avons contact & eacute;s, 48 y ont r & eacute;pondu (667 %). Plus de 98 % ont fait & eacute;tat de malaises physiques ou de douleur lors des chirurgies rectales, et plus de la moiti & eacute; sur une base hebdomadaire. Les douleurs ou malaises au cou, aux & eacute;paules et au dos & eacute;taient fr & eacute;quentes, qu'il s'agisse de chirurgies ouvertes ou d'interventions effectu & eacute;es au moyen de plateformes minimalement effractives. L'utilisation d'appareils laparoscopiques, de lampes frontales ou d'& eacute;carteurs pelviens & eacute;tait le plus souvent en cause. Plusieurs chirurgiennes et chirurgiens (54 %) ont requis des traitements professionnels et ont appliqu & eacute; des strat & eacute;gies de r & eacute;duction des risques, comme des & eacute;tirements durant les interventions (48 %), ou des exercices de musculation apr & egrave;s le travail (52 %). La satisfaction & agrave; l'endroit des niveaux de douleur durant les interventions & eacute;tait faible (40 %). Une analyse multivari & eacute;e a montr & eacute; que l'avanc & eacute;e en & acirc;ge (rapport des cotes [RC] 1,12, intervalle de confiance [IC] de 95 % 1,02-1,23) et un pourcentage plus & eacute;lev & eacute; d'interventions minimalement effractives (RC 2,61, IC de 95 % 1,28-5,33) & eacute;taient d'importants pr & eacute;dicteurs d'un inconfort plus marqu & eacute;. La pratique d'exercices apr & egrave;s le travail a exerc & eacute; un r & ocirc;le protecteur, tant lors des chirurgies ouvertes (RC 0,14, IC de 95 % 0,02-0,95) que des interventions minimalement effractives (RC 0,60, IC de 95 % 0,37-0,98).Conclusion: La douleur et les blessures sont fr & eacute;quentes chez les sp & eacute;cialistes en chirurgie rectale au Canada, ce qui rappelle la n & eacute;cessit & eacute; d'appliquer des mesures de pr & eacute;vention pour pr & eacute;server leur int & eacute;grit & eacute; physique et prolonger leur carri & egrave;re.

