Performance curve of basic skills in single-incision laparoscopy versus conventional laparoscopy: Is it really more difficult for the novice?

Abstract

BackgroundSingle-incision laparoscopy is a step forward toward nearly scarless surgery. Concern has been raised that single-incision laparoscopy is technically more challenging than conventional laparoscopy. This study researched the performance curves of novice trainees for single-incision laparoscopy (SILS) versus conventional laparoscopy for performing two basic tasks on a box trainer.MethodsIn this study, 20 novice participants performed two tasks (peg transfer and a dissection task) on a standard box trainer. All the participants practiced each task 11 times and were randomized in two groups. The first group performed the tasks on a box trainer through three incisions. The second group used a single-incision access with the same box trainer. The assessment scores for errors and time were recorded. The 2nd, 8th, and 11th runs of both tasks in both settings were assessed to objectify the gain in basic laparoscopic skills.ResultsThe performance curves for both groups improved significantly in terms of both time and errors in performing the two tasks [P < 0.01, analysis of variance (ANOVA)]. For the first task, no significant difference in time between the two groups was observed at the top of the performance curve (mean, 212 ± 64 vs. 182 ± 48 s), but the SILS group performed with fewer errors (1.3 ± 1.5 vs. 2.7 ± 2.11). However, the difference was not significant (P = 0.10). The dissection task was performed faster in the SILS group (mean, 205 ± 78 vs. 243 ± 40 s; P = 0, 18) with fewer errors (0.7 ± 1.05 vs. 1.9 ± 2.1; P = 0. 12), but the difference was not significant.ConclusionThis study showed a significant improvement in basic skills for both the SILS and conventional laparoscopy settings after 11 repetitions. These data suggest that box training shows no significant difference between conventional laparoscopic and single-incision laparoscopic settings in terms of error or time in performing basic tasks at a low complexity level for the novice. These data also show significant improvement in basic skills over a relatively short period.

Physical and Mental Workload in Single-Incision Laparoscopic Surgery and Conventional Laparoscopy

“…14 SILS is shown to be technically more challenging than standard laparoscopy, even in experienced surgeons. 15,16 In accordance with these reports, time to complete the tasks was significantly longer in SILS than in standard laparoscopy in our study. SILS has been criticized for poor instrumentation and longer operative time, which may cause higher mental and physical workload.…”

A comparison of the oxidative stress response in single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair.

“…Further development of laparoscopic surgery technique focused on decreasing the number of incisions in single incision laparoscopic surgery, which is also used in hernia operations. Available scientific evidence does not demonstrate a clear clinical advantage of single incision laparoscopic surgery used in hernia repair over traditional laparoscopic surgery in terms of length of hospital stay, operative time, pain, recurrence, post-operative complications, issues related to ergonomics, surgical learning curve, and equipment needs [15][16][17][18][30][31][32]. Our study tries to join in the discussion about advantages of TEP-SI over TEP by revealing the differences in oxidative stress levels between two types of surgery.…”

Gaze entropy reflects surgical task load

“…The first three dimensions (MD, PD, and TD) reflect task-related factors such as task complexity [19]. Furthermore, because surgeon fatigue might be a confounding factor in affecting performance [48,49], we asked residents to fill in the Borg rating of perceived exertion [50] [Borg Scale] after each simulated laparoscopic exercise (i.e., three different measuring times). This scale indicates the levels of perceived fatigue.…”