Surgical Endoscopy

, Volume 25, Issue 4, pp 1238–1244 | Cite as

Analysis of standard multiport versus single-site access for laparoscopic skills training

  • Daniel R. Cox
  • Wenjing Zeng
  • Margaret M. Frisella
  • L. Michael Brunt



Single-site-access (SSA) laparoscopy is more challenging to perform than multiport (MP) laparoscopy. This study examined the effect of MP versus SSA skills training on laparoscopic performance using surgically naive medical students.


For the study, 40 medical students at the end of their first year were randomized into two groups. Both groups were trained in four basic laparoscopic drills (peg, rope, bean drop, pattern cutting) using a standard MP setup (group 1) and an SSA approach (group 2). The time and number of repetitions required to attain proficiency were recorded. Each group then crossed over to the alternate approach and repeated the sequence. Data are presented as mean ± standard deviation, and statistical analysis was performed using the two-tailed, unpaired t test.


The total times required to attain proficiency for the SSA and MP approaches were not significantly different between the MP-trained group (234.0 ± 114.9 min) and the SSA-trained group (216.4 ± 106.5 min) (p = 0.67). The MP-trained group required less time to reach proficiency on the standard MP setup than the group using the SSA approach (119.1 ± 69.7 vs. 178.0 ± 93.4 min; p = 0.058) and significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3; p = 0.027). The SSA-trained group required significantly less time to reach proficiency on the MP setup than the standard MP-trained group (38.4 ± 29.4 vs. 119.1 ± 69.7 min; p = 0.0013) and needed only a mean of 26.9 repetitions. When the standard MP trainees crossed over to the SSA setup, they required significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ± 50.5 vs. 178.0 ± 93.4 min; p = 0.026) but required more repetitions than with the MP approach (86.2 ± 35.2 vs. 77.6 ± 42.6; nonsignificant difference).


Laparoscopic SSA skills training results in longer times and more repetitions to achieve proficiency than MP training, but the skills acquired transfer well to the MP approach.


Laparoscopic skills training Multiport laparoscopy Single-site access 



The authors acknowledge the Washington University Institute for Minimally Invasive Surgery for support of this study. Daniel Cox was supported by T35 DK074375.


Michael Brunt had educational grant support from Ethicon Endosurgery, Inc., educational grant support and equipment support from Karl Storz Endoscopy and Stryker Endoscopy, grant and research support from Lifecell Corp., and honoraria for speaking and teaching from Ethicon Endosurgery, Covidien, and Cook Medical. None of these disclosures are related to the content of this study, which was conducted in a completely independent manner and free of industry funding.

Conflict of interest

Daniel R. Cox, Wenjing Zeng, and Margaret M. Frisella have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Daniel R. Cox
    • 1
  • Wenjing Zeng
    • 1
  • Margaret M. Frisella
    • 1
  • L. Michael Brunt
    • 1
  1. 1.Department of Surgery and Institute for Minimally Invasive SurgeryWashington University School of MedicineSt. LouisUSA

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