RATIONALE:Colonoscopy is a common diagnostic and screening test used in the management of many gastrointestinal diseases. Colonoscopy can be uncomfortable, so there is an impetus to optimize sedative medications for test performance and patient comfort. Traditionally, a combination of opioids and benzodiazepines have been used to increase comfort during colonoscopy. Propofol is a potential alternative sedative agent for use during colonoscopy, though it often leads to deeper sedation than with traditional sedatives used for colonoscopy. Many jurisdictions require anesthesiologists to administer propofol. OBJECTIVES:The primary aim of this review was to assess the effects of propofol sedation for colonoscopy in adult patients compared to opioids or benzodiazepines, or both. Our secondary aim was to assess the effects of propofol sedation for adult patients undergoing colonoscopy administered by anesthesiologists compared to that administered by non-anesthesiologists. SEARCH METHODS:In the previous iteration of this review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Cancerlit, CINAHL, LILACS, Biological Abstracts, and Web of Science databases for entries up to December 2010. In the current update, we searched CENTRAL (Ovid), Ovid MEDLINE, Ovid Embase, CINAHL (EBSCO), LILACS (VHL), Web of Science Core Collection (Clarivate), WHO ICTRP, and ClinicalTrials.gov from December 2010 until February 2024. We applied no language restrictions. ELIGIBILITY CRITERIA:Randomized controlled trials (RCTs) comparing the use of propofol and traditional sedatives or administration of propofol by anesthesiologists versus non-anesthesiologists for sedation during colonoscopy. We defined traditional sedatives to include only sedative regimens consisting of opioids or benzodiazepines, or both. All other drugs were excluded. OUTCOMES:Critical outcomes included cecal intubation rate (colonoscopy completion rate), post-procedure recovery time, time to discharge from the endoscopy unit, patient satisfaction, and pain control. Important outcomes included safety outcomes (hypoxia, apnea, respiratory events requiring intervention, hypotension, arrhythmias, colonic perforations, and death), hospital admissions (for outpatient procedures), level of sedation, procedure duration, sedation time (new in 2024 update), and adenoma detection rate (new in 2024 update). RISK OF BIAS:We assessed risk of bias using Cochrane's RoB 2 tool for all critical outcomes. SYNTHESIS METHODS:We synthesized the results for each outcome using meta-analysis where possible. We used random-effects models for the meta-analysis. We calculated odds ratios (ORs) for dichotomous data and mean differences (MDs) or standardized mean differences (SMD) for continuous data, each with 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence. INCLUDED STUDIES:We included 33 unique studies (12 carried forward from the previous iteration of this review, 21 uniquely identified in this update) with a total of 12,485 participants. Thirty studies (12,036 participants) examined propofol compared to traditional sedatives during colonoscopy, five of which were published as abstracts only. Three studies (449 participants) compared anesthesiologist- to non-anesthesiologist-directed propofol sedation during colonoscopy, all of which were in full-text form. SYNTHESIS OF RESULTS:Propofol sedation may improve recovery time (MD -3.09 minutes, 95% CI -4.88 to -1.30; 17 RCTs, 2661 participants; low-certainty evidence) and patient satisfaction score (MD 0.42, 95% CI 0.19 to 0.65; 14 RCTs, 1856 participants; low-certainty evidence) compared to traditional sedative agents. The effect is uncertain for discharge time (MD -3.65 minutes, 95% CI -6.93 to -0.37; 17 RCTs, 3131 participants; very low-certainty evidence) and pain score (MD -0.62, 95% CI -1.28 to 0.05; 9 RCTs, 1084 participants; very low-certainty evidence). Propofol likely results in little to no difference in cecal intubation rate (OR 0.99, 95% CI 0.36 to 2.72; 6 RCTs, 1856 participants; moderate-certainty evidence), and may result in little to no difference in respiratory events requiring intervention (OR 0.65, 95% CI 0.21 to 1.97; 10 RCTs, 1614 participants; low-certainty evidence) and colonic perforations (OR 2.87, 95% CI 0.60 to 13.83; 3 RCTs, 7978 participants; low-certainty evidence). The certainty of the evidence was limited by unexplained statistical heterogeneity, wide CIs, and some concerns regarding risk of bias, due primarily to lack of trial information. Non-anesthesiologist-directed propofol sedation resulted in little to no difference in cecal intubation rate (OR 0.73, 95% CI 0.23 to 2.28; 3 RCTs, 433 participants; high-certainty evidence) and patient satisfaction score (MD -0.02, 95% CI -0.13 to 0.09; 1 RCT, 277 participants; high-certainty evidence) compared to anesthesiologist-directed propofol sedation during colonoscopy, but may slightly reduce recovery time (MD -9 minutes, 95% CI -16.30 to -1.70; 1 RCT, 277 participants; low-certainty evidence). There is likely little to no difference between groups in pain scores (MD -0.02, 95% CI -0.26 to 0.22; 1 RCT, 277 participants; moderate-certainty evidence), and there may be little to no difference in respiratory events requiring intervention (OR 0.50, 95% CI 0.02 to 13.12; 2 RCTs, 327 participants; low-certainty evidence). Colonic perforations, apnea events, hospital admissions, and death were not reported in any study. AUTHORS' CONCLUSIONS:Propofol sedation for colonoscopy may improve recovery time and patient satisfaction scores, without affecting cecal intubation, perforations, or respiratory events requiring intervention, compared to traditional sedative regimens. Effects on time to discharge and pain score are uncertain. Evidence for this comparison was generally of low certainty, indicating the need for better-quality studies and more standardized outcome reporting. Non-anesthesiologist- compared to anesthesiologist-directed propofol sedation for colonoscopy results in little to no difference in cecal intubation rate and patient satisfaction, but may slightly reduce recovery times. There is likely little to no difference between groups in pain scores, and there may be little to no difference in respiratory events requiring intervention. The certainty of the evidence was high for many outcomes in this second comparison; however, there were very few studies, and many important safety outcomes were not examined. FUNDING:This review was funded by operating grants from the George and Fay Yee Centre for Healthcare Innovation, the Department of Surgery, Section of General Surgery, and the Clinician Investigator Program, all at the University of Manitoba, Max Rady College of Medicine, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada. REGISTRATION:Protocol and previous versions available via https://doi.org/10.1002/14651858.CD006268, and https://doi.org/10.1002/14651858.CD006268.pub2.

