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

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

doi:10.1007/s00464-010-1197-5

Cited by 76 publications

(67 citation statements)

References 22 publications

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“…Although the results obtained may potentially have been influenced by these technical considerations, all participating surgeons used the same laparoscopic equipment. Our findings are consistent with clinical studies [8,9] and ergonomic analyses [10,11] showing that SILS is a more technically challenging surgery than standard multi-port laparoscopy. Moreover, the present results should be interpreted taking into account that experimental conditions are not directly comparable to real-life stress in individual patients where the environment can be more complex and demanding, further increasing mental and physical stress.…”

Section: Discussionsupporting

confidence: 92%

“…Physical and mental challenges between SILS and standard laparoscopy have been highlighted by different authors such as frequent instrument collisions, limited maneuverability, loss of triangulation, in-line viewing leading to unfamiliar angles of dissection and potential difficulty in reaching the intended target with instruments [10,11]. However, although the importance of minimally invasive surgery is constantly increasing most surgeons have limited knowledge of ergonomic aspects (physical and mental) of their work and additional data accrual and analysis are necessary [21].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, ergonomic assessment of performance of basic tasks (cutting, ligature, etc.) comparing both procedures have shown that SILS is a more technically challenging surgery than standard laparoscopy [10,11]. …”

Section: Introductionmentioning

confidence: 99%

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An Ergonomic Study of Single-Port versus Multi-Port Laparoscopic Mesh Insertion for Ventral Hernia Repair

et al. 2012

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Purpose: To assess the mental effort and physical discomfort of placement of a prosthetic mesh into the abdominal cavity with single-incision laparoscopic surgery (SILS) or multi-port laparoscopic access for incisional ventral hernia repair. Methods: A total of 10 surgeons with previous experience in conventional laparoscopic surgery performed four surgical tasks through a multi-port laparoscopic access and a SILS access in a porcine model during a first 4-hour working session and a second 2-hour working session. These tasks included (a) introduction of a prosthetic mesh for abdominal wall surgery, (b) manipulation of the mesh inside the abdomen, (c) manipulation of the laparoscopic instruments and (d) mesh insertion to the intraperitoneal abdominal wall and fixation with tackers. The level of mental effort was assessed with the Subjective Mental Effort Questionnaire (SMEQ) and physical discomfort with the Local Experienced Discomfort Scale (LED). Results: Seventy percent were men, with a mean age of 45 years and a mean of 18 years of experience in practicing surgery. The SMEQ questionnaire showed a median physical effort of 24.4 (range 9–36.1) points for the multi-port laparoscopic access and 107.4 (range 74.7–128.4) for SILS (p < 0.01). Statistically significant differences between multi-port laparoscopic surgery and SILS were consistently demonstrated in all tasks as well as in both the 4-hour and 2-hour working sessions. The median (interquartile range) score of the LED scale was 12.5 (2–34.5) for tasks during multi-port laparoscopic surgery and 53.5 (29–89.2) for SILS (p < 0.001). All individual tasks were associated with a significantly higher physical effort for SILS than for conventional laparoscopic access, which were also independent of being performed during the 4-hour or 2-hour working periods. Conclusions: Placement and manipulation of a prosthetic mesh for incisional ventral hernia repair is more difficult with SILS than using multi-port laparoscopic access, independently of previous experience with standard laparoscopic techniques. This greater difficulty was observed both in terms of mental effort and physical discomfort. More experimental and clinical studies are needed to define specific training aspects and clinical advantages of incisional ventral hernia repair through SILS.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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An Ergonomic Study of Single-Port versus Multi-Port Laparoscopic Mesh Insertion for Ventral Hernia Repair

et al. 2012

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“…The fellows involved in the study did have prior experience in advanced multiport laparoscopic procedures, but their median operating time was similar to the time required by residents. These difficulties of conventional laparoscopic proficient surgeons to translate these skills to SILS have also been reported by three laboratory-based studies comparing laparoscopic-and SILS-trained candidates [16][17][18]. Pucher et al concluded that the skills required for SILS are not automatically acquired through multiport laparoscopic experience [19].…”

