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document
Pre-bent instruments used in single-port laparoscopic surgery versus conventional laparoscopic surgery : comparative study of performance in a dry lab . BACKGROUND Different types of single-incision laparoscopic surgery ( SILS ) have become increasingly popular . Although SILS is technically even more challenging than conventional laparoscopy , published data of first clinical series seem to demonstrate the feasibility of these approaches . Various attempts have been made to overcome restrictions due to loss of triangulation in SILS by specially designed SILS-specific instruments . This study involving novices in a dry lab compared task performances between conventional laparoscopic surgery ( CLS ) and single-port laparoscopic surgery ( SPLS ) using newly designed pre-bent instruments . METHODS In this study , 90 medical students without previous experience in laparoscopic techniques were randomly assigned to undergo one of three procedures : CLS , SPLS using two pre-bent instruments ( SPLS-pp ) , or SPLS using one pre-bent and one straight laparoscopic instrument ( SPLS-ps ) . In the dry lab , the participants performed four typical laparoscopic tasks of increasing difficulty . Evaluation included performance times or number of completed tasks within a given time frame . All performances were videotaped and evaluated for unsuccessful attempts and unwanted interactions of instruments . Using subjective questionnaires , the participants rated difficulties with two-dimensional vision and coordination of instruments . RESULTS Task performances were significantly better in the CLS group than in either SPLS group . The SPLS-ps group showed a tendency toward better performances than the SPLS-pp group , but the difference was not significant . Video sequences and participants` questionnaires showed instrument interaction as the major problem in the single-incision surgery groups . CONCLUSIONS Although SILS is feasible , as shown in clinical series published by laparoscopically experienced experts , SILS techniques are demanding due to restrictions that come with the loss of triangulation . These can be compensated only partially by currently available SILS-designed instruments . The future of SILS depends on further improvements in the available equipment or the development of new approaches such as needlescopically assisted or robotically assisted procedures .
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Intervention_Physical
Pre-bent instruments
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Intervention_Surgical
single-port laparoscopic surgery versus conventional laparoscopic surgery :
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Intervention_Surgical
single-incision laparoscopic surgery ( SILS )
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Intervention_Surgical
conventional laparoscopic surgery ( CLS )
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Intervention_Surgical
single-port laparoscopic surgery
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Intervention_Surgical
SPLS
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Outcome_Mental
task performances
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Outcome_Mental
performance times
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Outcome_Mental
number of completed tasks within a given time frame
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Outcome_Mental
performances
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Outcome_Mental
unsuccessful attempts and unwanted interactions of instruments
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Outcome_Other
subjective questionnaires
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Outcome_Mental
rated difficulties with two-dimensional vision and coordination of instruments
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Outcome_Mental
Task performances
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Outcome_Other
performances
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Outcome_Mental
instrument interaction
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Outcome_Adverse-effects
major problem
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Participant_Sample-size
90