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

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Abstract

Background

Over the past decades, minimally invasive surgery has undergone continuous development due to the demand for scarless results, with laparo-endoscopic single-site (LESS) surgery constituting one of today’s most favored alternatives. In this study, we aim to assess the relative technical difficulty and performance benefits of dynamic articulating and pre-bent instruments, either combined with conventional laparoscopic tools or not, during the completion of two basic tasks hands-on simulator.

Methods

A total of 20 surgeons were included and performed two basic simulator tasks—coordination and cutting—carried out using four different combinations of LESS-designed and straight conventional laparoscopy instruments. Assessment took place before and after the completion of a 14-week training program. Performance data were objectively analyzed over video recordings with an adapted global rating scale (a-GRS) for performance evaluation, combined with a registry of total trial completion time.

Results

In the coordination task, the worst performance scores (p < 0.001) and longest completion times (p < 0.001 on first assessment and p < 0.01 on last assessment) were obtained with the two dynamic articulating tip instruments. On the cut trials, no significant differences between the different setups were found in a-GRS scores. The two dynamic articulating tip instruments also constituted the most time-demanding setup on both assessment trials (p < 0.05). The use of two dynamic articulating tip instruments showed significant improvement with training in all measured parameters except for performance in the cut task, in which the increase in a-GRS score was not significant.

Conclusions

We conclude that the least adequate instrument set for initiation in LESS surgery is the one that combines two dynamic articulating tip instruments, as this has consistently obtained the worst results in all trials. Further data on more complex tasks and on a complete learning and skills-acquisition program must be obtained to confirm these findings.

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Acknowledgments

The authors are especially grateful to all participants in the study, for the extra hours dedicated to completing all simulator trials. This work has been partially funded by the project PI12/01467 granted by the Institute of Health Carlos III—FIS of Spain.

Disclosures

Drs. F.M. Sánchez-Margallo, A.M. Matos-Azevedo, F.J. Pérez-Duarte, S. Enciso, and I. Díaz-Güemes Martín-Portugués have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Scientific Direction, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain

    Francisco Miguel Sánchez-Margallo

  2. Laparoscopy Unit, Minimally Invasive Surgery Centre Jesús Usón, Carretera N 521, km 41.8, 10071, Cáceres, Spain

    Ana Maria Matos-Azevedo, Francisco Julián Pérez-Duarte, Silvia Enciso & Idoia Díaz-Guëmes Martín-Portugués

Authors
  1. Francisco Miguel Sánchez-Margallo
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  2. Ana Maria Matos-Azevedo
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  3. Francisco Julián Pérez-Duarte
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  4. Silvia Enciso
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  5. Idoia Díaz-Guëmes Martín-Portugués
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Corresponding author

Correspondence to Ana Maria Matos-Azevedo.

Additional information

Objective comparison of different LESS-specific instruments during the execution of simulator tasks in a laboratory setting performed by 20 subjects with different previous experience levels, and analyzed by two independent expert raters.

Appendix

Appendix

See Tables 3 and 4

Table 3 a-GRS for coordination tasks
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Table 4 a-GRS for cut tasks
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Sánchez-Margallo, F.M., Matos-Azevedo, A.M., Pérez-Duarte, F.J. et al. Performance analysis on physical simulator of four different instrument setups in laparo-endoscopic single-site (LESS) surgery. Surg Endosc 28, 1479–1488 (2014). https://doi.org/10.1007/s00464-013-3337-1

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  • DOI: https://doi.org/10.1007/s00464-013-3337-1

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