Section: Discussionmentioning

confidence: 93%

The Influence of Training Levels and Surgical Experience on Outcomes after Single-Incision Laparoscopic Appendectomy

Raakow¹,

Liesaus²,

Raakow³

2015

Surgery

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IntroductionOver the last thirty years, laparoscopic appendectomy has gained wide acceptance as the surgical procedure of choice for patients with acute or chronic appendicitis. A shorter hospital stay, earlier return to work and activity, better wound healing, and less postoperative pain are now well known reasons for the transition from laparotomy to laparoscopy. These benefits raise the question as to whether more minimalized surgery would offer patients even greater benefits. Therefore, single-incision laparoscopic surgery (SILS) has raised tremendous interest among surgeons in the last few years, and has emerged as a serious alternative to conventional multiport laparoscopy. Although larger series and extended follow-up analyses are still missing and may well provide valuable additional information regarding postoperative outcomes, several studies have demonstrated the technical feasibility and safety of single-incision laparoscopic appendectomy (SILA) [1][2][3][4][5][6].Experienced laparoscopic surgeons were reported to have a short learning curve for SILS. As senior surgeons are becoming increasingly familiar with the technique, it is being incorporated in surgical training as well. Appendectomy is one of the most common surgical procedures performed worldwide [7]. Being one of the most basic laparoscopic procedures in general surgery, it is mainly performed by residents. The influence of resident involvement in surgery and postoperative care is controversially discussed. It is reported to be associated with longer operating times, higher costs, and higher complications rates [8][9][10]. However, it has also been reported to exert a protective effect on the patients' outcome [11]. Little is known about the effect of residentperformed SILA on intraoperative and postoperative outcomes. The purpose of the present study was to determine resident performance and postoperative outcomes in patients undergoing SILA performed by a resident versus SILA performed by an experienced laparoscopic surgeon. Material and MethodsWe performed a review of all patients who underwent singleincision laparoscopic appendectomy between July 2009 and January 2014 at Vivantes Klinikum Am Urban in Berlin, Germany. Patients who underwent appendectomy as part of another single-incision laparoscopic procedure were excluded from the study. Patients with primary multiport laparoscopic or open appendectomy were also excluded. Demographic data included age, gender, weight, height, body mass index (BMI), the American Society of Anesthesiologists score (ASA score), preoperative comorbidities, previous abdominal surgery, and laboratory data concerning leukocytes and C-reactive protein (CRP) on admission. Details of surgery included operating time, the need for conversion to multiport laparoscopy or the open procedure and the reasons for conversion, intraoperative findings such AbstractBackground: Single-incision laparoscopic appendectomy (SILA) has become an accepted alternative to conventional multiport laparoscopic appendectomy. Yet, little...

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“…16 This coupled with steep Trendelenburg position made single incision surgeries possible. Byron F et al 17 reported a study which had compared the performance of standardized tasks from the fundamentals of laparoscopic surgery (FLS) program using either the regular laparoscopic or the single incision laparoscopic surgery (SILS) technique. His study demons trated that performing tasks using SILS techniques is more technically challenging even for surgeons with previous SILS experience.…”

mentioning

confidence: 99%

Single Incision Gasless Laparoscopic Myomectomy

Gnanaraj¹

2015

International Journal of Infertility &Amp; Fetal Medicine

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

Cited by 76 publications

References 22 publications

An Ergonomic Study of Single-Port versus Multi-Port Laparoscopic Mesh Insertion for Ventral Hernia Repair

An Ergonomic Study of Single-Port versus Multi-Port Laparoscopic Mesh Insertion for Ventral Hernia Repair

The Influence of Training Levels and Surgical Experience on Outcomes after Single-Incision Laparoscopic Appendectomy

Single Incision Gasless Laparoscopic Myomectomy

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