Introduction Lack of documented tattooing of colorectal neoplasms at index colonoscopy results in high repeat preoperative colonoscopy rates. We developed national consensus recommendations for endoscopic localization and piloted an electronic synoptic reporting template. We report on the implementation and perceptions of using synoptic reporting to enhance colorectal lesion marking in a central Canadian healthcare system. Methods We implemented the template within our endoscopy reporting system and ran an infographic education campaign. We then conducted a follow-up email -based interview with all regional endoscopists. Thematic analysis and a mixed -methods triangulation approach were employed to synthesize qualitative and quantitative data. Results The interview was completed by 28/52 endoscopists (54%). Most (60.7%; n = 17) completed >100 colonoscopies and 71.4% (n = 20) identified six to 20 neoplasms requiring tattooing since introduction. A total of 50% (n = 14) used the template. Those not using it were unaware of it (42.9%; n = 12), or preferred using narrative text (17.9%; n = 5). Users reported modest mean functionality scores (intuitiveness: 3.56/5; efficiency: 3.7/5) and high impact scores (credible: 4.22/5; informative: 4.21/5). However, the perception of the synoptic template's ability to reduce the repeat preoperative colonoscopy rate was more circumspect (3.76/5). Conclusions Endoscopists believed the synoptic template was a functional, impactful tool that would improve communication and help to decrease the repeat preoperative colonoscopy rate. However, synoptic template uptake was limited by provider awareness, therefore more educational efforts are needed to increase uptake.

Introduction Local recurrence (LR) rates after transanal endoscopic microsurgery (TEM) are unclear, and the utility of early postoperative surveillance for low-risk lesions is unknown. This study aimed to define LR after TEM for benign polyps and invasive adenocarcinoma, describe risk factors for LR, and evaluate the utility of early surveillance endoscopy. Methods This retrospective cohort study was conducted at two hospitals in Winnipeg, Manitoba, Canada. Adult patients who underwent TEM between 2009 and 2020 were evaluated for inclusion. The primary outcome was the rate of LR on surveillance endoscopy. Other outcomes included risk factors for LR and diagnostic yield of surveillance endoscopy. Results Among 357 patients who underwent TEM for benign polyps, LR was 10.5% (95% confidence interval (CI) 5.8-15.2) at three years. Positive margin was correlated with LR on multivariate analysis (hazard ratio (HR) 8.01, 95% CI 2.78-23.08). TEM defect closure was associated with lower LR on multivariate analysis (HR 0.19, 95% CI 0.06-0.59). Among 124 patients who underwent TEM for rectal adenocarcinoma, LR was 15.0% (95% CI 6.0-24.0) at three years. The first surveillance endoscopy had a 1.4% yield for low-risk patients (benign lesion, negative margins, and closed TEM defect) and 6.9% for all others. Conclusions LR at three years after TEM was 10.5% for benign polyps and 15.0% for adenocarcinomas. Early surveillance endoscopy can be considered low yield in some patients after TEM, which can be informative for shared decision-making regarding whether to proceed with early endoscopy in a low-risk subgroup of patients.

National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.

Abstract Background Colonoscopy is the gold standard for diagnosing colorectal neoplasms. However, colonoscopy is often repeated preoperatively due to non-standard documentation and inconsistent practices by index endoscopists. Repeat endoscopies result in treatment delays and can increase risks of complications. National consensus recommendations were recently developed for optimal endoscopic colorectal lesion localization. We aimed to assess baseline colonoscopy practice differences from the new recommendations with a focus on geographical variability in report quality between urban and rural referral sites. Methods We performed a retrospective review of patients who underwent elective surgery for colorectal neoplasms at a single institution in Winnipeg between 2007–2020. We compared endoscopy report quality to the national recommendations with charts stratified by endoscopy location. Our primary outcomes were overall report documentation completeness and use of recommended practices. Results One hundred ninety-four patients were included (97 rural, 97 urban). The mean overall compliance with the recommendations for urban endoscopies was marginally better compared to rural endoscopies (50% vs. 48%, p = 0.04). Sixty-eight percent of the reports complied with tattoo indications (72% urban; 63% rural, p = 0.16). On average, reports included 29% of recommended tattoo information (30% urban; 28% rural, p = 0.25) and demonstrated 74% appropriate tattoo technique (70% urban; 81% rural, p = 0.10). Twenty-one percent of reports included photographs of lesions in accordance with the national recommendations (28% urban; 13% rural, p = 0.01). Conclusions Endoscopists frequently omit recommended practices for optimal colorectal lesion localization. Rural reports miss more recommended information compared to urban reports. Future research is needed to facilitate province-wide high-quality endoscopy reporting for patients regardless of endoscopy location.

