Ramifications of single-port laparoscopic surgery: measuring differences in task performance using simulation.

Authors

Nathan Conway MD, Baystate HealthFollow
John Romanelli MD, Baystate HealthFollow
Ron Bush, Baystate Health
Neal Seymour MD, Baystate HealthFollow

Author Department

Surgery

Document Type

Article, Peer-reviewed

Publication Date

2-2014

Abstract

INTRODUCTION:

Single-port laparoscopic surgery imposes unique psychomotor challenges. We used surgical simulation to define performance differences between surgeons with and without single-port clinical experience and examined whether a short course of training resulted in improved performance.

METHODS:

Study participants were assigned to 3 groups: resident group (RES), experienced laparoscopic surgeons with (SP) and without (LAP) prior single-port laparoscopic experience. Participants performed the Fundamentals of Laparoscopic Surgery precision cutting task on a ProMIS trainer through conventional ports or with articulating instruments via a SILS Port (Covidien, Inc). Two iterations of each method were performed. Then, 6 residents performed 10 successive single-port iterations to assess the effect of practice on task performance.

RESULTS:

The SP group had faster task times for both laparoscopic (P = .0486) and single-port (P = .0238) methods. The LAP group had longer path lengths for the single-port task than for the laparoscopic task (P = .03). The RES group was slower (P = .0019), with longer path length (P = .0010) but with greater smoothness (P = .0186) on the single-port task than the conventional laparoscopic task. Resident performance task time (P = .005) and smoothness (P = .045) improved with successive iterations.

DISCUSSION:

Our data show that surgeons with clinical single-port surgery experience perform a simulated single-port surgical task better than inexperienced single-port surgeons. Furthermore, this performance is comparable to that achieved with conventional laparoscopic techniques. Performance of residents declined dramatically when confronted with the challenges of the single-port task but improved with practice. These results suggest a role for lab-based single-port training.

Recommended Citation

Conway NE, Romanelli JR, Bush RW, Seymour NE. Ramifications of single-port laparoscopic surgery: measuring differences in task performance using simulation. Surg Innov. 2014 Feb;21(1):106-11.