Top

Surgical Endoscopy

Published in:

01-02-2011

Single-incision laparoscopic surgery (SILS™) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator

Authors: Byron F. Santos, Daniel Enter, Nathaniel J. Soper, Eric S. Hungness

Published in: Surgical Endoscopy | Issue 2/2011

Abstract

Background

Single-incision laparoscopic surgery (SILS™) is a potentially less invasive approach than standard laparoscopy (LAP). However, SILS™ may not allow the same level of manual dexterity and technical performance compared to LAP. We compared the performance of standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS) program using either the LAP or the SILS™ technique.

Methods

Medical students, surgical residents, and attending physicians were recruited and divided into inexperienced (IE), laparoscopy-experienced (LE), and SILS™-experienced (SE) groups. Each subject performed standardized tasks from FLS, including peg transfer, pattern cutting, placement of ligating loop, and intracorporeal suturing using a standard three-port FLS box-trainer with standard laparoscopic instruments. For SILS™, the subjects used an FLS box-trainer modified to accept a SILS Port™ with two working ports for instruments and one port for a 30° 5-mm laparoscope. SILS™ tasks were performed with instruments capable of unilateral articulation. SILS™ suturing was performed both with and without an articulating EndoStitch™ device. Task scores, including cumulative laparoscopic FLS score (LS) and cumulative SILS™ FLS score (SS), were calculated using standard time and accuracy metrics.

Results

There were 27 participants in the study. SS was inferior to LS in all groups. LS increased with experience level, but was similar between LE and SE groups. SS increased with experience level and was different among all groups. SILS™ suturing using the articulating suturing device was superior to the use of a modified needle driver technique.

Conclusions

SILS™ is more technically challenging than standard laparoscopic surgery. Using currently available SILS™ platforms and instruments, even surgeons with SILS™ experience are unable to match their overall LAP performance. Specialized training curricula should be developed for inexperienced surgeons who wish to perform SILS™.

Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427CrossRefPubMed

Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695CrossRefPubMed

Chow A, Purkayastha S, Paraskeva P (2009) Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience. Surg Innov 16:211–217CrossRefPubMed

Barbaros U, Dinccag A (2009) Single incision laparoscopic splenectomy: the first two cases. J Gastrointest Surg 13:1520–1523CrossRefPubMed

Canes D, Berger A, Aron M, Brandina R, Goldfarb DA, Shoskes D, Desai MM, Gill IS (2010) Laparo-endoscopic single site (LESS) versus standard laparoscopic left donor nephrectomy: matched-pair comparison. Eur Urol 57(1):95–101CrossRefPubMed

Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, Desai MR, Rao PP, Sotelo R, Stein R, Gill IS (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812CrossRefPubMed

Merchant AM, Lin E (2009) Single-incision laparoscopic right hemicolectomy for a colon mass. Dis Colon Rectum 52:1021–1024PubMed

Saber AA, Elgamal MH, Itawi EA, Rao AJ (2008) Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg 18:1338–1342CrossRefPubMed

Nguyen NT, Hinojosa MW, Smith BR, Reavis KM (2008) Single laparoscopic incision transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631CrossRefPubMed

10.

Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL (1998) Development of a model for training and evaluation of laparoscopic skills. Am J Surg 175:482–487CrossRefPubMed

11.

Fraser SA, Klassen DR, Feldman LS, Ghitulescu GA, Stanbridge D, Fried GM (2003) Evaluating laparoscopic skills: setting the pass/fail score for the MISTELS system. Surg Endosc 17:964–967CrossRefPubMed

12.

Fried GM, Feldman LS, Vassiliou MC, Fraser SA, Stanbridge D, Ghitulescu G, Andrew CG (2004) Proving the value of simulation in laparoscopic surgery. Ann Surg 240:518–525 (discussion 525-518)CrossRefPubMed

13.

McCluney AL, Vassiliou MC, Kaneva PA, Cao J, Stanbridge DD, Feldman LS, Fried GM (2007) FLS simulator performance predicts intraoperative laparoscopic skill. Surg Endosc 21:1991–1995CrossRefPubMed

14.

Peters JH, Fried GM, Swanstrom LL, Soper NJ, Sillin LF, Schirmer B, Hoffman K, Committee SF (2004) Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery. Surgery 135:21–27CrossRefPubMed

15.

Joseph RA, Goh AC, Cuevas SP, Donovan MA, Kauffman MG, Salas NA, Miles B, Bass BL, Dunkin BJ (2010) “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc 24(6):1331–1335CrossRefPubMed

16.

Martinec DV, Gatta P, Zheng B, Denk PM, Swanstrom LL (2009) The trade-off between flexibility and maneuverability: task performance with articulating laparoscopic instruments. Surg Endosc 23:2697–2701CrossRef

17.

Stefanidis D, Korndorffer JR Jr, Markley S, Sierra R, Scott DJ (2006) Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. J Am Coll Surg 202:599–603CrossRefPubMed

18.

Moore MJ, Bennett CL (1995) The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg 170:55–59CrossRefPubMed

19.

Archer SB, Brown DW, Smith CD, Branum GD, Hunter JG (2001) Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg 234:549–558 (discussion 558-549)CrossRefPubMed

20.

Massarweh NN, Devlin A, Symons RG, Broeckel Elrod JA, Flum DR (2009) Risk tolerance and bile duct injury: surgeon characteristics, risk-taking preference, and common bile duct injuries. J Am Coll Surg 209:17–24CrossRefPubMed

21.

Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM (2010) Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial. Am J Surg 199:115–120CrossRefPubMed

Title: Single-incision laparoscopic surgery (SILS™) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator
Authors: Byron F. Santos
Daniel Enter
Nathaniel J. Soper
Eric S. Hungness
Publication date: 01-02-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-010-1197-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Single-incision laparoscopic surgery (SILS™) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2011

Endoscopic mucosal resection for gastroesophageal cancer in a U.K. population. Long-term follow-up of a consecutive series

Single-incision laparoscopic cholecystectomy: lessons learned for success

Outcomes after repair of the intrathoracic stomach: objective follow-up of up to 5 years

Bridge to surgery using partially covered self-expandable metal stents (PCMS) in malignant biliary stricture: an acceptable paradigm?

Population perception of surgical safety and body image trauma: a plea for scarless surgery?

Review of methods for objective surgical skill evaluation