Surgical Endoscopy

, Volume 26, Issue 5, pp 1214–1219

Does previous laparoscopic experience improve ability to perform single-incision laparoscopic surgery?

  • Trystan Lewis
  • Rajesh Aggarwal
  • Richard Kwasnicki
  • Ara Darzi
  • Paraskevas Paraskeva
Article

DOI: 10.1007/s00464-011-2058-6

Cite this article as:
Lewis, T., Aggarwal, R., Kwasnicki, R. et al. Surg Endosc (2012) 26: 1214. doi:10.1007/s00464-011-2058-6

Abstract

Background

Single-site laparoscopic surgery (SSLS) has been suggested as a safe and less invasive alternative to standard laparoscopic surgery (LAP). It is not clear whether previous laparoscopic experience influences the ability to perform SSLS. This study aimed to assess the impact of laparoscopic experience on the performance of SSLS.

Methods

For this study, 18 surgeons were recruited including 12 novice surgeons, four experienced laparoscopic surgeons (intermediate) and two experienced SSLS surgeons (expert). All these subjects completed four tasks from the validated Fundamentals of laparoscopic surgery (FLS) curriculum. The tasks were performed using both a LAP and an SSLS approach with a randomized crossover design. Assessment of the tasks was performed with standardized FLS metrics and dexterity analysis using the Imperial college surgical assessment device.

Results

The novice group performed two tasks (precision cutting and intracorporeal suture) significantly better with a LAP approach than with an SSLS approach in all parameters (P < 0.05). The two other tasks (peg transfer and endoloop) were performed significantly better with LAP than with SSLS in terms of time and dexterity only (P < 0.05) but not in terms of error score. The intermediate and expert groups demonstrated no significant difference between their LAP and SSLS performances for any of the tasks in any parameter. Intergroup analysis of performance demonstrated construct validity of the SSLS tasks, with significant differences between novice and intermediate performances for three tasks (peg transfer, endoloop, and intracorporeal suture) (P < 0.05) and between novice and expert performances for three tasks (peg transfer, precision cutting, and intracorporeal suture) (P < 0.05).

Conclusions

This study demonstrated that previous laparoscopic experience improves ability to perform SSLS tasks. Some SSLS tasks do not show construct validity due to the complexity of the SSLS technique. It also is implied that current LAP technical skills training curricula are insufficient for teaching SSLS.

Keywords

Laparoscopic experienceSingle-site laparoscopic surgeryStandard laparoscopic surgery

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Trystan Lewis
    • 1
  • Rajesh Aggarwal
    • 1
  • Richard Kwasnicki
    • 1
  • Ara Darzi
    • 1
  • Paraskevas Paraskeva
    • 1
  1. 1.Department of Cancer and SurgeryImperial College LondonLondonUK