Background: Preoperative treatment with oral neomycin combined with erythromycin or metronidazole is recommended to decrease the risk of surgical site infections (SSIs) in elective colorectal surgery. However, oral neomycin is not commercially available in Canada, and therefore it is not routinely used. Fluoroquinolones are widely available and have excellent activity against aerobic Gram-negative bacteria. The aim of this systematic review was to identify, critically appraise and -summarize the evidence on the efficacy and safety of preoperative use of oral fluoroquinolone antibiotics for the prevention of SSIs in adult patients undergoing elective colorectal resection. Methods: Following Cochrane guidelines, we included English-language randomized controlled trials (RCTs) comparing oral fluoroquinolones plus routine preoperative intravenous antibiotics against intravenous antibiotics alone from MEDLINE (Ovid), Embase ( Ovid), the Cochrane Central Register of Controlled Trials----(Ovid) and ClinicalTrials.gov. Results: We included 3 RCTs (1136 patients). Risk of bias was uncertain in 2 trials and high in 1 trial. Preoperative oral fluoroquinolones led to significantly decreased total SSIs (risk ratio [RR] 0.43, 95% confidence interval [CI] 0.32-0.57, I2 = 0%), superficial incisional (RR 0.38, 95% CI 0.22-0.68, I2 = 32%), deep incisional (RR 0.19, 95% CI 0.06-0.65, I2 = 0%) and organ/ space SSIs (RR 0.34, 95% CI 0.12-0.90, I2 = 33%). There was also a significant reduction in anastomotic leaks (RR 0.22, 95% CI 0.06-0.87, I2 = 0%). No antibiotic-related adverse events were reported. Conclusion: This review suggests that preoperative oral fluoroquinolones with intravenous antibiotics are superior to intravenous antibiotics alone for preventing SSIs after colorectal surgery. If neomycin is unavailable, oral fluoroquinolones should be considered as a reasonable alternative. Future trials are required to further compare the relative efficacy of oral antibiotic regimens.

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Background Prophylactic cholecystectomy following endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP-S) remains the gold standard management of choledocholithiasis. Some clinicians propose ERCP-S alone as the definitive management in the elderly, given perioperative complication risks. This retrospective cohort study aimed to assess the long-term efficacy and safety of non-operative management of choledocholithiasis in adults aged ≥70. Methodology A total of 252 patients aged ≥70 underwent ERCP from 2004 to 2014 at a single institution. The rates of cholecystectomy, ERCP, complications, and mortality were gathered. Data were linked to a provincial health database to capture follow-up visits to alternate hospitals. Predictors of operation, recurrence, and mortality were analyzed using multivariable regression. Results Following ERCP, of the 252 patients, 33 (13.1%) underwent prophylactic cholecystectomy within three months, while 219 (86.9%) were initially managed conservatively. Of the 219 patients, 147 (67.1%) experienced no further choledocholithiasis after conservative management, while 23 (10.5%) patients underwent cholecystectomy. The mean follow-up was 2.9 years. Delayed operative patients were younger (mean age: 77.56 vs. 82.90; p < 0.001) and had lower Charlson Comorbidity Index (CCI) (1.04 vs. 1.84; p = 0.030). When adjusted for age, CCI score, and sex, cholecystectomy was associated with increased survival, with an odds ratio of 0.48 (95% confidence interval = 0.26-0.90; p = 0.021). Perioperative complications occurred in 7/56 (12.5%) patients. Conclusions Recurrent choledocholithiasis is common in elderly patients. Despite recurrent symptoms, these patients are unlikely to undergo cholecystectomy. Surgeons operate on patients with greater life expectancy and fewer comorbidities with high success despite advanced patient age. Future prospective studies should examine objective criteria for prophylactic cholecystectomy in this population, given purported safety and benefits.

Background Procedural simulation enhances early endoscopy training. Multiple commercial simulators are available; however, their application is limited by cost and poor user compliance. First-person "shooter" (FPS) video games are popular. In this study, we aimed to show that a novel in-house designed colonoscope controller used to play an FPS video game shares similar constructs with real-life endoscopy. Methodology Participants completed the first three levels on an FPS video game, Portal (Valve Corporation, Bellevue, WA), first using a conventional controller and then the modified endoscope controller. A total of 12 expert endoscopists and 12 surgical residents with minimal endoscopy experience were evaluated based on completion time, button presses, and hand motion analyses. Results Experts outperformed novices for completion time (expert: 944 seconds; novice: 1,515 seconds; p = 0.006) and hand movements (expert: 1,263.1; novice: 2,052.6; p = 0.004) in using the novel colonoscope controller. There was no difference in button presses or total path length traveled. Furthermore, performance did not differ using conventional game controls. Conclusions Experts outperformed novices using the endoscope but not the conventional controller with respect to the economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar paradigms with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.