Performance analysis on physical simulator of four different instrument setups in laparo-endoscopic single-site (LESS) surgery

Sánchez‐Margallo, Francisco M.; Matos-Azevedo, Ana Maria; Pérez-Duarte, Francisco J.; Enciso, Silvia; Martín-Portugués, I. Díaz-Güemes

doi:10.1007/s00464-013-3337-1

Cited by 10 publications

(11 citation statements)

References 26 publications

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“…2 e Graphical representation of average total completion time observed from the first to the last week and mean a-GRS score registered during the 9 wk of training for the cut task with each LESS access device. To use our modified a-GRS to objectively score the performance on the cut task, we carried out its preliminary construct validation [20], with experts obtaining a significant superior a-GRS score on the cut task when compared with novices (novice 12.35 AE 1.84 versus experts 16.83 AE 1.81 [P < 0.001]), and thus establishing accuracy in the measurements of anchored scores.…”

Section: Cut Taskmentioning

confidence: 99%

“…r e f e r e n c e s Appendix 1. a-GRS for objective assessment of the performance of cut tasks on physical simulator [20] Appendix 2. GRS (A) and 1/0 CL (B) for Objective Structured Assessment of Technical Skills in LESS intracorporeal suturing [21,22] …”

Section: Disclosurementioning

confidence: 99%

“…The cut task was rated on a modified global rating scale (a-GRS) [20], adapted from a previously validated assessment tool [24e27]. This scale covers the essential maneuvers needed to complete the exercise and is scored on a 1-5 Likert scale with detailed objective assessment anchors (Appendix 1).…”

Section: 3mentioning

confidence: 99%

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Comparison of single access devices during cut and suturing tasks on simulator

Matos-Azevedo

Martín-Portugués

Pérez-Duarte

et al. 2014

Journal of Surgical Research

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Section: Cut Taskmentioning

confidence: 99%

Section: Disclosurementioning

confidence: 99%

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Comparison of single access devices during cut and suturing tasks on simulator

Matos-Azevedo

Martín-Portugués

Pérez-Duarte

et al. 2014

Journal of Surgical Research

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“…Several attempts have been made to demonstrate the benefit of curved, articulating or even intra-corporeal flexible instruments to address these challenges. 7,8 The use of different articulating instruments allows increased triangulation, preventing instrument collisions to enable efficient operating flow. To our knowledge, currently there are a limited number of trials investigating the effect of instruments in laparoscopic simulation.…”

Section: Introductionmentioning

confidence: 99%

Single-incision laparoscopic surgery operative performance by experienced surgeons: a randomized trial comparing articulating versus standard straight instruments

Pafitanis¹,

Veljanoski²,

Patel³

2016

JSS

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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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“…This corroborates Sanchez-Margallo and colleagues' conclusion that using two articulated instruments impairs surgical easiness. 5 Postoperative cosmetic appearance and limited puncture of the peritoneum are indisputable advantages of LESS. The barely visible umbilical scar will make it more difficult for physicians to recapitulate the patient surgical history from the physical examination, as it was previously possible.…”

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confidence: 99%

LESS is more for the patient

Moore

2015

CUAJ

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Performance analysis on physical simulator of four different instrument setups in laparo-endoscopic single-site (LESS) surgery

Cited by 10 publications

References 26 publications

Comparison of single access devices during cut and suturing tasks on simulator

Comparison of single access devices during cut and suturing tasks on simulator

Single-incision laparoscopic surgery operative performance by experienced surgeons: a randomized trial comparing articulating versus standard straight instruments

LESS is more for the patient

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