Aims: In the rapidly advancing world of laparoendoscopic surgery, surgeons are faced with new devices all of which are aimed towards a single access. Various single-access devices are available on the market. Our study aimed to compare the performance of experienced laparoscopic surgeons on validated laparoscopic tasks using five devices within a simulation setting. Methods: Ten experienced consultant laparoscopic surgeons were recruited after completing a questionnaire and meeting the inclusion criteria of the study. Five different single-access devices were assessed. Each participant performed two validated laparoscopic simulation tasks: peg transfer and pattern cut. All surgeons completed both tasks on all five devices in a randomized order. The performance time and the number of errors and instrument clashes on each task were measured. Statistical analysis was carried out using one-way analysis of variance. Results: All participants were consultant laparoscopic surgeons with 4-20 years of experience with laparoscopy and fulfilled the selection criteria. One-way analysis of variance revealed no statistically significant differences in performance time (peg transfer, P = 0.306; pattern cut, P = 0.819), number of errors (peg transfer, P = 0.182; pattern cut, P = 0.478) or instrument clashes (peg transfer, P = 0.446; pattern cut, P = 0.061) between the different singe-access devices. Conclusion: In our study, the laparoscopy experts performed equally well on all five single-access devices within a validated simulation environment. More and larger studies in simulated as well as clinical environments are required to provide further evidence.
Background: Laparoscopic surgery is based on 2D imaging, with limited depth perception. The aim of this study was to analyse the impact of 3D training on the performance of surgical trainees in 2D laparoscopic simulation. Methods: Thirty medical students were randomised into group A, completing five training attempts of three modified Fundamentals of Laparoscopic Surgery tasks (peg transfer, pattern cutting, and intra-corporeal suturing) using a 3D simulator, or group B, who were only exposed to the 2D platform. Time to completion, error rate, and efficiency improvement were measured. Results: The overall performance time was lower for group A than for group B, and this was statistically significant in task 2 (P = 0.02) and task 3 (P 5 0.01). The mean error rate was lower for group A versus group B, which was statistically significant for all three tasks (task 1, 0 vs 0.2; task 2, 0.4 vs 1.8; task 3, 0.24 vs 1.1). When efficiency improvement was evaluated, group B displayed a faster rate of improvement during task 1 (132.1% vs 248.8%; P 5 0.01) and task 2 (123.9% vs 139%; P = 0.15). For task 3, group A demonstrated a superior rate of improvement (190% vs 173.1%; P = 0.2). Conclusions: Introducing 3D training is beneficial for novices to execute 2D laparoscopic skills, particularly for complex tasks where depth perception is critical. 3D-based laparoscopic training, in conjunction with standard 2D platforms, should be introduced into surgical training to facilitate quicker and better preparation before translation of these skills into clinical practice.
Background: Single-incision laparoscopic surgery (SILS) is the latest innovation in minimally invasive surgery. Advantages of SILS over conventional laparoscopic surgery include faster patient recovery, reduced peri-operative pain and further improvement in cosmesis. The challenges of SILS are attributed to the coaxial arrangement of the instruments, which requires certain technical skills and manual dexterity different to that of conventional laparoscopic surgery. Technical difficulties due to the loss of triangulation require further investigation to allow this novel technique to be refined. The aim of our study is to compare the operative performance by experienced surgeons using standard straight versus articulating instruments on a simulated SILS box trainer. Methods: Consultant laparoscopic surgeons performed two basic laparoscopic tasks, according to the Fundamentals of Laparoscopic Surgery (FLS) course: peg transfer and pattern cutting, using two types of instruments in a randomized order. The influence of the instrumentation on the surgeon's performance was measured by calculating time taken, errors and instrument clashes. These parameters reflected the effectiveness of the instrument on the surgeon's laparoscopic skills (handeye coordination, depth perception, dexterity and complementary bimanual skills). The difference in performance reflects the effect of instrumentation on the surgeon's laparoscopic skill. Statistical analysis was carried out using an independentsample t-test. Two parameters were generated in order to avoid multiple comparisons: overall precision (OP) and overall performance time (OPT). All results were presented the as mean AE standard error of the mean with the P value. Results: Ten consultant laparoscopic surgeons from four different specialties were recruited. The average experience in conventional laparoscopic surgery was 11.8 AE 5.2 years. The OPT with articulating instruments was 282 AE 11 s and 275 AE 12 s with standard straight instruments. The difference in operating time between the groups was not statistically significant (P = 0.856). The OP with the articulating instruments was 4.2 AE 0.4 and 9.8 AE 0.7 with the standard straight instruments. The articulating instruments demonstrated a statistically significant decrease in both errors and instrument clashes (P = 0.03). Conclusions: The use of an articulating instrument proved to be superior to standard straight instruments in SILS. The increased triangulation improved precision and reduced errors. Novel articulating instruments demonstrate different characteristics, the benefits of which should be established before their application in clinical SILS practice.
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